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Revista do Colégio Brasileiro de Cirurgiões

Print version ISSN 0100-6991

Rev. Col. Bras. Cir. vol.25 no.5 Rio de Janeiro Sept./Oct. 1998 



O óxido nitrico como neurotransmissor no sistema nervoso entérico: fisiopatologia e implicações no íleo adinâmico


Nitric oxide as neurotransmitter of nervous system: implications and pathophysiology of adinamic ileus



Rowilson Flora Filho, TCBC-MGI; Bruno Zilberstein, TCBC.SPII

IGraduado em Gastroenterologia - Hospital das Clínicas da Faculdade de Medicina da USP
IIProfessor Assistente do Departamento de Gastroenterologia do Hospital das Clínicas da Faculdade de Medicina da USP

Endereço para correspondência




Nesta revisão do sistema nervoso entérico, enfatiza-se o mecanismo da inibição não-adrenérgica e não-colinérgica na contratilidade do sistema digestório. Introduz-se a síntese e metabolismo do óxido nítrico com apresentação das sintases do óxido nítrico. Atualiza-se mostrando o óxido nítrico como neurotransmissor do mecanismo inibitório não-adrenérgico e não-colinérgico, demonstrando sua atividade na musculatura lisa gastrointestinal e possível mecanismo intracelular através da cGMP. Após atualização do mecanismo do peristaltismo e do complexo motor migratório, faz-se uma descrição do íleo adinâmico. Por fim, todo raciocínio apresentado condensa-se na fisiopatologia do íleo adinâmico.

Unitermos: Óxido nítroco; Íleo adinâmico; Íleo paralítico; Sintases do óxido nítrico; Complexo motor migratório; Peristaltismo; Sistema nervoso entérico; Neurotransmissores.


The non-adrenergic and non-cholinergic (NANC) inhibition has an important role in the intrinsic control of enteric nervous system (ENS). The ENS is poor in the upper digestive tract (esophagus and stomach) and totally present in the intestine. Starling and Bayliss experiments demonstrated the intrinsic activity of ENS in 1899. Since then there are searching for neurotransmitters of NANC like VIP (Vasoactive Intestinal Polypeptide) and ATP (Adenosine Triphosphate). Recent works demonstrate nitric oxide as a neurotransmitter of NANC. The nitric oxide (NO) is a gaseous molecule produced from L- arginine, with less than ten seconds half-life. The enzymes involved in the synthesis of NO are the NO synthases (NOS): neuronal NOS or isoform I, inducible NOS or isoform II, and endothelial NOS or isoform III. The isoform I and III are constitutive, and the isoform 11 is inducible. The mechanisms involved in the induction of isoform III are TNFα (Tumor Necrosis Factora), IL-Iβ (Interleukin I-β), and bacteria lypopolyssacarides stimulus. The intestinal smooth muscle motility is mediated by NANC and one example of this is the migratory motor complex (MMC). The MMC can be modified by infusion of NO-like drugs and this modification is reversed by infusion of L-NAME (L-arginine analog) in experimental trials with animals. The NO causes relaxation and inhibition of peristalsis in the small intestine. The adynamic ileum is a very common situation for surgeons. In the adynamic ileum is observed the dysfunction of MMC. The adynamic ileum induced by infusion of endotoxins is reverted by use of NOS inhibitors.

Key words: Nitric oxide; Nitric oxide synthesis; Nitric oxide synthases; Adynamic ileus; Paralitic ileus; Migratory Motor Complex; Peristaltism; Enteric nervous system; Neurotransmitters.



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Endereço para correspondência:
Dr. Rowilson Flora Filho
Rua Dr. Mário Mourão, 5437701-019 - Poços de Caldas-MG

Recebido em 14/11/97
Aceito para publicação em 16/7/98



Trabalho realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - USP.

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