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Gastrointestinal tract
The gastrointestinal tract (digestive tract, digestional tract, GI
Human gastrointestinal tract
tract, GIT, gut, or alimentary canal) is an organ system within
humans and other animals which takes in food, digests it to extract and
absorb energy and nutrients, and expels the remaining waste as feces.
The mouth, esophagus, stomach and intestines are part of the
gastrointestinal tract. Gastrointestinal is an adjective meaning of or
pertaining to the stomach and intestines. A tract is a collection of
related anatomic structures or a series of connected body organs.

All bilaterians have a gastrointestinal tract, also called a gut or an

alimentary canal. This is a tube that transfers food to the organs of
digestion.[1] In large bilaterians, the gastrointestinal tract also has an
exit, the anus, by which the animal disposes of feces (solid wastes).
Some small bilaterians have no anus and dispose of solid wastes by
other means (for example, through the mouth).[2] The human
Diagram of stomach, intestines and
gastrointestinal tract consists of the esophagus, stomach, and
rectum
intestines, and is divided into the upper and lower gastrointestinal
Details
tracts.[3] The GI tract includes all structures between the mouth and the
anus,[4] forming a continuous passageway that includes the main System Digestive system
organs of digestion, namely, the stomach, small intestine, and large Identifiers
intestine. However, the complete human digestive system is made up of
Latin Tractus digestorius (mouth to
the gastrointestinal tract plus the accessory organs of digestion (the
anus),
tongue, salivary glands, pancreas, liver and gallbladder).[5] The tract
canalis alimentarius
may also be divided into foregut, midgut, and hindgut, reflecting the
(esophagus to large intestine),
embryological origin of each segment. The whole human GI tract is
canalis gastrointestinales
about nine metres (30 feet) long at autopsy. It is considerably shorter in
(stomach to large intestine)
the living body because the intestines, which are tubes of smooth
MeSH D041981 (https://meshb.nlm.n
muscle tissue, maintain constant muscle tone in a halfway-tense state
ih.gov/record/ui?ui=D041981)
but can relax in spots to allow for local distention and peristalsis.[6][7]
Anatomical terminology
The gastrointestinal tract contains trillions of microbes, with some
4,000 different strains of bacteria having diverse roles in maintenance of immune health and metabolism.[8][9][10]
Cells of the GI tract release hormones to help regulate the digestive process. These digestive hormones, including
gastrin, secretin, cholecystokinin, and ghrelin, are mediated through either intracrine or autocrine mechanisms,
indicating that the cells releasing these hormones are conserved structures throughout evolution.[11]

Contents
Human gastrointestinal tract
Structure
Upper gastrointestinal tract
Lower gastrointestinal tract
Small intestine
Large intestine
Development
Histology
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Mucosa
Submucosa
Muscular layer
Adventitia and serosa
Gene and protein expression
Function
Immune function
Immune barrier
Immune system homeostasis
Intestinal microbiota
Detoxification and drug metabolism

Clinical significance
Diseases
Symptoms
Treatment
Imaging
Other related diseases
Uses of animal guts
Other animals
See also
References
External links

Human gastrointestinal tract

Structure
The structure and function can be described both as gross anatomy and as microscopic anatomy or histology. The tract
itself is divided into upper and lower tracts, and the intestines small and large parts.[12]

Upper gastrointestinal tract

The upper gastrointestinal tract consists of the mouth, pharynx, esophagus, stomach, and duodenum.[13] The exact
demarcation between the upper and lower tracts is the suspensory muscle of the duodenum. This differentiates the
embryonic borders between the foregut and midgut, and is also the division commonly used by clinicians to describe
gastrointestinal bleeding as being of either "upper" or "lower" origin. Upon dissection, the duodenum may appear to be
a unified organ, but it is divided into four segments based upon function, location, and internal anatomy. The four
segments of the duodenum are as follows (starting at the stomach, and moving toward the jejunum): bulb, descending,
horizontal, and ascending. The suspensory muscle attaches the superior border of the ascending duodenum to the
diaphragm.

The suspensory muscle is an important anatomical landmark which shows the formal division between the duodenum
and the jejunum, the first and second parts of the small intestine, respectively.[14] This is a thin muscle which is
derived from the embryonic mesoderm.

