INTRODUCTIONThe influence of the central nervous system (eNS) on gastric secretory and motor function has been recognized for one and a half centuries, ever since William Beaumont's studies of his fistulous subject. In 1833 he reported that "fear, anger, whatever depresses or disturbs the nervous system" was accom panied by suppression of gastric secretion and by a marked delay in gastric digestion and emptying (4). A landmark in the establishment of a physiolog ical role for the brain in the regulation of gastric secretion was Pavlov's work at the beginning of this century. He discovered that sham feeding, anticipation of eating, and the sight or smell of food were powerful stimulants of hoth gastric acid and pepsin secretion in the dog (78). These studies were extended to humans in 1907 (40) and since then have been amply confinued (17). Brain pathways influencing gastric secretion were subsequently investigated via electrical stimulation or lesions of specific nuclei in various experimental animals (5, 25). More recently, advances in neurophysiological techniques, the development of sensitive anterograde and retrograde transport techniques and the discovery of a large number of peptides and their receptors in brain structures influencing gastric function have provided new tools and impetus to the investigation of the anatomical and chemical substrates mediating brain gut interactions. Further ANNUAL REVIEWS 20 TACHE This review emphasizes recent advances in the elucidation of brain sites, mechanisms of action, and possible physiological roles of neuropeptides in the regulation of gastric secretion. NEUROANATOMIC BASIS OF CNS PEPTIDERGIC CONTROL OF GASTRIC ACID SECRETION Several brain sites have been identified as involved in the control of gastric acid secretion on the basis of experiments using electrical stimulation or lesion of these areas, namely the hypothalamus (lateral, ventromedial, and paraventricular nucleus), the locus coeruleus, the amygdala (centromedial), and the dorsal vagal complex (medial dorsal motor nucleus of the vagus) (5, 45, 103). Subsequently, the introduction of sensitive anterograde and retro grade transport techniques and electrophysiological approaches has allowed the delineation of the central organization of gastric afferent and efferent pathways, particularly in the medulla, and their connections with forebrain nuclei (84, 94, 103). The bulk of sensory and motor innervation of the stomach is carried within the vagus nerve (94). Gastric vagal afferent fibers terminate predominantly within the nucleus of the solitary tract and to a lesser extent in the ventral part of the area postrema and the dorsal motor nucleus (94). Gastric efferent fibers arise mostly from cells located in the medial subnucleus of the dorsal motor nucleus of the vagus and the nucleus ambiguus (45, 94). Gastric neurons in the dorsal motor nucleus of the va � us possess an extensive plexus of dendrites that penetrates the nucleus tractus solitarius. This interconnection provides an anatomical basis for monosynap...