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Myenteric plexus

The myenteric plexus, also known as Auerbach's plexus, is a network of interconnected ganglia and nerve fibers forming a key division of the enteric nervous system within the gastrointestinal tract, situated between the inner circular and outer longitudinal smooth muscle layers of the muscularis externa and extending from the esophagus to the rectum.^[1] It primarily regulates gastrointestinal motility by coordinating peristaltic contractions and relaxations through excitatory and inhibitory neural pathways, enabling the propulsion of food and waste without direct central nervous system input.^[2] Named after German anatomist Leopold Auerbach who described it in 1862, the plexus contains diverse neuronal subtypes, including sensory, motor, and interneurons, supported by glial cells that modulate signaling.^[1] Structurally, the myenteric plexus comprises up to 20 distinct neuron types per ganglion, with axons projecting over 100 micrometers to influence smooth muscle cells, though it lacks traditional neuromuscular junctions.^[2] Excitatory motor neurons release neurotransmitters such as acetylcholine and tachykinins (e.g., substance P) to stimulate contraction, while inhibitory neurons employ nitric oxide, vasoactive intestinal peptide (VIP), and ATP to promote relaxation, ensuring coordinated segmentation and propulsion along the gut.^[1] Interneurons within the plexus facilitate ascending (excitatory, cholinergic) and descending (inhibitory) reflex arcs, integrating sensory input from intrinsic primary afferent neurons that detect mechanical and chemical stimuli in the lumen.^[2] Embryologically, the myenteric plexus arises from neural crest cells that migrate into the foregut by the third week of gestation, differentiating into neurons and glia by the ninth week to form a functional network throughout the developing intestine.^[1] Disruptions in this migration can lead to congenital disorders like Hirschsprung's disease, characterized by aganglionosis and absence of peristalsis in affected segments, while acquired dysfunction contributes to conditions such as achalasia and gastroparesis.^[2] Beyond motility, the plexus influences local blood flow, secretion, and immune responses, underscoring its role as the "second brain" of the body with semi-autonomous capabilities.^[1]

Anatomy

Location and Organization

The myenteric plexus, also known as Auerbach's plexus, forms a key component of the enteric nervous system (ENS) and is situated between the longitudinal and circular smooth muscle layers of the muscularis externa throughout the gastrointestinal tract, extending from the esophagus to the rectum.^[3]^[4] This positioning allows it to directly interface with the muscular layers responsible for gut propulsion.^[5] Structurally, the myenteric plexus consists of a network of interconnected ganglia linked by bundles of nerve fibers, creating a continuous mesh-like arrangement that runs parallel to the axis of the gastrointestinal tract.^[3] These ganglia vary in size and shape but collectively form an intricate lattice that spans the entire length of the digestive tube.^[6] The density and organization of the myenteric plexus exhibit regional variations along the gastrointestinal tract.^[7]^[8] In humans, neuronal density in the myenteric plexus tends to be higher in proximal regions like the small intestine compared to the colon, correlating with functional demands such as mixing and propulsion, though exact values vary by study (e.g., approximately 20,000–30,000 neurons/cm² in small intestine vs. lower in colon).^[9] These variations differ across species, with animal models showing distinct patterns. In relation to adjacent structures, the myenteric plexus is distinct from the submucosal (Meissner's) plexus, which resides within the submucosa layer beneath the muscularis externa, providing a layered separation in the ENS architecture.^[4]

