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PubMed1986

Porcine proliferative enteritis: serological, microbiological and pathological studies from three field epizootics.

Three outbreaks of porcine proliferative enteritis were evaluated clinically, pathologically, microbiologically and serologically. The disease was characterized by a chronic intermittent diarrhea. Pathological lesions included a thickened, turbid ileum with the microscopic appearance of proliferating ileal crypt epithelial cells. Comma shaped intracytoplasmic organisms were observed in the apical portions of the proliferating crypt epithelial cells with a Warthin-Starry silver stain. Microbiologically, both Campylobacter sputorum subspecies mucosalis and Campylobacter hyointestinalis, were cultured from ileal specimens of seven pigs with lesions of porcine proliferative enteritis. Microagglutination antibody titers were determined on sera from 12 of 14 pigs with porcine proliferative enteritis and on sera from 91 clinically normal swine. Pigs with porcine proliferative enteritis had a low antibody titer to subspecies mucosalis that ranged from 1-3 with a mean of 2.17. A varied C. hyointestinalis titer from 3-7 with mean of 4.83 was determined. Titers to either subspecies mucosalis and C. hyointestinalis were higher in non-porcine proliferative enteritis pigs. The results indicate that the presence of a positive titer to either C. hyointestinalis or subspecies mucosalis in swine is not indicative of clinical disease. The isolation of C. hyointestinalis from diseased ileal specimens (porcine proliferative enteritis) confirms previous reports implicating this agent in the disease.

Animals↗
PubMedDate not supplied

[Enteral nutrition in ICU patients on a high-protein diet].

BASIS: The need for nutritional support is at present beyond question, while the use of early enteral nutrition in critical patients admitted to Intensive Care Units is increasingly common and would appear to offer a set of advantages as nutritional support. PATIENTS: Of a total of 26 consecutive enteral nutrition patients, 22 were studied prospectively (84.6%), and, through a nasal-gastric probe, were administered early high protein enteral polymeric diet with 25% of total calorific value from proteins, for an average of 10 days. The other four (15.4%) did not enter the study, according to the exclusion criteria established, and so were not taken into account in the statistics. METHOD: A design was followed in which the diet was administered progressively until reaching 30 ml/kg/day, in a maximum of three days, during which aspects were analyzed dealing with tolerance and ease of use, on the one hand, and other metabolic and nutritional aspects on the other. Analytical controls were carried out on days 0, 4, 8 and 12. Tolerance and adverse effects were monitored continuously. RESULTS: During the study, one of the twenty-two patients died (4.54%): the other 21 remained alive. In analysis of the metabolic and nutritional parameters, improvement was obtained in all those expected to reach normal levels, with p < 0.001 (glucose, prealbumin, TF, RBP, Zn, Mg and P). Of particular note was the evolution of the nitrogen balance (p < 0.001 and r = 0.77). As to tolerance, diarrhea appeared in two patients (9.09%), ileus in one (4.5%): no cases were detected of abdominal distension, nausea or vomiting. In no case was diet suspended for causes attributable to the enteral nutrition, nor was any therapeutic manipulation required. CONCLUSIONS: Excellent tolerance of enteral nutrition was obtained, with almost no complications associated with its use, despite the gravity of the patients (APACHE 14). On the other hand, an improvement was obtained in metabolic and nutritional parameters, with the particular significance of the nitrogen balance.

Adult↗
PubMed1993

Enteral versus parenteral nutrition as adjunct therapy in acute ulcerative colitis.

To ascertain the role of total enteral nutrition, compared with total parenteral nutrition, as adjunct therapy to steroids in patients with severe acute ulcerative colitis, a prospective randomized trial was conducted in 42 of such patients. Inclusion criteria were the persistence of a moderate or severe attack of the disease (Truelove's index) after 48 h on full steroid treatment (prednisone 1 mg/kg/day). Patients were randomized to receive polymeric total enteral nutrition or isocaloric, isonitrogenous total parenteral nutrition as the sole nutritional support. Remission rate and need for colectomy were similar in both groups. No significant changes in anthropometric parameters were observed in either nutritional group at the end of the study. Median increase in serum albumin was 16.7% (-0.5% to +30.4%) in the enteral feeding group, and only 4.6% (-12.0% to +13.7%) in the parenteral nutrition patients (p = 0.019). Adverse effects related to artificial nutritional support were less frequent (9% vs. 35%, p = 0.046) and milder in enterally fed patients. Postoperative infections occurred more often with parenteral nutrition (p = 0.028). These results suggest that total enteral nutrition is safe and nutritionally effective in severe attacks of ulcerative colitis. It is also cheaper and associated with fewer complications than parenteral nutrition. Total enteral nutrition should be regarded as the most suitable type of nutritional support in these patients.

