Gastrointestinal neurotransmitters.

The enteric nervous system contains neurones that are intrinsic to the gastrointestinal tract and the axons of extrinsic neurones. More than 30 functional types of neurone are present and about 25 different possible neurotransmitters have been identified in enteric neurones. Most neurones utilize several transmitters; amongst the transmitters of an individual neurone, one is usually a primary transmitter and other substances are subsidiary transmitters or neuromodulators. The primary transmitter is the substance that has the major role in acutely changing the excitability of the innervated cell. Current evidence indicates that primary transmitters are strongly conserved; that is, the same substance will be the neurotransmitter in functionally equivalent neurones in different regions of the gastrointestinal tract and in different species. In contrast, subsidiary transmitters and neuromodulators of equivalent neurones in different regions are not necessarily the same. Only about seven of the approximately 25 enteric neurotransmitters are known to be primary transmitters. Acetylcholine is the primary transmitter of vagal and pelvic preganglionic neurones, of enteric interneurones, of one class of secretomotor neurone in the intestine and of motor neurones controlling gastric acid secretion. Acetylcholine and tachykinins are co-primary transmitters of muscle motor neurones, with acetylcholine appearing to have the greater role. Tachykinins are probably primary transmitters of enteric sensory neurones at neuroneuronal synapses. Serotonin may also be a transmitter to neurones in the enteric ganglia. Nitric oxide appears to be the usual primary transmitter of enteric inhibitory motor neurones to the muscle. ATP and vasoactive intestinal peptide are subsidiary transmitters of these neurones, although in some regions they may have a primary transmitter role. Vasoactive intestinal peptide is the primary transmitter of non-cholinergic secretomotor neurones. Gastrin releasing peptide is the primary transmitter of motor neurones to gastrin cells. Noradrenaline is the primary transmitter of sympathetic neurones that supply the intestine.