Gastrointestinal pain

Abstract

Gastrointestinal (GI) pain — a form of visceral pain — is common in some disorders, such as irritable bowel syndrome, Crohn’s disease and pancreatitis. However, identifying the cause of GI pain frequently represents a diagnostic challenge as the clinical presentation is often blurred by concomitant autonomic and somatic symptoms. In addition, GI pain can be nociceptive, neuropathic and associated with cancer, but in many cases multiple aetiologies coexist in an individual patient. Mechanisms of GI pain are complex and include both peripheral and central sensitization and the involvement of the autonomic nervous system, which has a role in generating the symptoms that frequently accompany pain. Treatment of GI pain depends on the precise type of pain and the primary disorder in the patient but can include, for example, pharmacological therapy, cognitive behavioural therapies, invasive surgical procedures, endoscopic procedures and lifestyle alterations. Owing to the major differences between organ involvement, disease mechanisms and individual factors, treatment always needs to be personalized and some data suggest that phenotyping and subsequent individual management of GI pain might be options in the future.

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Fig. 1: Pathways and mechanisms that contribute to GI pain.
Fig. 2: Peripheral nerve activation.
Fig. 3: Causes of pain in GI disorders.
Fig. 4: Pharmacological management of GI pain.

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Introduction (A.M.D. and E.S.); Epidemiology (S.S.O. and A.D.F.); Mechanisms/pathophysiology (A.M.D. and V.R.); Diagnosis, screening and prevention (A.M.D., S.S.O. and A.D.F.); Management (A.E.O., E.S., V.R., S.S.O. and A.M.D.); Quality of life (E.S. and S.S.O.); Outlook (S.S.O., A.M.D. and A.E.O.); Overview of Primer (A.M.D.).

Correspondence to Asbjørn M. Drewes.

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Drewes, A.M., Olesen, A.E., Farmer, A.D. et al. Gastrointestinal pain. Nat Rev Dis Primers 6, 1 (2020) doi:10.1038/s41572-019-0135-7

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