Acute Disease↗
PubMed1993

[Enteral nutrition of critically ill patients].

OBJECTIVE: The purpose of this article is to review the facilities of early enteral nutrition in critically ill patients. DATA SOURCES: Review articles as well as original papers are the main sources for this contribution. SELECTION CRITERIA: Pathophysiologic conditions of intestinal substrate assimilation during hypermetabolism are described. The resulting consequences for enteral alimentation are discussed. Practical aspects such as classification and different indications of formulas, performance of enteral nutrition as well as management of tube feeding complications are further subjects of this review. RESULTS: Paying attention to tolerance, enteral nutrition can be started early in the postoperative or posttraumatic course. Jejunal substrate application, however, reveals to be a major issue for successful management. CONCLUSION: Clinical performance as well as efficiency of enteral nutrition seem to be essentially dependent on the intestinal blood flow. New methods for estimating intestinal blood flow, such as tonometry, will have to be evaluated especially in critically ill patients to improve the indications for enteral nutrition.

Contraindications↗
PubMedDate not supplied

Relationship of sex, age, and concurrent intestinal disease to necrotic enteritis in turkeys.

A retrospective case-control study of necrotic enteritis in turkeys was done. Male flocks were involved in a significantly greater proportion of necrotic enteritis cases compared with control cases. Necrotic enteritis cases occurred most frequently between 6 and 11 weeks of age. Within this age range, the probability of a necrotic enteritis case having a concurrent intestinal disease diagnosis was significantly higher than the probability in control cases. Coccidiosis was the most frequently diagnosed concurrent intestinal disease with necrotic enteritis, followed by clinical hemorrhagic enteritis and ascaridiasis.

Age Factors↗
PubMedDate not supplied

[Description of a computer program and results of its application to the follow up of enteral nutrition].

Computerization has been introduced little by little in the different activities which take place in a department of pharmacy, due to the fact that it means an increased agility of the tasks to be performed as well as an improvement of the care and managerial quality. In our hospital, the department of pharmacy makes up enteral nutrition units, and it participates in the follow up and control of the patients with this type of nutrition through a computer program designed for this purpose. The objective of the present study is to describe this computerized program as well as the results obtained by its application. The enteral nutrition computer program is made up of two data bases which are indexed between each other: that of daily follow up of the enteral nutrition prescriptions, and that of the follow up of the patients who have been given this nutritional support. In this way it allows us to obtain identification labels and consumption listings. During a two year period a total of 632 enteral nutrition treatments were given. The department with the greatest number of prescriptions was internal medicine (187, 29.5%). The polymeric diets were the most frequently used (435, 68.7%). The have mainly been used as a supplement to a hospital kitchen diet (149, 41.8%). The oral administration was the most frequent route of administration (331, 52.4%). The main reason for not implementing the nutrition was refusal by the patient (114, 38%). The computer program allows greater agility of the circuit which in our hospital generates the preparation of the enteral nutrition formulations, which are made up in the Department of Pharmacy, and given the large number of variables which this implies, this means a quality guarantee in the preparation and follow up of the patients with enteral nutrition.

Enteral Nutrition↗
PubMedDate not supplied

Clinical experience with early enteral feeding in very-low-birth-weight infants.