Cellular Components

The myenteric plexus consists primarily of neurons and enteric glial cells, forming a complex network that regulates gastrointestinal motility. Neurons in the myenteric plexus are classified functionally into sensory neurons (also known as intrinsic primary afferent neurons or IPANs), interneurons, and motor neurons, which are further subdivided into excitatory and inhibitory types. Interneurons facilitate signal integration and coordination between sensory inputs and motor outputs, and sensory neurons detect mechanical and chemical stimuli within the gut wall. Enteric glial cells, which outnumber neurons, provide structural support, maintain the extracellular environment, and modulate neuronal activity through interactions that influence ion homeostasis and synaptic transmission.^[10]^[2]^[11] Morphologically, myenteric neurons exhibit diverse shapes, including unipolar, bipolar, and predominantly multipolar forms, reflecting their varied projections and functions. A foundational classification, developed by Aleksandr Dogiel in the late 19th century, divides enteric neurons into three types based on cell body shape and process distribution: Dogiel type I neurons are typically multipolar with a stellate appearance, featuring a single long axon and multiple short dendrites, and they constitute the majority (around 60-70%) of myenteric neurons in the human small intestine. Dogiel type II neurons are larger, often uniaxonal with extensive dendritic arborizations (up to 16 dendrites), forming flask-like or spindle-shaped cell bodies, and represent about 10-20% of the population, commonly associated with sensory roles. Dogiel type III neurons are rarer, characterized by filamentous or serpentine processes without distinct dendrites, and are primarily observed in certain species or regions. These morphological distinctions aid in identifying neuronal subtypes under histological examination, though modern classifications increasingly incorporate molecular markers for precision. Note that while this classification is foundational, ratios and morphologies can vary by species and GI region.^[12]^[13]^[14] In humans, the enteric nervous system (ENS), of which the myenteric plexus forms the major neuronal component, contains an estimated 100-200 million neurons overall, with the myenteric plexus accounting for approximately two-thirds of this total due to its role in coordinating longitudinal and circular muscle layers. The neuron-to-glia ratio in the human myenteric plexus varies across studies but generally favors glia, with ratios of about 1:4 to 1:7 (neuron:glia), contrasting with the central nervous system where glia predominate more markedly; this balance supports the plexus's high metabolic demands and plasticity. Enteric glia in the myenteric plexus are star-shaped or fibrous, enveloping neuronal somata and axons to form a supportive scaffold within ganglia.^[15]^[16]^[11] Axonal projections from myenteric neurons extend as intramuscular nerve fibers, densely innervating the circular and longitudinal smooth muscle layers of the gastrointestinal tract to enable precise control of peristalsis and segmentation. These fibers form varicose terminals that release neurotransmitters directly onto muscle cells, with motor neurons projecting up to several centimeters orally or anally to coordinate propagated contractions. Sensory and interneuron axons interconnect ganglia within the plexus, forming a reticular network that integrates local and extrinsic inputs, while glial processes often align along these axons to facilitate signal propagation and maintenance.^[10]^[17]^[18]

Physiology

Role in Gastrointestinal Motility

The myenteric plexus plays a central role in regulating gastrointestinal motility by coordinating the contractions and relaxations of the smooth muscle layers in the gut wall. It achieves this through its network of motor neurons, which include excitatory neurons that promote contraction of both circular and longitudinal muscles and inhibitory neurons that induce relaxation, enabling patterned movements essential for digestion. This coordination underlies two primary motility patterns: peristalsis, which propels contents forward in an oral-to-caudal direction, and segmentation, which mixes chyme through localized contractions in the small intestine.^[3]^[1] Peristalsis, first described as the "Law of the Intestine" by Bayliss and Starling, involves a wave-like propagation where proximal contraction is coupled with distal relaxation, facilitating the movement of food from the esophagus through the stomach and intestines. In the esophagus and stomach, this ensures bolus transit and gastric emptying, while in the intestines, it drives the slow advancement of contents over distances up to several meters. The myenteric plexus maintains this propulsion independently within the enteric nervous system, adapting to luminal distension or content presence to sustain efficient transit without constant external input.^[2]^[3] Regionally, the myenteric plexus exhibits specialized functions to meet varying digestive demands. In the fasting state, it orchestrates the migrating motor complex (MMC), a cyclic pattern of contractions that sweeps residual contents through the small intestine every 90-120 minutes, preventing bacterial overgrowth and preparing for the next meal. In the stomach, it supports receptive relaxation and accommodation, allowing the fundus to expand and store food without significant pressure increase, which is crucial for buffering incoming boluses. These adaptations highlight the plexus's versatility across GI segments.^[3]^[2]^[1] Although capable of autonomous operation, the myenteric plexus receives modulatory inputs from the autonomic nervous system, including vagal and sacral parasympathetic fibers that enhance excitatory motility and sympathetic fibers that generally inhibit it, fine-tuning propulsion in response to systemic needs. This integration allows the plexus to maintain core motility functions even if central connections are disrupted, as evidenced in isolated gut preparations.^[3]^[2]