Lower gastrointestinal tract

The lower gastrointestinal tract includes most of the small intestine and all of the large intestine.[15] In human
anatomy, the intestine (bowel, or gut. Greek: éntera) is the segment of the gastrointestinal tract extending from the
pyloric sphincter of the stomach to the anus and, as in other mammals, consists of two segments, the small intestine

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and the large intestine. In humans, the small intestine

is further subdivided into the duodenum, jejunum and
ileum while the large intestine is subdivided into the,
cecum, ascending, transverse, descending and sigmoid
colon, rectum, and anal canal.[16][17]

Small intestine
The small intestine begins at the duodenum and is a
tubular structure, usually between 6 and 7 m long.[18]
Its mucosal area in an adult human is about 30 m2.[19]
Its main function is to absorb the products of digestion
(including carbohydrates, proteins, lipids, and
vitamins) into the bloodstream. There are three major
divisions:

1. Duodenum: A short structure (about 20–25 cm

long[18]) which receives chyme from the stomach,
together with pancreatic juice containing digestive
enzymes and bile from the gall bladder. The
digestive enzymes break down proteins, and bile
emulsifies fats into micelles. The duodenum
contains Brunner's glands which produce a
mucus-rich alkaline secretion containing
bicarbonate. These secretions, in combination with
bicarbonate from the pancreas, neutralize the
stomach acids contained in the chyme.
2. Jejunum: This is the midsection of the small Upper and lower human gastrointestinal tract
intestine, connecting the duodenum to the ileum. It
is about 2.5 m long, and contains the circular folds
also known as plicae circulares, and villi that
increase its surface area. Products of digestion
(sugars, amino acids, and fatty acids) are
absorbed into the bloodstream here.
3. Ileum: The final section of the small intestine. It is
about 3 m long, and contains villi similar to the
jejunum. It absorbs mainly vitamin B12 and bile
acids, as well as any other remaining nutrients.

Large intestine
The large intestine also called the colon, consists of the
cecum, rectum, and anal canal. It also includes the
appendix, which is attached to the cecum. The colon is
further divided into:

1. Cecum (first portion of the colon) and appendix Illustration of human gastrointestinal tract
2. Ascending colon (ascending in the back wall of the
abdomen)
3. Right colic flexure (flexed portion of the ascending and transverse colon apparent to the liver)
4. Transverse colon (passing below the diaphragm)
5. Left colic flexure (flexed portion of the transverse and descending colon apparent to the spleen)
6. Descending colon (descending down the left side of the abdomen)
7. Sigmoid colon (a loop of the colon closest to the rectum)
8. Rectum
9. Anus

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The main function of the large intestine is to absorb water. The area of the large intestinal mucosa of an adult human is
about 2 m2.[19]

Development
The gut is an endoderm-derived structure. At approximately the sixteenth day of human development, the embryo
begins to fold ventrally (with the embryo's ventral surface becoming concave) in two directions: the sides of the embryo
fold in on each other and the head and tail fold toward one another. The result is that a piece of the yolk sac, an
endoderm-lined structure in contact with the ventral aspect of the embryo, begins to be pinched off to become the
primitive gut. The yolk sac remains connected to the gut tube via the vitelline duct. Usually this structure regresses
during development; in cases where it does not, it is known as Meckel's diverticulum.

During fetal life, the primitive gut is gradually patterned into three segments: foregut, midgut, and hindgut. Although
these terms are often used in reference to segments of the primitive gut, they are also used regularly to describe regions
of the definitive gut as well.