The primary objective of this study was to evaluate the safety and benefit of early enteral feeding in very-low-birth-weight (VLBW) infants without parenteral nutrition. Weight gain, feeding intolerance, nosocomial infection rate and a postnatal growth curve were recorded for 61 VLBW premature infants who were admitted to the Neonatal Intensive Care Unit of Mackay Memorial Hospital from September 1, 1995 to February 28, 1997. Nine infants were unable to complete the study and three were excluded because of severe bronchopulmonary dysplasia; therefore only 49 infants could be evaluated. They were divided into two groups based on birth weight: 1001 gm to 1250 gm (Group A, mean birth weight 1153 +/- 64 gm, mean gestational age 29.0 +/- 2.2 weeks), and less than or equal to 1000 gm (Group B, mean birth weight 911 +/- 82 gm, mean gestational age 27.1 +/- 1.5 weeks). They received breast milk or premature formula by intermittent nasogastric or continuous nasogastric feeding. Growth was followed over the first 30 postnatal days. Group A reached 100 kcal/kg/day of enteral feeding at a mean age of 17 days as compared with a mean age of 20 days for group B. Infants regained their birth weight at 20 and 25 days in Groups A and B, respectively. By the 30th postnatal day, weight gain exceeded birth weight by 218.2 +/- 143.1 gm and 95.3 +/- 81.5 gm in groups A and B respectively. No definite episodes of necrotizing enterocolitis (NEC) developed. Two cases of Escherichia coli sepsis and one of Klebsiella sepsis occurred. The conclusion was that early enteral feeding in very-low-birth-weight infants does not increase the risk of NEC. It was also demonstrated that enteral feeding alone can produce biphasic postnatal growth curves in very-low-birth-weight infants. Although early enteral feeding was well tolerated in the study infants, the occurrence of feeding intolerance in some (36%) would suggest that additional parenteral nutrition may benefit some infants until full enteral feeding can be achieved.

Enteral Nutrition↗
PubMed1997

[Usefulness of enteral feeding in surgery].

Eighty malnourished patients with neoplasms, enteric fistulae, multiorgan trauma and septic complications administered food by means of enteral feeding (EF). It was found that EF prevents weight loss and even causes weight gain in patients, increases total protein and albumin concentrations and decreases urea and creatinine levels in blood which is a proof of catabolism fall. Patient condition improvement and healing of the majority of enteric fistulae was achieved after EF. Factory diet intolerance affected 5% of patients and diarrhoea-6%. Investigations prove that enteral feeding is a good alternative to parenteral nutrition. If enteral feeding follows proper indications, technique and route of administration are chosen the right way, it allows the surgeon to perform operation, decreases the number of complications and enables the patient's organism fight septic syndrome. Enteral feeding is a state of the art method of severely ill patient nutrition.

Cachexia↗
PubMed1997

Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial.

BACKGROUND: Parenteral nutrition is well established for providing nutritional support in acute pancreatitis while avoiding pancreatic stimulation. However, it is associated with complications and high cost. Benefits of enteral feeding in other disease states prompted a comparison of early enteral feeding with total parenteral nutrition in this clinical setting. METHODS: Thirty-eight patients with acute severe pancreatitis were randomized into two groups. The first (n = 18) received enteral nutrition through a nasoenteric tube with a semi-elemental diet, while the second group (n = 20) received parenteral nutrition through a central venous catheter. Safety was assessed by clinical course of disease, laboratory findings and incidence of complications. Efficacy was determined by nitrogen balance. The cost of nutritional support was calculated. RESULTS: Enteral feeding was well tolerated without adverse effects on the course of the disease. Patients who received enteral feeding experienced fewer total complications (P < 0.05) and were at lower risk of developing septic complications (P < 0.01) than those receiving parenteral nutrition. The cost of nutritional support was three times higher in patients who received parenteral nutrition. CONCLUSION: This study suggests that early enteral nutrition should be used preferentially in patients with severe acute pancreatitis.

Acute Disease↗
PubMedDate not supplied

[Incidence of gastrointestinal complications following enteral nutrition in critical patients].

The use of enteral nutrition in critically ill patients in an increasingly common technique which is presenting greater indications and benefits. Our objective is to quantify and evaluate gastrointestinal complications following the use of enteral nutrition in patients admitted into our unit. A prospective study was performed during one year, in 152 patients admitted into our service who were fed with enteral nutrition by probe for 4 or more days, using our enteral nutrition protocol. The complications recorded were: Abdominal distension, increase of gastric residuum, vomits or regurgitation, diarrhoea, constipation and broncho-aspiration of the diet. From the results obtained we point out that gastric residuum was the most common complication followed by constipation, whereas diarrhoea, abdominal distension and broncho-aspiration are very infrequent. We concluded than when complications associated to enteral nutrition appear, the are very frequent and tend to appear more than once. Our enteral nutrition protocol guarantees a correct feeding of patients with a low failure rate.

Critical Illness↗
PubMed1998

The effect of enteral fibre-containing feeds on stool parameters in the post-surgical period.

