The hypothalamus and gastric mucosal injuries: origin of stress-induced injury?

This paper reviews the role of the central nervous system in the genesis of gastrointestinal mucosal injuries. The discussion makes particular reference to the significance and mechanism of stress-induced injury of the gastroduodenal mucosa. It points out that in the rat, stress activates the hypothalamus, producing delivery of alpha-adrenergic stimulation to the stomach by the adrenergic hypothalamovagal pathway. This stimulation controls intragastric blood flow and 5-HT release. Low magnitude pharmacologically-induced stress enhances gastric acid secretion and, if this stress is maintained, it produces chronic duodenal ulceration. High magnitude pharmacologically-induced stress depresses acid secretion and injures the gastric mucosa. If such stress is maintained, it produces chronic gastric ulceration. The paper provides a detailed account of the mechanisms of these stress-induced gastroduodenal effects.