Since the exhaustive Handbook of Physiology (Alimentary Canal, Section 6, Motility) edited by CHARLES F. CODE in 1968, no complete survey of the morphological basis and the physiological control of intestinal motility has been published, in spite of the enormous amount of new data in the literature on this topic. The new techniques and methodologies, the use of electron microscopy, radioimmunoassay and binding techniques, as weIl as ever more sophisticated electrophysiological procedures have made possible areal flood of discoveries in this field. Moreover, the possibility ofnew studies ofthe endocrine cells in biopsies of human intestinal mucosa even during routine endoscopies, has opened new horizons for gastroenterologists and generated a number of important contribu­ tions to our knowledge of the morphology and physiopathology of the gut. As usual, new discoveries have also revealed both ignorance and many new problems. For tbis reason, although many of the data reported in this volume can be considered as firmly established, others still require confirmation, and the results of new research in this field are awaited with extreme interest. Since advances are occurring so rapidly, even experts in the specific topics need frequent comprehensive reviews. To avoid an excessively large volume, considera­ tions ofthe pancreas, liver, and biliary system were not included in this Handbook, which, nevertheless, has attempted to off er the reader the essence of more than 1,500 papers.

Inhalt

1 Historical Perspective.- 2 Morphological Basis of Gastrointestinal Motility: Structure and Innervation of Gastrointestinal Tract.- A. Introduction.- B. Structure of Smooth Muscle.- I. Arrangement and Ultrastructure of Smoth Muscle Cells.- II. Types of Contact Between Muscle Cells.- III. Muscle Connective Tissue Links.- C. Innervation of Gastrointestinal Smooth Muscle.- I. Extrinsic Innervation.- 1. Parasympathetic and Sympathetic Innervation.- II. Intrinsic Innervation.- III. Neurons and Nerve Fibers Involved in Gastrointestinal Motility.- 1. Neuronal Perikarya.- 2. Nerve Fibers Originating from Extrinsic and Intrinsic Neurons.- D. Integration of Extrinsic and Intrinsic Neurons into Reflex Circuits.- E. Conclusions.- References.- 3 Morphological Basis of Gastrointestinal Motility: Ultrastructure and Histochemistry of Endocrine-Paracrine Cells in the Gut.- A. General Cytology and Physiology.- B. Classification and Description of Cell Types.- I. P and D1 Cells.- II. Enterochromaffin (EC) Cells.- III. Somatostatin (D) Cells.- IV. Pancreatic Polypeptide (PP or F) Cells.- V. Glucagon (A) Cells.- VI. X Cells.- VII. ECL Cells.- VIII. Gastrin-Storing (G) Cells.- IX. Cholecystokinin (I) Cells.- X. Secretin (S) Cells.- XI. Gastric Inhibitory Polypeptide (K) Cells.- XII. Motilin (Mo) Cells.- XIII. Neurotensin (N) Cells.- XIV. Glucagon-Like Immunoreactive (L) Cells.- XV. Bombesin (BN) Cells.- C. Pathology.- D. Summary.- References.- 4 Ionic Basis of Smooth Muscle Action Potentials.- A. Introduction.- B. Methodologic Problems.- I. Electrophysiologic Analysis.- II. Analysis of Ion Fluxes.- C. Effects of Na Ions.- I. Changes in Electrical Properties.- II. Changes in Ionic Distribution.- 1. Extracellular Na.- 2. Intracellular Na.- D. Effects of Tetrodotoxin.- E. Na-Dependent Activity in Ca-Free Solution.- F. Effects of Ca Ions.- I. Excitable Membranes and Ca.- II. Changes in Electrical Properties.- III. Bound Ca and Action Potentials.- G. Regulation of Intracellular Ca.- I. Ca Distribution.- II. Na-Ca Exchange.- III. Ca Pump.- H. Effects of Intracellular Ca.- I. Effects of Decreasing K Conductance.- K. Effects of Membrane Polarization.- L. Effects of Ca Antagonists.- I. Inorganic Antagonists.- II. Organic Antagonists.- M. General Properties of Spikes and Their Implications.- N. Summary.- References.- 5 Electrophysiology of Intestinal Smooth Muscle.- A. Introduction.- B. Methods Used In Electrical Recording.- I. Intracellular Recording Technique.