BACKGROUND/AIM OF STUDY: Specialised nutritional support includes both enteral and parenteral routes. When oral intake is not an option, but gastro-intestinal function is present, enteral tube feeding should be considered. However, one of the complications of enteral feeding access is diarrhoea. The aim of this study was to test the effect of fibre on a local population, in a prospective, single-blinded trial to determine whether the presence of fibre in enteral feeds reduced the incidence of diarrhoea in Asian patients. METHODS: Sixteen post-surgical candidates were randomly assigned to receive a fibre-supplemented (FSF) enteral formula or a fibre-free formula (FFF) for 10 days post-surgery to assess the usefulness of FSF in reducing the incidence of diarrhoea in tube-fed patients. Differences in stool consistency, stool frequency, capillary blood glucose and serum albumin levels between the two groups were determined. Antibiotic usage in both groups was noted. RESULTS: Patients in the FSF group had more bowel movements throughout the 10-day period and firmer stools than the FFF group, but this difference was not statistically significant (p = 0.39). There were no significant differences in daily mean glucose levels between both groups. CONCLUSION: We conclude that there is insufficient evidence that fibre-containing enteral formulae reduce the incidence of diarrhoea in tube-fed patients in the short term. However, these products could inherently be included for patients on tube-feeds during extended periods, with the prospect of maintaining gut function integrity and flora.

Adult↗
PubMed1998

[Enteral nutrition in severe ulcerative colitis. Digestive tolerance and nutritional efficiency].

BACKGROUNDS AND AIMS: Total parenteral nutrition (TPN) has been traditionally used as an adjunctive therapy in severe ulcerative colitis patients. We performed a prospective study to ascertain the safety, nutritional efficiency, tolerance and costs of total enteral nutrition in this situation. METHODS: After 48 hours of intensive medical treatment, severe ulcerative colitis patients initiated enteral feeding with a polymeric formula. The formula concentration and volume were increased daily. RESULTS: 17 patients (7 women, 10 men; age 36.8 +/- 12.8 years) with a mean clinical activity score of 15.6 +/- 1.5 were included. In 14 patients (82.4%) enteral nutrition was well tolerated, attaining in 11 of them more than 80% of the caloric requirements by day 4. In 3 cases we observed vomiting and bloating. Prealbumin levels improved significantly from 11.1 +/- 3.4 mg/dl to 22.7 +/- 6.8 mg/dl (p = 0.002) at the end of enteral nutrition (11.8 +/- 4.7 days). Albumin and other nutritional parameters did not change. CONCLUSIONS: Total enteral nutrition could be considered a safe and well tolerated nutritional support in these patients. Although albumin and other nutritional parameters did not change during the study period, the increase in prealbumin levels suggests a favourable anabolic effect of total enteral nutrition.

Adolescent↗
PubMed1998

A neuronal subpopulation in the mammalian enteric nervous system expresses TrkA and TrkC neurotrophin receptor-like proteins.

Increasing evidence suggests that, in addition to peripheral sensory and sympathetic neurons, the enteric neurons are also under the control of neurotrophins. Recently, neurotrophin receptors have been detected in the developing and adult mammalian enteric nervous system (ENS). Nevertheless, it remains to be established whether neurotrophin receptors are expressed in all enteric neurons and/or in glial cells and whether expression is a common feature in the enteric nervous system of all mammals or if interspecific differences exist. Rabbit polyclonal antibodies against Trk proteins (regarded as essential constituents of the high-affinity signal-transducing neurotrophin receptors) and p75 protein (considered as a low-affinity pan-neurotrophin receptor) were used to investigate the cell localization of these proteins in the ENS of adult man, horse, cow, sheep, pig, rabbit, and rat. Moreover, the percentage of neurons displaying immunoreactivity (IR) for each neurotrophin receptor protein was determined. TrkA-like IR and TrkC-like IR were observed in a neuronal subpopulation in both the myenteric and submucous plexuses, from esophagus to rectum in humans, and in the jejunum-ileum of the other species. Many neurons, and apparently all glial cells, in the human and rat enteric nervous system also displayed p75 IR. TrkB-like IR was found restricted to the glial cells of all species studied, with the exception of humans, in whom IR was mainly in glial cells and a small percentage of enteric neurons (about 5%). These findings indicate that the ENS of adult mammals express neuronal TrkA and TrkC, glial TrkB, and neuronal-glial p75, this pattern of distribution being similar in all examined species. Thus, influence of specific neurotrophins on their cognate receptors may be considered in the physiology and/or pathology of the adult ENS.

