Innervation of the human gastric wall.

The intrinsic innervation of the human gastric wall was studied by means of (1) demonstration of the acetylcholinesterase activity, (2) fluorescence microscopy, and (3) electron microscopy. The cholinergic innervation was rich: in the mucosa, a dense three dimensional network consisting of single delicate varicose acetylcholinesterase-positive axons and small nerve fascicles was observed in close relation to the gastric glands. In the submucosa, large nerve trunks and densely woven plexuses mainly consisting of single varicose axons (obviously perivascular plexuses)) were seen. In the muscularis external, a small-meshed net consisting of single varicose axons and nerve fascicles was observed. The ganglia of the myenteric plexus were small and scattered irregularly between and within the muscle layers. Most of the nerve cells exhibited moderate to intense acetylcholinesterase activity. In the serosa, only a few nerves were observed. By fluorescence microscopy, an abundance of brightly yellow fluorescing irregularly fusiform enterochromaffin cells was observed in the epithelial lining of the antral glands. The parietal cells of the fundic glands exhibited a granular, yellow to orange autofluorescence. Fluorescing axons were seen in intimate relation to some enterochromaffin cells, whereas most enterochromaffin cells and parietal cells did not receive any direct functional adrenergic innervation. In the other tissue layers, only a few fluorescing nerves were seen. The main ultrastructural characteristics of the intrinsic innervation of the mucosa were: (1) 'Innervation fasciculée'; (2) the axons were unmyelinated; (3) two main types of nerve terminals were identified according to their vesicle population(s): (a) nerve terminals containing only clear vesicles, (b) nerve terminals containing clear vesicles and large dense-cored vesicles. Most of the axons and nerve terminals within the nerve fascicles were acetylcholinesterase-positive. The nerve terminals were separated from the gastric glands (and the parietal cells, chief cells and endocrine cells of their epithelial lining) by a considerable gap so that it seems unlikely that the gastric glands, parietal cells, chief cells and endocrine cells receive a direct innervation in the sense of synaptic neurotransmission; the transmitter substance must diffuse across a wide gap. In contrast, the endocrine cells were in close contact with the parietal cells and chief cells, and occasional membrane specialization (desmosomes) reinforce the assumption that (also) direct local humoral interaction may be possible. In addition, a large number of mast cells was observed in the lamina propria, many lying as close to glandular cells (parietal cells, chief cells and endocrine cells) as were the nearest nerve terminals.