The enteric nervous system (ENS) is central to normal gut function and is involved in most, if not all, disorders of the luminal gastrointestinal tract. The primary pathology of oesophageal and gastrointestinal disorders can lie in the ENS,in adjacent structures such as enteric smooth muscle and gut epithelium, or in extrinsic nerves (local, spinal, and cerebral) controlling gut function. Even if the primary pathology lies in another part of the gut, such as in the mucosa, or outside the gastrointestinal tract, such as in the extrinsic neural pathways, the ENS still serves as the effector neural controller, leading to a disturbance in gut function and generation of symptoms.

The ENS, therefore, serves as a useful therapeutic target for disorders in which it is the source of dysfunction and also for disorders in which it is the effector organ. For example, in treating distal ulcerative colitis, enemas containing the neurally active membrane stabiliser lignocaine have been shown to be effective, suggesting possible involvement of neural processes in the inflammatory process. In patients with irritable bowel syndrome and diarrhoea, there is substantial evidence that the primary disorder is one of cerebral regulation of gut function, mediated …