Aged↗
PubMed2001

Interstitial cells of Cajal: primary targets of enteric motor innervation.

For many years morphologists have noted the close relationship between interstitial cells of Cajal (ICC) and nerve fibers within the tunica muscularis of gastrointestinal (GI) organs. These observations led to speculations about a role for ICC in mediating neural inputs to the GI tract. Immunohistochemical and functional studies demonstrated the presence of receptors for the neurotransmitters utilized by enteric motor neurons, and changes in second messengers in ICC after field stimulation of intrinsic enteric neurons showed that ICC were functionally innervated in GI muscles. Recent double labeling experiments have shown that both excitatory and inhibitory enteric motor neurons are closely associated with ICC in the deep muscular plexus (IC-DMP) of the small intestine and intramuscular ICC (IC-IM) of the proximal and distal GI tract. Enteric motor neurons form synaptic-like structures with IC-IM and IC-DMP. Far fewer close contacts are found between enteric motor neurons and smooth muscle cells. Experiments on W/W(V) mutants that lack IC-IM in the stomach, lower esophageal sphincter, and pylorus have shown that these ICC are critical components of the neuromuscular junction. Cholinergic excitatory and nitrergic inhibitory neurotransmission are severely decreased in tissues lacking IC-IM, yet there is no loss of cholinergic or nitrergic neurons in W/W(V) mutants. These data suggest that either the post-junctional mechanisms responsible for receiving and transducing neurotransmitter signals are specifically expressed by ICC, or that the large extracellular spaces typically between nerve terminals and smooth muscle cells may not allow effective concentrations of neurotransmitters to reach receptors expressed by smooth muscle cells. These findings indicate an important role for certain classes of ICC in enteric neurotransmission and predict that loss of ICC in human motor disturbances may significantly compromise neural regulation of GI motility.

Animals↗
PubMed1981

Development of enteric neurons from non-recognizable precursor cells.

Precursors of the neurons that populate enteric ganglia cannot be recognized morphologically when they first enter the gut; therefore embryonic gut in culture, explanted before neurons appear, develops a myenteric plexus that contains cholinergic and serotonergic neurons. The evidence indicates that the developing gut maintains an immature proliferating pool of neuronal precursors that may tentatively and transiently express a given neuronal phenotype. Catecholaminergic expression is an example of such a transient phenotype. It is possible that sequential changes, occurring as a function of gestational age in the enteric neuronal microenvironment and interacting with this persistent pool of neuronal precursors, are responsible for the generation of enteric neuronal diversity. The sequential appearance of the various types of enteric neuron is consistent with this hypothesis. The persistence of a dividing cell population may also be linked to the generation of the large number of enteric neurons.

Animals↗
PubMed1980

Phylogeny of enteric serotonergic neurons.

Serotonergic neurons have previously been identified in the enteric nervous systems of humans, subhuman primates, rodents, and rabbits. The distribution of enteric serotonergic neurons in lower vertebrates was examined in order to determine if these neurons are restricted to mammals and, if they are found more generally amongst vertebrates, when they first appear in vertebrate phylogeny. Since mammalian enteric serotonergic neurons take up 3H-serotonin by a highly specific mechanism, the radioautographic demonstration of axonal uptake of 3H-serotonin was used as the primary tool in looking for these neurons. As controls, conditions known to interfere with 3H-serotonin uptake by mammalian enteric neurons were also examined. These controls included incubation with 10 microM fluoxetine, a specific antagonist, incubation in Na+-free medium, and incubation in the presence of a 100-fold excess of nonradioactive serotonin. Radio-autographic labeling had to be absent or greatly reduced under all three control conditions for labeling by 3H-serotonin to be considered specific. Labeled enteric axons were found in cyclostomes (hagfish), teleosts (goldfish), and amphibia (bull-frog) but not in tunicates (sea squirt; sea vase) or echinoderms (sea cucumber). In addition, the serotonin concentration was measured in the intestine of two vertebrates, hagfish and goldfish, that do not have serotonin-containing enterochromaffin cells. Serotonin was found in both; in hagfish, the amine concentration was highest in preparations of muscularis externa containing the myenteric plexus. It is concluded that enteric serotonergic neurons arose early in vertebrate evolution, possibly in an ancestral chordate resembling amphioxus, although probably not in more primitive prevertebrates, and that they are a general feature of the vertebrate bowel.

