TABLE 142-1.

Stimuli of Intestinal Secretion

AGENT	INTRACELLULAR MEDIATOR	RELATED DIARRHEAL ILLNESS
Enterotoxins
Cholera, E. coli heat labile toxin, Salmonella, Yersinia }	cAMP }	Travelers, endemic
E. coli heat stable toxin	cGMP
Rotatoxin (NSP4)	?	Viral gastroenteritis
Serotonin, PAF	Ca	Inflammatory, allergic
PG, leukotrienes	cAMP, Ca	Invasive enteric bacteria*
PG	cAMP	Villous adenoma
Histamine	Ca	Intestinal allergies, mastocytosis, scombroid poisoning
VIP	cAMP	VIPoma, ganglioneuromas
5-HT, substance P, bradykinin	Ca	Malignant carcinoid
Calcitonin	?	Medullary carcinoma thyroid
Acetylcholine	Ca	Insecticides, nerve gas poisoning, cholinergic drugs
Ricinoleic acid	cAMP, Ca	Laxative abuse†
Caffeine	cAMP	Coffee, sodas, tea

5-HT = 5-hydroxytryptamine; Ca = calcium; cAMP = cyclic adenosine monophosphate; cGMP = cyclic guanosine monophosphate; PAF - platelet-activating factor; PG = prostaglandin; VIP = vasoactive intestinal peptide.

^*Shigella species, Clostridium difficile, enteroinvasive E. coli, Vibrio parahaemolyticus, Clostridium perfringens.

^†Also phenolphthalein, anthraquinones, bisacodyl, dioctyl sodium sulfosuccinate, and senna.