Neural Integration and Reflexes

The myenteric plexus serves as the primary command center for gastrointestinal motility within the enteric nervous system (ENS), integrating sensory inputs from mechanoreceptors and other endings to orchestrate coordinated muscle activity. Sensory neurons in the myenteric plexus, often classified as intrinsic primary afferent neurons (IPANs), detect mechanical stimuli such as luminal distension caused by food boluses, initiating local reflex arcs. These sensory signals are processed by interneurons, which form polysynaptic pathways to connect with motor neurons, enabling ascending excitatory and descending inhibitory outputs that propel contents forward. This hierarchical structure allows the myenteric plexus to function semi-autonomously, generating patterns like peristalsis without constant central oversight.^[19]^[20] A classic example of intrinsic reflex activity is the peristaltic reflex, where distension activates mechanosensitive sensory neurons to trigger coordinated contractions oral to the stimulus and relaxation anal to it, facilitated by interneuron-mediated integration. Approximately 60% of myenteric neurons exhibit mechanosensitivity, responding to stretch or compression with varying adaptation rates to fine-tune motility responses. Molecularly, Piezo1 mechanosensitive ion channels expressed in cholinergic enteric neurons enable the detection of mechanical forces, supporting proper peristaltic responses and gastrointestinal motility.^[21]^[20]^[22]^[23] This reflex arc remains localized within the ENS, ensuring efficient propulsion even in isolated gut segments. The myenteric plexus integrates closely with the submucosal plexus to couple motility with secretion, forming functional circuits that synchronize propulsion and fluid adjustments for optimal digestion. Interconnections between the two plexuses allow myenteric motor outputs to influence submucosal secretory neurons, ensuring that peristaltic waves are accompanied by appropriate electrolyte and water secretion to lubricate contents. This coordination prevents issues like dry propulsion or excessive fluid loss during transit.^[19]^[21] Extrinsic inputs further modulate myenteric plexus activity, with parasympathetic fibers providing excitatory drive to enhance motility. Vagal nerves innervate the cephalic gut (esophagus to mid-colon), while pelvic nerves target the caudal regions, both projecting to myenteric motor neurons to amplify reflex responses during feeding or defecation. In contrast, sympathetic innervation from prevertebral ganglia exerts inhibitory control, reducing motility via noradrenergic pathways that dampen excitatory circuits, particularly during stress or fasting to conserve energy. These extrinsic influences integrate with intrinsic reflexes to adapt gut function to whole-body demands.^[24]^[19]^[21]

Neurochemistry

Neurotransmitters

The myenteric plexus employs a diverse array of neurotransmitters to facilitate communication among its neurons, enabling coordinated regulation of gastrointestinal function. These chemical messengers are released from various neuronal subtypes, including motor neurons, interneurons, and sensory neurons, and are characterized by their excitatory, inhibitory, or modulatory roles. Excitatory and inhibitory transmitters predominate in motor pathways, while modulatory ones influence interneuron and sensory signaling. A hallmark of enteric neurotransmission is co-transmission, where single neurons release multiple substances to achieve nuanced effects.^[25]^[2] Acetylcholine (ACh) serves as the primary excitatory neurotransmitter in the myenteric plexus, released by cholinergic neurons to promote smooth muscle contraction. Synthesized from choline and acetyl-CoA by choline acetyltransferase in enteric neurons, ACh is stored in vesicles and released in response to action potentials. This excitatory signaling is essential for peristaltic propulsion, originating from both motor neurons and interneurons.^[25]^[2] In contrast, inhibitory neurotransmission in the myenteric plexus relies on vasoactive intestinal peptide (VIP) and nitric oxide (NO), which mediate smooth muscle relaxation. VIP, a 28-amino-acid peptide synthesized from prepro-VIP mRNA in inhibitory motor neurons, is released to inhibit contraction and facilitate descending relaxation during peristalsis. NO, a gaseous signaling molecule produced via nitric oxide synthase (NOS) enzymes in nitrergic neurons, diffuses rapidly without vesicular storage, acting locally to induce relaxation through guanylate cyclase activation—though its synthesis and release are calcium-dependent and activity-triggered, mirroring other enteric transmitters. These, along with ATP and other mediators, constitute non-adrenergic non-cholinergic (NANC) transmission, where ATP is released from inhibitory neurons and contributes to fast inhibitory potentials via purinergic mechanisms.^[25]^[2] Modulatory neurotransmitters such as substance P, serotonin (5-HT), and gamma-aminobutyric acid (GABA) fine-tune signaling within the myenteric plexus, particularly in sensory-to-interneuron pathways and interneuron circuits. Substance P, a tachykinin peptide derived from preprotachykinin A, is released from sensory neurons to enhance excitatory transmission and sensory integration. Serotonin (5-HT), synthesized from tryptophan by tryptophan hydroxylase in enterochromaffin cells and some enteric neurons, modulates interneuron activity and sensory signaling, influencing overall network excitability. GABA, produced via glutamic acid decarboxylase in a subset of interneurons, exerts inhibitory modulation on neuronal firing, helping to shape reflex arcs. These modulators often operate in concert with primary transmitters, highlighting the plexuses' chemical complexity.^[25]^[2] Co-transmission is prevalent in myenteric plexus neurons, allowing integrated signaling; for instance, excitatory cholinergic neurons frequently co-release ACh with tachykinins like substance P, enabling both fast and sustained excitatory effects. Similarly, inhibitory neurons co-transmit NO with VIP or ATP, providing layered control over relaxation. This plurichemical strategy, unique to the enteric nervous system, involves differential synthesis pathways—such as peptide processing in the Golgi for VIP and enzymatic generation for NO—and regulated release via calcium influx, ensuring precise spatiotemporal control without reliance on synaptic vesicles for all transmitters.^[25]^[2]

