Chapter 14
Disturbances of Gastrointestinal Motility
and the Nervous System
Michael Camilleri and Adil E. Bharucha
Copyright © 2014 Elsevier Inc. All rights reserved.
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Figure 14-1 Control of gut motility: interactions between extrinsic neural pathways and the intrinsic nervous
system (“enteric brain” or enteric nervous system plexuses) modulate contractions of gastrointestinal smooth
muscle. Interactions between transmitters (e.g., peptides and amines) and receptors alter muscle membrane
potentials by stimulating bidirectional ion fluxes. In turn, membrane characteristics dictate whether the muscle
cell contracts.
(Adapted from Camilleri M, Phillips SF: Disorders of small intestinal motility. Gastroenterol Clin North Am
18:405, 1989, by permission of Mayo Foundation.)
Copyright © 2014 Elsevier Inc. All rights reserved.
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Figure 14-2 The enteric plexuses in the intestinal layers. The chief neural plexuses are in the
submucosal and intermuscular layers.
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Figure 14-3 A, Tracing showing normal upper gastrointestinal motility in the fasting and fed states. The fasting tracing
shows phase III of the interdigestive migrating motor complex. B, Manometric tracings showing the myopathic pattern
of intestinal pseudo-obstruction due to systemic sclerosis (left panel). Note the low amplitude of phasic pressure
activity compared with control (middle panel). A manometric example of neuropathic intestinal pseudo-obstruction in
diabetes mellitus shows the absence of antral contractions and persistence of cyclical fasting-type motility in the
postprandial period (right panel).
(A from Malagelada J-R, Camilleri M, Stanghellini V: Manometric Diagnosis of Gastrointestinal Motility Disorders.
Thieme, New York, 1986, by permission of Mayo Foundation. B from Camilleri M: Medical treatment of chronic
intestinal pseudo-obstruction. Pract Gastroenterol 15:10, 1991, with permission.)
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Figure 14-4 Schema showing normal alternations of pelvic floor, rectoanal angle, and sphincters during
defecation.
(From Lembo T, Camilleri M: Chronic constipation. N Engl J Med 349:1360, 2003, with permission.)
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Figure 14-5 Algorithm for the investigation of suspected gastrointestinal (GI) dysmotility. ANA, antinuclear
antibodies; ANNA, antineuronal enteric antibodies; CK, creatine kinase; CXR, chest radiograph; Ig,
immunoglobulin; TSH, thyroid-stimulating hormone.
(From Camilleri M: Study of human gastroduodenojejunal motility: applied physiology in clinical practice. Dig Dis
Sci 38:785, 1993, with permission.)
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Figure 14-6 Assessment of thoracic vagal function by documentation of sinus arrhythmia and abdominal vagal
function by the plasma pancreatic polypeptide (PP) response to modified sham feeding by chewing and spitting
a bacon-and-cheese toasted sandwich.
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