Animals↗
PubMedDate not supplied

An investigation of the prevalence of the toxigenic types of Clostridium perfringens in horses with anterior enteritis: preliminary results.

Equine anterior enteritis is an acute syndrome with unknown aetiology, although salmonellosis and infection with Clostridium perfringens have both been suggested as potential causes. The main aim of this preliminary study was to compare the prevalence of toxigenic types of C. perfringens in clinically healthy horses and in horses with anterior enteritis. From horses admitted with colic at Phillip Leverhulme Large Animal Hospital in 1995-1996, samples of gastric reflux, small intestinal contents and faeces were taken for isolation of C. perfringens. Five of those horses were admitted as anterior enteritis cases, of which C. perfringens was isolated in pure culture in all five horses. Two of the anterior enteritis cases from which viable bacterial counts had been performed revealed 10(6) CFU/g faeces C. perfringens. Samples of gastric reflux and small intestinal contents submitted from one of these horses revealed 10(4) CFU/mL and 10(5) CFU/mL respectively. The number of C. perfringens observed in the gastric reflux was considered significant as the total volume removed was 12 L. The counts observed in faeces taken from horses admitted with anterior enteritis, were significantly higher than the <10(2) CFU/g faeces observed in faeces from healthy horses and horse presenting with colic and with other diagnoses. The major toxigenic types of C. perfringens in both healthy and diseased horses are being investigated using the polymerase chain reaction (PCR) to amplify target DNA sequences of the toxin genes. Primers have been designed from the published DNA sequences of the enterotoxin, alpha, beta, epsilon and iota toxin genes. PCR products obtained from NCTC strains of C. perfringens have been cloned and the sequenced, to verify that the amplicon sequence is correct. Initial typing suggests that C. perfringens type A is the predominant toxin type isolated from healthy horses and horses with colic with other diagnoses.C. perfringens strains isolated from horses with anterior enteritis are of type D.

Journal Article↗
PubMed1989

Diagnosis of innervation-related motility disorders of the gut and basic aspects of enteric nervous system development.

Motility disorders of the gut in children have become a matter of increasing concern for the pediatric surgeon. Infantile hypertrophic pyloric stenosis is the most common disease requiring surgery in early infancy. While this entity was first described as early as 1888 by Hirschsprung, its etiology and pathogenesis are still an enigma. Fortunately, its surgical treatment is simple and safe, which cannot be said of all other motility disorders of the infantile gut. Dysmotility in small bowel atresia and in gastroschisis is related to damaged smooth muscle cells caused by concomitant ischemia of the bowel wall. In contrast, the temporarily adynamic bowel of the prematurely born child, as well as Hirschsprung's disease and related disorders, is the result of anomalies of the intestinal innervation. The pathogenesis of congenital malformations of the enteric nervous system is still a mystery to surgeons and physicians alike. With his pressure studies of the colon, Swenson first recognized Hirschsprung's disease for what it was. This led to the resection of the manometrically diagnosed abnormal colon, which was found to be aganglionic. Histological investigation of the bowel wall became the decisive tool, replacing manometry, in the diagnosis of Hirschsprung's disease. Histochemical investigation of the bowel wall is not conclusive in other malformations of the enteric nervous system, since the presence or absence of enteric neurons is not the definitive factor discriminating between normally and abnormally functioning bowel. Monoclonal antibodies raised against neuron-specific markers may become important tools for differentiation within the spectrum of congenital malformations of the enteric nervous system. The immunocytochemical technique, however, does not provide sufficient information to explain the cause of innervation disorders of the gut in infancy and childhood. Primary migration disturbances or selective disappearance of enteric neurons following ischemia are highly unlikely to cause aganglionosis of the gut. With respect to the pathogenesis and etiology of Hirschsprung's disease, current research is focused on the embryonic bowel (target organ) in plexus formation. The enteric nervous system is still an enigma, although its origin is known, at least in birds. Why neural crest cells travel, along what paths, how they reach their destination, and what may go wrong during the migratory process, are questions that must be answered. There is increasing knowledge concerning the way in which neural crest cells aggregate and form plexuses in the gut. It is largely unknown why neural crest cells settle, in the bowel, at the sites of the myenteric and submucous plexus.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