Receptors and Mechanisms

The myenteric plexus features a diverse array of cholinergic receptors that mediate excitatory neurotransmission in the gastrointestinal tract. Muscarinic acetylcholine receptors, particularly the M2 and M3 subtypes, are predominantly expressed on smooth muscle cells and enteric neurons, where M3 activation primarily drives contraction through Gq-protein coupling and phospholipase C activation, while M2 receptors inhibit adenylyl cyclase to modulate relaxation or fine-tune excitability.^[26] Nicotinic acetylcholine receptors, ligand-gated ion channels composed of α3, β4, and other subunits, facilitate fast synaptic transmission within myenteric ganglia, enabling rapid depolarization and propagation of excitatory signals between neurons.^[27] Inhibitory neurotransmission in the myenteric plexus involves receptors sensitive to vasoactive intestinal peptide (VIP) and nitric oxide (NO). VIP binds to VPAC1 and VPAC2 receptors, which are G-protein-coupled receptors (GPCRs) linked to Gs proteins, leading to increased intracellular cyclic AMP (cAMP) levels and subsequent activation of protein kinase A, which promotes smooth muscle relaxation and inhibition of excitatory pathways.^[28] Similarly, NO activates soluble guanylyl cyclase in smooth muscle and neuronal targets, catalyzing the production of cyclic GMP (cGMP), which in turn activates protein kinase G to phosphorylate targets that reduce intracellular calcium and induce hyperpolarization-mediated relaxation.^[29] Additional receptor types contribute to the modulation of myenteric plexus activity. Serotonin (5-HT) receptors, including the ionotropic 5-HT3 subtype on sensory and motor neurons and the metabotropic 5-HT4 subtype on excitatory neurons, enhance motility by facilitating acetylcholine release and peristaltic reflexes, with 5-HT4 activation coupling to Gs proteins to elevate cAMP.^[30] Purinergic receptors respond to ATP released from enteric neurons and glia; P2X receptors (e.g., P2X2/3) are cation-selective ion channels that mediate fast depolarizing responses in synaptic transmission, whereas P2Y receptors (e.g., P2Y1/2) are GPCRs that trigger slower modulatory effects via Gq or Gi/o pathways, influencing neuron-glia interactions and motility coordination.^[31] Signaling cascades downstream of these receptors integrate myenteric plexus function through ion channel modulation and second messenger systems. For instance, substance P acting on neurokinin-1 receptors activates Gq-coupled phospholipase C, generating inositol trisphosphate (IP3) and diacylglycerol (DAG), which mobilize intracellular calcium via IP3 receptors and activate protein kinase C through DAG, enhancing excitability and contraction.^[32] Many receptors, including muscarinic and purinergic types, directly or indirectly modulate ion channels such as voltage-gated calcium channels or potassium channels to control membrane potential and neurotransmitter release. Receptor expression in the myenteric plexus exhibits plasticity, adapting to inflammatory states or injury by upregulating subtypes like 5-HT4 or VPAC1 to maintain motility homeostasis.^[33]