Each segment of the gut is further specified and gives rise to specific gut and gut-related structures in later
development. Components derived from the gut proper, including the stomach and colon, develop as swellings or
dilatations in the cells of the primitive gut. In contrast, gut-related derivatives — that is, those structures that derive
from the primitive gut but are not part of the gut proper, in general develop as out-pouchings of the primitive gut. The
blood vessels supplying these structures remain constant throughout development.[20]

Part Part in adult Gives rise to Arterial supply

Esophagus, Stomach, Duodenum (1st and 2nd parts),
Liver, Gallbladder, Pancreas, Superior portion of
Esophagus to first 2 pancreas
Foregut celiac trunk
sections of the duodenum (Note that though the Spleen is supplied by the celiac
trunk, it is derived from dorsal mesentery and therefore
not a foregut derivative)
branches of the
lower duodenum, to the lower duodenum, jejunum, ileum, cecum, appendix,
superior
Midgut first two-thirds of the ascending colon, and first two-third of the transverse
mesenteric
transverse colon colon
artery
branches of the
last third of the transverse
last third of the transverse colon, descending colon, inferior
Hindgut colon, to the upper part of
rectum, and upper part of the anal canal mesenteric
the anal canal
artery

Histology
The gastrointestinal tract has a form of general histology with some differences that reflect the specialization in
functional anatomy.[21] The GI tract can be divided into four concentric layers in the following order:

Mucosa
Submucosa
Muscular layer
Adventitia or serosa

Mucosa
The mucosa is the innermost layer of the gastrointestinal tract. The mucosa surrounds the lumen, or open space within
the tube. This layer comes in direct contact with digested food (chyme). The mucosa is made up of:

Epithelium – innermost layer. Responsible for most digestive, absorptive and secretory processes.
Lamina propria – a layer of connective tissue. Unusually cellular compared to most connective tissue

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Muscularis mucosae – a thin layer of smooth muscle that

aids the passing of material and enhances the interaction
between the epithelial layer and the contents of the
lumen by agitation and peristalsis.
The mucosae are highly specialized in each organ of the
gastrointestinal tract to deal with the different conditions. The
most variation is seen in the epithelium.

Submucosa
The submucosa consists of a dense irregular layer of
connective tissue with large blood vessels, lymphatics, and General structure of the gut wall
nerves branching into the mucosa and muscularis externa. It 1: Mucosa: Epithelium
contains the submucosal plexus, an enteric nervous plexus, 2: Mucosa: Lamina propria
situated on the inner surface of the muscularis externa. 3: Mucosa: Muscularis mucosae
4: Lumen
5: Lymphatic tissue
Muscular layer
6: Duct of gland outside tract
The muscular layer consists of an inner circular layer and a
7: Gland in mucosa
longitudinal outer layer. The circular layer prevents food from
8: Submucosa
traveling backward and the longitudinal layer shortens the
9: Glands in submucosa
tract. The layers are not truly longitudinal or circular, rather
10: Meissner's submucosal plexus
the layers of muscle are helical with different pitches. The
inner circular is helical with a steep pitch and the outer 11: Vein

longitudinal is helical with a much shallower pitch.[22] Whilst 12: Muscularis: Circular muscle
the muscularis externa is similar throughout the entire 13: Muscularis: Longitudinal muscle
gastrointestinal tract, an exception is the stomach which has 14: Serosa: Areolar connective tissue
an additional inner oblique muscular layer to aid with 15: Serosa: Epithelium
grinding and mixing of food. The muscularis externa of the 16: Auerbach's myenteric plexus
stomach is composed of the inner oblique layer, middle 17: Nerve
circular layer and outer longitudinal layer . 18: Artery
19: Mesentery
Between the circular and longitudinal muscle layers is the
myenteric plexus. This controls peristalsis. Activity is initiated
by the pacemaker cells, (myenteric interstitial cells of Cajal). The gut has intrinsic peristaltic activity (basal electrical
rhythm) due to its self-contained enteric nervous system. The rate can be modulated by the rest of the autonomic
nervous system.[22]

The coordinated contractions of these layers is called peristalsis and propels the food through the tract. Food in the GI
tract is called a bolus (ball of food) from the mouth down to the stomach. After the stomach, the food is partially
digested and semi-liquid, and is referred to as chyme. In the large intestine the remaining semi-solid substance is
referred to as faeces.[22]

Adventitia and serosa

The outermost layer of the gastrointestinal tract consists of several layers of connective tissue.

Intraperitoneal parts of the GI tract are covered with serosa. These include most of the stomach, first part of the
duodenum, all of the small intestine, caecum and appendix, transverse colon, sigmoid colon and rectum. In these
sections of the gut there is clear boundary between the gut and the surrounding tissue. These parts of the tract have a
mesentery.

