Review article: adrenergic control of motor and secretory function in the gastrointestinal tract.

The role that the sympathetic nervous system plays in modulating physiological processes in the gastrointestinal tract is becoming clearer. It is now known that motor, secretomotor and vasomotor activity are all modulated independently by the system. Adrenoreceptor stimulation appears to reduce intestinal contraction (except at sphincters), both via alpha-receptors which inhibit neurotransmitter release and also by a direct beta-receptor mediated action on smooth muscle. There is also evidence for tonic activity in the beta-adrenergic pathway, since beta-antagonists tend to increase contraction pressures. In animals alpha-receptor-mediated pathways modulate fluid and electrolyte absorption, and alpha-adrenergic agonists enhance net absorption and reduce net secretion. In man there is also evidence for a beta-adrenergic pathway which controls secretomotor function. Carbohydrate absorption appears to be dependent on activity in a beta-adrenergic pathway, although this may be an indirect effect of changes in motor function. The time course of changes of both secretomotor and motor activity, induced by modulating sympathetic or adrenergic input, differ from the vascular changes indicating that the effects occur independently of each other. The gastrointestinal response to stressors is mediated, in part at least, by the sympathetic nervous system. Differences between individuals are likely to prove important. Since the sympathetic nervous system regulates gastrointestinal function both in the basal state and under stressful conditions, it will have effects on pathophysiological responses. Modification of such responses is likely to ameliorate symptoms, as has already been found for alpha-2-adrenergic agonists which have an antidiarrhoeal action.