Clinical Significance

Associated Disorders

Hirschsprung's disease is a congenital aganglionosis disorder characterized by the absence of ganglion cells in the myenteric and submucosal plexuses of the distal colon and rectum, stemming from a failure of neural crest-derived cells to migrate, proliferate, and differentiate properly during embryonic development.^[34]^[35] This aganglionic segment leads to tonic contraction of the affected bowel, resulting in functional obstruction and severe constipation from birth.^[36] The condition affects approximately 1 in 5,000 live births and is more common in males.^[37] Gastroparesis is an acquired motility disorder involving delayed gastric emptying without mechanical obstruction, often linked to myenteric plexus dysfunction, including loss of interstitial cells of Cajal and degeneration of inhibitory neurons.^[38] Common in diabetic patients, it results from vagal neuropathy and enteric neuronal damage, leading to symptoms like nausea, vomiting, and bloating. Idiopathic forms may involve viral or autoimmune targeting of the plexus.^[39] Achalasia represents a degenerative disorder of the esophagus involving selective loss of inhibitory neurons, particularly those expressing nitric oxide synthase, within the myenteric plexus.^[40]^[41] This neuronal depletion impairs relaxation of the lower esophageal sphincter and disrupts peristalsis, causing dysphagia and regurgitation.^[42] The etiology is primarily idiopathic but may involve autoimmune mechanisms targeting myenteric neurons.^[43] Chagas disease, caused by infection with the protozoan Trypanosoma cruzi, induces progressive destruction of the myenteric plexus through chronic inflammation, neuronal degeneration, and fibrosis in the gastrointestinal tract.^[44]^[45] This damage predominantly affects the esophagus and colon, leading to megaesophagus and megacolon with severe motility disruptions.^[46] The inflammatory process involves invasion of the plexuses by parasites and immune cells, resulting in up to 50-90% neuronal loss in advanced cases.^[47] Inflammatory bowel diseases, such as Crohn's disease, feature structural alterations in the myenteric plexus, including neuronal hyperplasia in some segments alongside hypoplasia and immune cell infiltration in others.^[48]^[49] These changes, often accompanied by apoptosis of enteric neurons and glia, contribute to irregular gastrointestinal motility and visceral hypersensitivity.^[50] In ulcerative colitis, similar but less pronounced plexal inflammation and neuronal loss occur, primarily in the colon.^[51] Parkinson's disease exhibits accumulation of alpha-synuclein aggregates in the myenteric plexus, forming Lewy body-like inclusions in enteric neurons and glia, which may precede central nervous system involvement and manifest as early gastrointestinal symptoms like constipation.^[52]^[53] Recent studies highlight this enteric pathology as part of the gut-brain axis in neurodegeneration, with alpha-synuclein immunoreactivity increased and detectable in nearly all patients with Parkinson's disease.^[54]^[55] This deposition correlates with autonomic dysfunction and supports the hypothesis of a peripheral origin for disease propagation.^[56]

Diagnosis and Therapeutic Approaches

Diagnosis of disorders involving the myenteric plexus primarily relies on histopathological examination of rectal biopsies, which confirm aganglionosis through the absence of ganglion cells in the submucosal and myenteric plexuses.^[57] This technique involves suction or full-thickness biopsies taken from the distal rectum, with acetylcholinesterase staining often used to highlight hypertrophic nerve fibers and the lack of ganglia, providing a definitive diagnosis in conditions like Hirschsprung's disease.^[58] Biopsies must be obtained sufficiently proximal to avoid false negatives due to the variable length of aganglionic segments.^[59] Manometry serves as a key functional assessment tool for evaluating gastrointestinal motility disruptions linked to myenteric plexus dysfunction, measuring pressure changes in the esophagus, stomach, small intestine, or colon to identify abnormal contraction patterns.^[60] High-resolution manometry, particularly anorectal manometry, detects absent rectoanal inhibitory reflex and prolonged anal sphincter tone, which are indicative of impaired myenteric coordination without directly visualizing the plexus.^[61] This invasive yet valuable method helps differentiate neuropathic from myopathic motility disorders by analyzing propagated pressure waves.^[62] Imaging modalities like endoanal ultrasound offer limited direct insight into the myenteric plexus, primarily visualizing anal sphincter integrity and perianal structures but not neural elements.^[63] It is useful for assessing secondary complications such as sphincter defects in motility-related incontinence but requires correlation with histopathology for plexus-specific evaluation.^[64] Emerging techniques, such as probe-based confocal laser endomicroscopy, enable real-time in vivo visualization of the enteric nervous system during endoscopy, allowing observation of ganglion cells and nerve fibers in the myenteric plexus for potential intraoperative diagnosis.^[65] This approach has demonstrated feasibility in identifying aganglionic regions in human subjects, marking a shift toward non-invasive neural imaging.^[66] Therapeutic strategies for myenteric plexus disorders emphasize surgical intervention to restore normal bowel function, with pull-through procedures being the standard for resecting aganglionic segments and anastomosing ganglionic bowel to the anus.^[34] Techniques such as the transanal endorectal pull-through minimize abdominal incisions and have shown high success rates in improving continence and motility postoperatively.^[67] Pharmacological options include prokinetic agents like metoclopramide, which enhance gastrointestinal motility by stimulating 5-HT4 receptors in the myenteric plexus to promote acetylcholine release and peristalsis.^[68] Administered at 5-10 mg doses, it is particularly indicated for upper gastrointestinal dysmotility but requires monitoring for extrapyramidal side effects.^[69] Post-2020 research highlights stem cell therapies as promising for enteric nervous system repair, involving transplantation of neural crest-derived progenitors to repopulate aganglionic regions and restore motility. As of 2025, human pluripotent stem cell-derived enteric neural progenitors have integrated into host tissue in preclinical models and early human studies, improving colonic contractility; additionally, highly neurogenic glia from myenteric ganglia have shown potential for regeneration in animal models of enteric neuropathies.^[70]^[71]^[72]^[73] Fecal microbiota transplantation (FMT) is an emerging adjunctive approach, modulating gut microbiota to influence enteric nervous system function and alleviate motility issues in chronic constipation, though its direct impact on myenteric repair remains under investigation.^[74] Experimental neuromodulation via electrical stimulation targets the myenteric plexus to regulate gastrointestinal motility, with closed-loop neuroprostheses generating peristaltic waves in animal models of dysmotility.^[75] Vagal or direct enteric stimulation enhances neuronal activity and muscle coordination, showing potential for treating refractory disorders.^[76] Gene therapy approaches, focusing on RET proto-oncogene pathways disrupted in congenital myenteric defects, aim to promote enteric neuron differentiation but are still in preclinical stages without clinical translation.^[77]