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Retroperitoneal parts are covered with adventitia. They blend into the surrounding tissue and are fixed in position. For
example, the retroperitoneal section of the duodenum usually passes through the transpyloric plane. These include the
esophagus, pylorus of the stomach, distal duodenum, ascending colon, descending colon and anal canal. In addition,
the oral cavity has adventitia.

Gene and protein expression

Approximately 20,000 protein coding genes are expressed in human cells and 75% of these genes are expressed in at
least one of the different parts of the digestive organ system.[23][24] Over 600 of these genes are more specifically
expressed in one or more parts of the GI tract and the corresponding proteins have functions related to digestion of
food and uptake of nutrients. Examples of specific proteins with such functions are pepsinogen PGC and the lipase
LIPF, expressed in chief cells, and gastric ATPase ATP4A and gastric intrinsic factor GIF, expressed in parietal cells of
the stomach mucosa. Specific proteins expressed in the stomach and duodenum involved in defence include mucin
proteins, such as mucin 6 and intelectin-1.[25]

Function
The time taken for food or other ingested objects to transit through the gastrointestinal tract varies depending on many
factors, but roughly, it takes less than an hour after a meal for 50% of stomach contents to empty into the intestines
while total emptying takes around 2 hours. Subsequently, 50% emptying of the small intestine takes between 1 and 2
hours. Finally, transit through the colon takes 12 to 50 hours with wide variation between individuals.[26][27]

Immune function

Immune barrier
The gastrointestinal tract forms an important part of the immune system.[28] The surface area of the digestive tract is
estimated to be about 32 square meters, or about half a badminton court.[29] With such a large exposure (more than
three times larger than the exposed surface of the skin), these immune components function to prevent pathogens
from entering the blood and lymph circulatory systems.[30] Fundamental components of this protection are provided
by the intestinal mucosal barrier which is composed of physical, biochemical, and immune elements elaborated by the
intestinal mucosa.[31] Microorganisms also are kept at bay by an extensive immune system comprising the gut-
associated lymphoid tissue (GALT)

There are additional factors contributing to protection from pathogen invasion. For example, low pH (ranging from 1
to 4) of the stomach is fatal for many microorganisms that enter it.[32] Similarly, mucus (containing IgA antibodies)
neutralizes many pathogenic microorganisms.[33] Other factors in the GI tract contribution to immune function
include enzymes secreted in the saliva and bile.

Immune system homeostasis

Beneficial bacteria also can contribute to the homeostasis of the gastrointestinal immune system. For example,
Clostridia, one of the most predominant bacterial groups in the GI tract, play an important role in influencing the
dynamics of the gut's immune system.[34] It has been demonstrated that the intake of a high fiber diet could be the
responsible for the induction of T-regulatory cells (Tregs). This is due to the production of short-chain fatty acids
during the fermentation of plant-derived nutrients such as butyrate and propionate. Basically, the butyrate induces the
differentiation of Treg cells by enhancing histone H3 acetylation in the promoter and conserved non-coding sequence
regions of the FOXP3 locus, thus regulating the T cells, resulting in the reduction of the inflammatory response and
allergies.

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Intestinal microbiota
The large intestine hosts several kinds of bacteria that can deal with molecules that the human body cannot otherwise
break down.[35] This is an example of symbiosis. These bacteria also account for the production of gases at host-
pathogen interface, inside our intestine(this gas is released as flatulence when eliminated through the anus). However
the large intestine is mainly concerned with the absorption of water from digested material (which is regulated by the
hypothalamus) and the re absorption of sodium, as well as any nutrients that may have escaped primary digestion in
the ileum.

Health-enhancing intestinal bacteria of the gut flora serve to prevent the overgrowth of potentially harmful bacteria in
the gut. These two types of bacteria compete for space and "food," as there are limited resources within the intestinal
tract. A ratio of 80-85% beneficial to 15–20% potentially harmful bacteria generally is considered normal within the
intestines.

Detoxification and drug metabolism

Enzymes such as CYP3A4, along with the antiporter activities, are also instrumental in the intestine's role of drug
metabolism in the detoxification of antigens and xenobiotics.[36]

Clinical significance

Diseases
There are many diseases and conditions that can affect the gastrointestinal system, including infections, inflammation
and cancer.

