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Abstract
Although physiological stimuli in the healthy gastrointestinal tract are generally
not associated with conscious perception, chronic abdominal discomfort and pain are
the most common symptoms resulting in patient visits with gastroenterologists. Symptoms
may be associated with inflammatory conditions of the gut or occur in the form of
so-called functional disorders. The majority of patients with functional disorders
appear to primarily have inappropriate perception of physiological events and altered
reflex responses in different gut regions. Recent breakthroughs in the neurophysiology
of somatic and visceral sensation are providing a series of plausible mechanisms to
explain the development of chronic hyperalgesia within the human gastrointestinal
tract. A central concept to all these mechanisms is the development of hyperexcitability
of neurons in the dorsal horn, which can develop either in response to peripheral
tissue irritation or in response to descending influences originating in the brainstem.
Taking clinical characteristics and the concept of central hyperexcitability into
account, a model is proposed by which abdominal pain from chronic inflammatory conditions
of the gut and functional bowel disorders such as noncardiac chest pain, nonulcer
dyspepsia, and irritable bowel syndrome could develop by multiple mechanisms either
alone or in combination.