History

Discovery

The discovery of the myenteric plexus emerged in the mid-19th century amid rapid advancements in microscopy that allowed for the detailed visualization of neural structures previously undetectable. Improvements in compound light microscopes, such as those developed by Joseph Lister in the 1830s and enhanced staining techniques using carmine and gold chloride, enabled researchers to examine thin tissue sections of the gastrointestinal tract with unprecedented clarity. These technological strides, part of a broader "golden age of microscopy" in the 19th century, facilitated the identification of intricate neural networks within the enteric nervous system (ENS).^[78] An important precursor to the myenteric plexus discovery was the work of Georg Meissner, who in 1857 described the submucosal plexus (also known as Meissner's plexus) through histological examination of intestinal tissue. Meissner's findings highlighted a dense network of ganglia and nerve fibers in the submucosal layer, establishing the concept of an intrinsic nervous system in the gut and laying the groundwork for further explorations of ENS components. This discovery underscored the gut's autonomous neural regulation, distinct from extrinsic autonomic influences.^[78] The myenteric plexus itself was first identified in 1862 by Leopold Auerbach, a German anatomist and neuropathologist, during microscopic studies of the intestine in vertebrates. Auerbach observed a continuous plexus of ganglia and nerve fibers situated between the longitudinal and circular muscle layers of the intestinal wall, which he termed the "intermuscular nerve plexus" or plexus myentericus. He emphasized its role in coordinating muscular contractions and distinguished it from the extrinsic sympathetic nerve chains, recognizing it as an integral part of the gut's independent neural architecture. Which became known as Auerbach's plexus in his honor, this structure marked a pivotal advancement in understanding gastrointestinal innervation.^[79]

Key Developments

In the late 19th and early 20th centuries, foundational classifications of enteric neurons emerged, with Alexander S. Dogiel identifying distinct morphological types in the myenteric plexus based on dendritic patterns, including uniaxonal type I neurons and multipolar type II (Dogiel) cells, which laid the groundwork for understanding neuronal diversity in the enteric nervous system (ENS).^[13] Concurrently, in 1899, William Bayliss and Ernest Starling demonstrated the peristaltic reflex through experiments on isolated intestinal segments, revealing an intrinsic neural mechanism where distension triggers oral contraction and anal relaxation, independent of central nervous input and mediated by the myenteric plexus.^[80] Mid-20th-century research advanced the recognition of non-adrenergic non-cholinergic (NANC) transmission in the ENS during the 1970s, as studies identified inhibitory pathways in the myenteric plexus that operate beyond acetylcholine and norepinephrine, involving mediators like vasoactive intestinal peptide and later nitric oxide.^[81] Building on this, John B. Furness and Marcello Costa's mappings in the 1980s elucidated the ENS's autonomy, using histochemical techniques to classify neuron types and trace circuit projections in the myenteric plexus, confirming its capacity for coordinated reflexes without extrinsic control.^[82] Embryological studies in the 1970s further solidified the neural crest origin of ENS neurons through quail-chick chimera experiments, where quail neural crest cells colonized chick gut tissues to form myenteric ganglia, proving migratory contributions to plexus development.^[83] Entering the 21st century, molecular genetics revealed key roles for the RET proto-oncogene in ENS disorders, with mutations identified in 1994 as a primary cause of Hirschsprung's disease by disrupting neural crest migration and myenteric plexus innervation in the distal gut.^[84] In the 2010s, neuroimaging and optogenetic tools enabled precise circuit mapping, allowing targeted activation of myenteric neurons to dissect motility pathways, as demonstrated in studies using channelrhodopsin to evoke peristalsis in isolated preparations.^[85] Post-2020 developments have highlighted microbiome-ENS interactions, with research showing gut bacteria modulate myenteric neuron excitability via short-chain fatty acids and immune signaling, influencing plexus function in health and disease.^[86] Additionally, AI-assisted modeling has emerged for structural analysis, such as automated neuron counting in myenteric preparations to quantify plexus integrity in disease models.^[87] Recent advances as of 2025 include spatial transcriptomics revealing neuronal composition in the myenteric plexus and improved imaging techniques for in vivo studies.^[88]