Various pathogens, such as bacteria that cause foodborne illnesses, can induce gastroenteritis which results from
inflammation of the stomach and small intestine. Antibiotics to treat such bacterial infections can decrease the
microbiome diversity of the gastrointestinal tract, and further enable inflammatory mediators.[37] Gastroenteritis is the
most common disease of the GI tract.

Gastrointestinal cancer may occur at any point in the gastrointestinal tract, and includes mouth cancer, tongue
cancer, oesophageal cancer, stomach cancer, and colorectal cancer.
Inflammatory conditions. Ileitis is an inflammation of the ileum, colitis is an inflammation of the large intestine.
Appendicitis is inflammation of the appendix located at the caecum. This is a potentially fatal condition if left
untreated; most cases of appendicitis require surgical intervention.
Diverticular disease is a condition that is very common in older people in industrialized countries. It usually affects the
large intestine but has been known to affect the small intestine as well. Diverticulosis occurs when pouches form on the
intestinal wall. Once the pouches become inflamed it is known as diverticulitis.

Inflammatory bowel disease is an inflammatory condition affecting the bowel walls, and includes the subtypes Crohn's
disease and ulcerative colitis. While Crohn's can affect the entire gastrointestinal tract, ulcerative colitis is limited to
the large intestine. Crohn's disease is widely regarded as an autoimmune disease. Although ulcerative colitis is often
treated as though it were an autoimmune disease, there is no consensus that it actually is such.

Functional gastrointestinal disorders the most common of which is irritable bowel syndrome. Functional constipation
and chronic functional abdominal pain are other functional disorders of the intestine that have physiological causes,
but do not have identifiable structural, chemical, or infectious pathologies.

Symptoms
Several symptoms are used to indicate problems with the gastrointestinal tract:

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Vomiting, which may include regurgitation of food or the vomiting of blood

Diarrhea, or the passage of liquid or more frequent stools
Constipation, which refers to the passage of fewer and hardened stools
Blood in stool, which includes fresh red blood, maroon-coloured blood, and tarry-coloured blood

Treatment
Gastrointestinal surgery can often be performed in the outpatient setting. In the United States in 2012, operations on
the digestive system accounted for 3 of the 25 most common ambulatory surgery procedures and constituted 9.1
percent of all outpatient ambulatory surgeries.[38]

Imaging
Various methods of imaging the gastrointestinal tract include the upper and lower gastrointestinal series:

Radioopaque dyes may be swallowed to produce a barium swallow

Parts of the tract may be visualised by camera. This is known as endoscopy if examining the upper
gastrointestinal tract, and colonoscopy or sigmoidoscopy if examining the lower gastrointestinal tract. Capsule
endoscopy is where a capsule containing a camera is swallowed in order to examine the tract. Biopsies may also
be taken when examined.
An abdominal x-ray may be used to examine the lower gastrointestinal tract.