- II. Extracellular Recording Technique.- 1. Pressure Electrode.- 2. Glass Pore Electrode.- 3. Wick Electrode.- 4. Needle Electrode.- 5. Sucrose Gap.- C. Electrical Activity of Gastrointestinal Smooth Muscle.- I. Slow Waves.- 1. Origin.- 2. Ionic Dependence.- 3. Frequency.- II. Spikes.- III. Prepotentials.- IV. Oscillatory Potentials.- D. Relationship Between Electrical and Mechanical Activity.- E. Migrating Myoelectric Complex.- F. Electromyography in Clinical Practice.- I. Vagotomy.- II. Idiopathic Intestinal Pseudoobstruction.- III. Diverticular Disease of the Colon.- IV. Irritable Colon Syndrome.- V. Hirschsprung's Disease.- References.- 6 Electrophysiology of the Enteric Neurons.- A. Introduction.- B. Extracellular Recording Techniques.- I. Neuronal Types and Properties.- II. Neuronal Connections.- 1. Connections Within Ganglia.- 2. Connections Within the Plexus.- 3. Connections with Extrinsic Nerves.- C. Intracellular Recording Techniques.- I. Neuronal Types and Properties.- II. Neuronal Connections.- 1. Connections Within Ganglia.- 2. Connections Within the Plexus.- III. Comparison of Results of Intracellular Recording with Results of Extracellular Recording.- 1. Recording from Enteric Neurons in Intact Segments of Gut Wall.- 2. Recording from Enteric Neurons in Separate Layers of Gut Wall Close to Intact Segments of Intestine.- 3. Recording from Enteric Neurons in Isolated Layers of Gut Wall.- D. Actions of Endogenous and Exogenous Substances on Enteric Neurons.- I. Acetylcholine and Related Substances.- II. Noradrenaline and Other Catecholamines.- III. 5-Hydroxytryptamine and Related Substances.- IV. Substance P.- V. Neurotensin.- VI. Vasoactive Intestinal Polypeptide.- VII. Morphine.- VIII. Enkephalin.- IX. Somatostatin.- X. Adenosine and Cyclic Nucleotides.- E. Functional Roles of Enteric Neurons in the Control of Gastrointestinal Motility.- References.- 7 In Vivo Techniques for the Study of Gastrointestinal Motility.- A. Introduction.- B. Techniques for the Study of Wall Movements.- I. Direct Inspection.- II. Radiologic Techniques.- III. External Transducers.- C. Techniques for the Study of Intraluminal Pressure.- I. Intraluminal Balloons.- 1. Large Balloons.- 2. Small Balloons.- II. Catheters with Distal Opening.- 1. Infusion Systems.- 2. Physical Characteristics.- III. Miniaturized Intraluminal Transducers.- IV. Radiotelemetering Capsules.- D. Techniqes for the Study of Transit of Contents.- I. External Collection of Contents.- II. Radiologic Techniques.- 1. Barium Transit.- 2. Particulate Radioopaque Markers.- 3. Time-Lapse Cinematography.- III. Intubation Techniques.- 1. Fractional Test Meal.- 2. Serial Test Meal.- 3. Marker Dilution Tests.- IV. Radioisotopic Techniques.- 1. Rectilinear Scintigraphy.- 2. Gamma Camera Scintigraphy.- 3. Radioactive Capsules.- V. Magnetic Techniques.- VI. Breath Test.- E. Use of Combined Techniques.- References.- 8 In Vitro Techniques for the Study of Gastrointestinal Motility.- A. Introduction.- B. General Methodology.- C. Muscle Segments and Strips.- D. Gastric Motility.- E. Intestinal Peristalsis.- I. Ileum.- II. Colon.- F. Effects of Stretch on Muscle Strips.- G. Electrical Stimulation of Autonomic Nerves.- I. Intrinsic Nerves.- II. Extrinsic Nerves.- H. Conclusions.- References.- 9 Nervous Control of Esophageal and Gastric Motility.- A. Nervous Control of the Esophagus.- I. Esophageal Body.- 1. General Survey of Motility Patterns.- 2. Anatomic and Histologic Data on Esophageal Innervation.- 3. Nervous Control of the Striated Muscle Esophagus.- 4. Nervous Control of the Smooth Muscle Esophagus.- II. Sphincters.- 1. Upper Esophageal Sphincter.- 2. Lower Esophageal Sphincter.- B. Nervous Control of the Stomach.- I. General Survey of Motility Patterns and Control Mechanisms.- II. General Survey of Gastric Innervation.- 1. Efferent Innervation.- 2. Sensitive Innervation.- III. Effects of Severing the Extrinsic Nerves.- 1. Vagotomy.- 2. Sympathectomy.- 3. Stomach Totally Deprived…