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Antagonists of 5-Hydroxytryptamine (5-HT) receptors are well known to inhibit gastrointestinal (GI)-motility and transit in a variety of mammals, ...
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Questioning the failure of neural crest cell migration theory in ...
Questioning the failure of neural crest cell migration theory in Hirschsprung's disease: A case report and literature review. Int J Surg Case Rep. 2021 Feb ...
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What is new about the genetic background of Hirschsprung disease?
Hirschsprung disease (HSCR) is a rare congenital disorder caused by an incorrect enteric nervous system development due to a failure in migration, proliferation ...
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An immunohistochemical study of the myenteric plexus in idiopathic ...
Background: Achalasia is a primary esophageal motor disorder characterized by degenerative changes of the myenteric plexus.
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Etiology and pathogenesis of achalasia: the current understanding
Current evidence suggests that the initial insult to the esophagus, perhaps a viral infection or some other environmental factor, results in myenteric plexus ...
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Anti-myenteric neuronal antibodies in patients with achalasia. A ...
Achalasia is a motility disorder of the esophagus characterized by the loss of inhibitory neurons in the distal esophagus. Although idiopathic in nature, ...
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The spectrum of achalasia: lessons from studies of pathophysiology ...
Laboratory studies indicate that achalasia is an autoimmune disease in which esophageal myenteric neurons are attacked in a cell-mediated and antibody-mediated ...
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Megacolon in Chagas disease: a study of inflammatory cells, enteric ...
Chagas disease with gastrointestinal involvement involves an inflammatory invasion of the enteric plexuses and degeneration of enteric neurons. It is known ...
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The enteric nervous system in chagasic and idiopathic megacolon
An increased amount of fibrosis was found in the smooth muscle and the myenteric plexus of chagasic patients compared to the idiopathic megacolon and the ...
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This study was made with the objective of reevaluating the colon denervation in chronic Chagas' disease. The diameters of neuron perikaryons of the ...
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Intestinal plexuses in Crohn's disease and ulcerative colitis in children
Increase in the relative fraction of neural tissue (myenteric plexus hyperplasia) was seen in the MEP of some patients in both ileum and colon in both diseases.
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Myenteric Plexus Immune Cell Infiltrations and Neurotransmitter ...
Jan 27, 2024 · An important structure in the transduction of pain signalling is the myenteric plexus [MP]. Nevertheless, IBD-associated infiltration of the MP ...
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Enteric neuroglial apoptosis in inflammatory bowel diseases - PubMed
In patients with inflammatory bowel disease apoptotic phenomena involve both enteric neurons and enteroglial cells, and may play a role in the abnormalities ...
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Enteric nervous system abnormalities in inflammatory bowel diseases
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Spatial transcriptome analysis of myenteric plexus and intestinal ...
Jul 5, 2025 · Alpha-synuclein (AS) accumulation is found in the nerve plexuses of the gastrointestinal tract in patients with Parknison's disease (PD).
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Alpha-synuclein-immunopositive myenteric neurons and vagal ...
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Enteric alpha-synuclein expression is increased in Parkinson's ...
Enteric alpha-synuclein expression is increased in Parkinson's disease but not Alzheimer's disease ... Myenteric Plexus / pathology; Parkinson Disease ...
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Detection of Phosphorylated Alpha-Synuclein in the Muscularis ...
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From the Gut to the Brain: The Role of Enteric Glial Cells and Their ...
Jan 20, 2024 · Enteric glial cells are the most abundant cellular component. Several studies have evaluated their role in Parkinson's disease.
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Hirschsprung Disease - StatPearls - NCBI Bookshelf
Jun 3, 2023 · [3] Its diagnosis relies upon the histopathological examination of rectal biopsies. Go to: Etiology. In Hirschsprung disease, there is a ...
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Hirschsprung disease - Colon - Pathology Outlines
Apr 27, 2022 · Absent enteric ganglion cells in submucosal and myenteric plexuses in distal rectum and variable length of contiguous intestine, causing functional obstruction ...
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Histologic studies of rectocolic aganglionosis and allied diseases
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Advances in the diagnosis and classification of gastric and intestinal ...
Apr 6, 2018 · Altered small bowel motility on manometry could suggest underlying myopathy or neuropathy. Severe motor pattern alterations in combination with ...
