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Control
Function
Stimulation Inhibition
GIP
↓ Stomach pH
Vagus nerve (ACh) Prostaglandins
Activates pepsinogen to pepsin
HCl Gastrin Secretin
Kills microorganisms
Histamine Somatostatin
(except Helicobacter pylori)
Cholecystokinin
Intrinsic GIP
Vagus nerve (ACh)
factor (IF; vitamin Binds to vitamin B12 and enables its Prostaglandins
Gastrin
B12 binding absorption in the terminal ileum Secretin
protein) Histamine
Somatostatin
Vagus nerve (ACh) High gastric pH

Pepsin Protein digestion
Low gastric pH Somatostatin
Bicarbonate Neutralizes gastric acid Secretin None
Vagus nerve (via gastrin-
releasing
peptide and GRP released

↑ Gastric acid secretion
from presynaptic terminals
↑ Gastric motility Somatostatin
Gastrin of postganglionic fibers)
Proliferation of the Gastric pH < 1.5
Amino acids and peptides
gastric mucosa
Decreased acidity
Distention of the stomach
Chronic PPI administration

Control
Function
↑ Appetite and hunger (lateral
hypothalamus) [5]
↑ Neuropeptide Y release
Fasting
Ghrelin (arcuate nucleus of hypothalamus) Stomach distention (food intake)
Sleep deprivation
↑ Growth hormone release (anterior
pituitary)
↑ Gastric motility [6]
Histamine ↑ Gastric acid secretion Gastrin Somatostatin
↑ Contraction of the gallbladder

Postprandial: fatty
↑ Secretion of pancreatic enzymes by
acids and amino Somatostatin
CCK acting on neural muscarinic pathways
acids entering the small Fasting
↑ Relaxation of the sphincter of Oddi
intestine
↓ Gastric emptying
Inhibits gastrointestinal secretions
↓ Gastric acid
↓ Gastrin
↓ Pepsinogen Postprandial: gastric
↓ Cholecystokinin acid, fatty acids,

Somatostatin Vagus nerve (ACh)
↓ Secretin and amino acids entering
↓ Pancreatic secretions the duodenum
(VIP, glucagon, insulin)
↓ Gastric inhibitory polypeptide
Inhibits gall bladder contraction

Control
Function
Decreases motility of
the stomach and intestine
Causes splanchnic vasoconstriction [7]
Decreases growth
hormone and TSH secretion
↑ Secretion of bile
↑ Pancreatic secretion of bicarbonate,
which neutralizes the Postprandial: ↑ gastric
Secretin acidic chyme arriving from acid and fatty acids in Somatostatin
the stomach (necessary for pancreatic the duodenum
enzyme function)
↓ Secretion of gastric acid
↑ Insulin secretion (more pronounced

Postprandial: fatty acids,
with the administration of oral
Gastric inhibitory glucose, amino
glucose compared to intravenous Fasting
polypeptide (GIP) acids entering small
glucose)
intestine
↓ Secretion of gastric acid
Produces migratory motor

Motilin Fasting Intake of food
complexes (↑ intestinal motility)
Vasoactive ↑ Secretion of water and electrolytes

Distention of the stomach
intestinal ↑ Relaxation of intestinal sphincters Sympathetic activity
Vagal stimulation
peptide (VIP)
and smooth muscle
Control
Function
Relaxation of smooth muscle and
Nitric sphincters (e.g., LES)

- •-
oxide (NO) [8] Improves circulation
(vasodilatory property)
The secretions of the pancreas are also involved in digestion. For a description of these,
see “Exocrine pancreas” and “Endocrine pancreas.”
Autoimmune destruction of parietal cells → ↓ intrinsic factor production → ↓
absorption of B12 in the terminal ileum → pernicious anemia
Elevated serum gastrin levels can be used to support the diagnoses of atrophic
gastritis and Zollinger-Ellison syndrome.
Ghrelin is increased in Prader-Willi syndrome and decreased following gastric bypass
surgery.
Ghrelin causes greed for food.
The antibiotic erythromycin belongs to the class of drugs called motilin agonists, which
can induce peristalsis and increase gastric emptying.
Octreotide, a somatostatin analog, is used to treat bleeding esophageal
varices, gastrinomas, severe noninfectious diarrhea (e.g., chemotherapy-induced
diarrhea, carcinoid syndrome), glucagonoma, and acromegaly.
VIPoma is a VIP-secreting tumor that can manifest
with WDHA syndrome: Watery Diarrhea, Hypokalemia, and Achlorhydria.
In achalasia, degeneration of inhibitory neurons within the myenteric plexuses
(Auerbach plexus) → deficient inhibitory neurotransmitters such as nitric oxide and
vasoactive intestinal peptide → higher resting pressures of the lower esophageal
sphincter.

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Control

Vagus nerve (ACh) High gastric pH

Bicarbonate Neutralizes gastric acid Secretin None

Vagus nerve (via gastrin-

peptide and GRP released

Distention of the stomach

Chronic PPI administration

↑ Appetite and hunger (lateral

↑ Gastric motility [6]

Histamine ↑ Gastric acid secretion Gastrin Somatostatin

↑ Contraction of the gallbladder

Inhibits gastrointestinal secretions

↓ Pepsinogen Postprandial: gastric

↓ Cholecystokinin acid, fatty acids,

↓ Pancreatic secretions the duodenum

(VIP, glucagon, insulin)

↓ Gastric inhibitory polypeptide

Inhibits gall bladder contraction

the stomach and intestine

Causes splanchnic vasoconstriction [7]

hormone and TSH secretion

↑ Pancreatic secretion of bicarbonate,

which neutralizes the Postprandial: ↑ gastric

the stomach (necessary for pancreatic the duodenum

↓ Secretion of gastric acid

↑ Insulin secretion (more pronounced

Produces migratory motor

Vasoactive ↑ Secretion of water and electrolytes

Relaxation of smooth muscle and

Nitric sphincters (e.g., LES)

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