健康と疾患における消化管機能の中枢制御

Thanks to its extensive intrinsic (enteric) neural networks spanning its entire length, the gastrointestinal (GI) tract has long been recognized for its ability to operate independently of the central nervous system (CNS). Despite that, the CNS provides both sympathetic and parasympathetic inputs to the GI tract, that confers an additional layer of regulation, modulation, and integration over GI functions. The sympathetic nervous system provides neurovascular control of GI blood flow in addition to its effects to decrease mucosal secretion, regulate sphincter tone, and modulate motility, principally via prejunctional and presynaptic actions. The parasympathetic nervous system, however, exerts both excitatory and inhibitory effects; the extent to which this influences gut functions varies throughout the length of the GI tract. Recent studies have also demonstrated that, in addition to regulation via the autonomic nervous system, 'higher' CNS nuclei also provide a significant degree of influence over GI functions under both physiological and pathophysiological conditions In addition to describing the anatomical neurocircuits and physiological functions of the extrinsic inputs to the GI tract, this review will also discuss the roles of brainstem, midbrain, and cortical nuclei that influence the gut within the context of relevant physiological and pathophysiological conditions.