Other related diseases

Cholera
Enteric duplication cyst
Giardiasis
Pancreatitis
Peptic ulcer disease
Yellow fever
Helicobacter pylori is a gram-negative spiral bacterium. Over half the world's population is infected with it, mainly
during childhood; it is not certain how the disease is transmitted. It colonizes the gastrointestinal system,
predominantly the stomach. The bacterium has specific survival conditions that our gastric microenvironment: it is
both capnophilic and microaerophilic. Helicobacter also exhibits a tropism for gastric epithelial lining and the
gastric mucosal layer about it. Gastric colonization of this bacterium triggers a robust immune response leading to
moderate to severe inflammation. Signs and symptoms of infection are gastritis, burning abdominal pain, weight
loss, loss of appetite, bloating, burping, nausea, bloody vomit, and black tarry stools. Infection can be detected in
a number of ways: GI X-rays, endoscopy, blood tests for anti-Helicobacter antibodies, a stool test, and a urease
breath test (which is a by-product of the bacteria). If caught soon enough, it can be treated with three doses of
different proton pump inhibitors as well as two antibiotics, taking about a week to cure. If not caught soon enough,
surgery may be required.[39][40][41][42]
Intestinal pseudo-obstruction is a syndrome caused by a malformation of the digestive system, characterized by a
severe impairment in the ability of the intestines to push and assimilate. Symptoms include daily abdominal and
stomach pain, nausea, severe distension, vomiting, heartburn, dysphagia, diarrhea, constipation, dehydration and
malnutrition. There is no cure for intestinal pseudo-obstruction. Different types of surgery and treatment managing
life-threatening complications such as ileus and volvulus, intestinal stasis which lead to bacterial overgrowth, and
resection of affected or dead parts of the gut may be needed. Many patients require parenteral nutrition.
Ileus is a blockage of the intestines.
Coeliac disease is a common form of malabsorption, affecting up to 1% of people of northern European descent.
An autoimmune response is triggered in intestinal cells by digestion of gluten proteins. Ingestion of proteins found
in wheat, barley and rye, causes villous atrophy in the small intestine. Lifelong dietary avoidance of these
foodstuffs in a gluten-free diet is the only treatment.
Enteroviruses are named by their transmission-route through the intestine (enteric meaning intestinal), but their
symptoms aren't mainly associated with the intestine.
Endometriosis can affect the intestines, with similar symptoms to IBS.
Bowel twist (or similarly, bowel strangulation) is a comparatively rare event (usually developing sometime after
major bowel surgery). It is, however, hard to diagnose correctly, and if left uncorrected can lead to bowel infarction
and death. (The singer Maurice Gibb is understood to have died from this.)
Angiodysplasia of the colon
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Constipation
Diarrhea
Hirschsprung's disease (aganglionosis)
Intussusception
Polyp (medicine) (see also colorectal polyp)
Pseudomembranous colitis
Toxic megacolon usually a complication of ulcerative colitis

Uses of animal guts

Intestines from animals other than humans are used in a number of ways. From each species of livestock that is a
source of milk, a corresponding rennet is obtained from the intestines of milk-fed calves. Pig and calf intestines are
eaten, and pig intestines are used as sausage casings. Calf intestines supply calf-intestinal alkaline phosphatase (CIP),
and are used to make goldbeater's skin. Other uses are:

The use of animal gut strings by musicians can be traced back to the third dynasty of Egypt. In the recent past,
strings were made out of lamb gut. With the advent of the modern era, musicians have tended to use strings made
of silk, or synthetic materials such as nylon or steel. Some instrumentalists, however, still use gut strings in order
to evoke the older tone quality. Although such strings were commonly referred to as "catgut" strings, cats were
never used as a source for gut strings.[43]
Sheep gut was the original source for natural gut string used in racquets, such as for tennis. Today, synthetic
strings are much more common, but the best gut strings are now made out of cow gut.
Gut cord has also been used to produce strings for the snares that provide a snare drum's characteristic buzzing
timbre. While the modern snare drum almost always uses metal wire rather than gut cord, the North African bendir
frame drum still uses gut for this purpose.
"Natural" sausage hulls, or casings, are made of animal gut, especially hog, beef, and lamb.
The wrapping of kokoretsi, gardoubakia, and torcinello is made of lamb (or goat) gut.
Haggis is traditionally boiled in, and served in, a sheep stomach.
Chitterlings, a kind of food, consist of thoroughly washed pig's gut.
Animal gut was used to make the cord lines in longcase clocks and for fusee movements in bracket clocks, but
may be replaced by metal wire.
The oldest known condoms, from 1640 AD, were made from animal intestine.[44]

Other animals
Many birds and other animals have a specialised stomach in the digestive tract called a gizzard used for grinding up
food.

Another feature not found in the human but found in a range of other animals is the crop. In birds this is found as a
pouch alongside the esophagus.

Other animals including amphibians, birds, reptiles, and egg-laying mammals have a major difference in their GI tract
in that it ends in a cloaca and not an anus.

See also
Gastrointestinal physiology
All pages with titles beginning with Gastrointestinal
All pages with titles containing Gastrointestinal

References
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External links
The gastro intestinal tract in the Human Protein Atlas (https://www.proteinatlas.org/humanproteome/gastrointestin
al+tract)
Your Digestive System and How It Works at National Institutes of Health (http://digestive.niddk.nih.gov/ddiseases/
pubs/yrdd/)

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