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Imaging Review of Gastrointestinal Motility Disorders - RSNA Journals
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Visualization of the human enteric nervous system by probe ...
Jul 31, 2021 · This study demonstrated the first, real-time observation of the enteric nervous system in humans using confocal laser endomicroscopy.
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Visualization of the human enteric nervous system by probe ...
Jul 31, 2021 · This study demonstrated the first, real-time observation of the enteric nervous system in humans using confocal laser endomicroscopy and ...
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Metoclopramide - OpenAnesthesia
Jul 8, 2025 · It also elicits prokinetic effects in the upper GI system by agonizing 5-HT4 receptors in the myenteric plexus, thereby enhancing the release of ...
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New Developments in Prokinetic Therapy for Gastric Motility Disorders
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Updates and Challenges in ENS Cell Therapy for the Treatment of ...
Feb 16, 2024 · This review discusses the progress that has been made in the sourcing of putative stem cells and the studies into their biology and therapeutic potential.
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Enteric neural stem cell transplant restores gut motility in mice with ...
Jul 23, 2024 · Cell-based therapy represents a novel approach that offers the potential to directly treat the cause of these neurointestinal diseases by ...
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Intestinal microbiota shapes gut physiology and regulates enteric ...
Oct 26, 2021 · The ENS is composed of two ganglionated plexuses, the myenteric and submucosal plexuses ... fecal microbiota transplantation. Annu Rev Med ...
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Gastrointestinal neuroprosthesis for motility and metabolic ... - Nature
Aug 10, 2025 · Here, we developed a closed-loop GI neuroprosthesis which activates or relaxes GI tract musculature through electrochemical stimulation in ...
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Bioelectric neuromodulation for gastrointestinal disorders - Nature
Nov 2, 2018 · ... gastric myenteric plexus ... Neuromodulation via interferential electrical stimulation as a novel therapy in gastrointestinal motility disorders.
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(epi)genetic mechanisms and future therapies of Hirschsprung ...
Sep 13, 2019 · Hence, alterations in expression of genes specific for the enteric nervous system may contribute to the pathogenesis of Hirschsprung's disease.
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Annotated translation of Georg Meissner's first description of the ...
Oct 10, 2022 · Thus, Leopold Auerbach wrote in the first description of the myenteric plexus in 1862 that he is prepared to receive distrust from the ...
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Leopold Auerbach's heritage in the field of morphology and ... - NIH
Dec 23, 2020 · In 1862, Auerbach made a first-class discovery of a ganglion plexus between longitudinal and circular layers of intestinal tunica muscularis ...
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The Peristaltic Reflex - SpringerLink
Bayliss and Starling (1899) showed that local stimulation of the intestine causes inhibition below the point of stimulation and excitation above it; ...Missing: myenteric | Show results with:myenteric
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Non-adrenergic non-cholinergic (NANC) transmission to smooth ...
In the succeeding 35 years, identification of these NANC transmitters has been a major task of neuropharmacology, with nitric oxide, neuropeptides, and purines ...Missing: 1970s enteric
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Types of Nerves in the Enteric Nervous System - PubMed
Types of Nerves in the Enteric Nervous System. Neuroscience. 1980;5(1):1-20. doi: 10.1016/0306-4522(80)90067-6. Authors. J B Furness, M Costa. PMID: 6154268 ...
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From head to tail: regionalization of the neural crest | Development
Oct 26, 2020 · The development of the quail-chick chimera system in the early 1970s by Nicole Le Douarin allowed for comprehensive analyses of NC migration and ...
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Mutations of the RET proto-oncogene in Hirschsprung's disease
Jan 27, 1994 · Here we report nonsense and missense mutations in the extracellular domain of RET protein (exons 2, 3, 5 and 6) in six unrelated probands.
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[PDF] Optogenetic Induction of Colonic Motility in Mice - NeuroLux
Colonic myenteric neurons were analyzed by immunohistochemistry, patch- clamp, and calcium imaging studies. Motility was assessed by mechanical, ...
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Who's talking to whom: microbiome-enteric nervous system ...
The intestinal microbiota and ENS interact during critical periods, with implications for normal development and potentially disease pathogenesis.
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COUNTEN, an AI-Driven Tool for Rapid and Objective Structural ...
Jul 15, 2021 · COUNTEN (COUNTing Enteric Neurons) is the first open-source AI-driven tool that performs automated, rapid, and objective enumeration and clustering of murine ...