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      Upper Gastrointestinal Sensitization And Symptom Generation

      review-article
      , * ,
      Journal of Medicine and Life
      Carol Davila University Press
      Functional Gastrointestinal Disorders, FGID, Brain-Gut Interaction, Sensitization, Visceral Hypersensitivity, ASICs - Acid-sensing ion channels, CHS - Cannabinoid hyperemesis syndrome, CNS - Central nervous system, CNVS - Chronic nausea vomiting syndrome, CVS - Cyclic vomiting syndrome, EPS- Epigastric pain syndrome, FGID - Functional gastrointestinal disorders, GNB3 - G-protein-coupled receptor in the brain-gut axis, HPA - Hypothalamic-pituitary-adrenal, NMDA N-methyl-D-aspartate receptor, PDS - Postprandial distress syndrome, PTSD - Posttraumatic stress disorder, TRPV1 - The transient receptor potential vanilloid 1.

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          Abstract

          Functional gastrointestinal disorders (FGIDs) are a highly prevalent group of heterogeneous disorders, and their diagnostic criteria are symptom-based, with the absence of anatomical and biochemical abnormalities of the gastrointestinal tract. Chronic visceral symptoms are common both in patients with an identifiable organic disease but also in FGID patients. Patients suffering from upper gastrointestinal functional disorders typically present with various symptoms such as early satiety, postprandial fullness, bloating, nausea, vomiting, and epigastric pain. Considering their increasing prevalence, difficulties in diagnosis, and low quality of life, FGIDs have become an emerging problem in gastroenterology. We aimed to provide an updated summary of pathways involved in visceral sensitization. We examined the recent literature searching for evidence of the most important studies about the mechanisms underlying gastrointestinal symptom generation and sensitization.

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          Most cited references43

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          Neuronal plasticity: increasing the gain in pain.

          We describe those sensations that are unpleasant, intense, or distressing as painful. Pain is not homogeneous, however, and comprises three categories: physiological, inflammatory, and neuropathic pain. Multiple mechanisms contribute, each of which is subject to or an expression of neural plasticity-the capacity of neurons to change their function, chemical profile, or structure. Here, we develop a conceptual framework for the contribution of plasticity in primary sensory and dorsal horn neurons to the pathogenesis of pain, identifying distinct forms of plasticity, which we term activation, modulation, and modification, that by increasing gain, elicit pain hypersensitivity.
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            Sexual and physical abuse in women with functional or organic gastrointestinal disorders.

            To determine the prevalence of a history of sexual and physical abuse in women seen in a referral-based gastroenterology practice, to determine whether patients with functional gastrointestinal disorders report greater frequencies of abuse than do patients with organic gastrointestinal diseases, and to determine whether a history of abuse is associated with more symptom reporting and health care utilization. A consecutive sample of women seen in a university-based gastroenterology practice over a 2-month period was asked to complete a brief questionnaire. The self-administered questionnaire requested information about demographics, symptoms, health care utilization, and history of abuse. Physicians indicated the primary diagnosis for each patient and whether she had ever discussed having been sexually or physically abused. Of 206 patients, 89 (44%) reported a history of sexual or physical abuse in childhood or later in life; all but 1 of the physically abused patients had been sexually abused. Almost one third of the abused patients had never discussed their experiences with anyone; only 17% had informed their doctors. Patients with functional disorders were more likely than those with organic disease diagnoses to report a history of forced intercourse (odds ratio, 2.08; 95% CI, 1.03 to 4.21) and frequent physical abuse (odds ratio, 11.39; CI, 2.22 to 58.48), chronic or recurrent abdominal pain (odds ratio, 2.06; CI, 1.03 to 4.12), and more lifetime surgeries (2.7 compared with 2.0 surgeries; P less than 0.03). Abused patients were more likely than nonabused patients to report pelvic pain (odds ratio, 4.05; CI, 1.41 to 11.69), multiple somatic symptoms (7.1 compared with 5.8 symptoms; P less than 0.001), and more lifetime surgeries (2.8 compared with 2.0 surgeries; P less than 0.01). We found that a history of sexual and physical abuse is a frequent, yet hidden, experience in women seen in referral-based gastroenterology practice and is particularly common in those with functional gastrointestinal disorders. A history of abuse, regardless of diagnosis, is associated with greater risk for symptom reporting and lifetime surgeries.
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              Basic and clinical aspects of visceral hyperalgesia.

              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.
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                Author and article information

                Journal
                J Med Life
                J Med Life
                JMedLife
                Journal of Medicine and Life
                Carol Davila University Press (Romania )
                1844-122X
                1844-3117
                Oct-Dec 2019
                : 12
                : 4
                : 316-321
                Affiliations
                Second Medical Department “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
                Author notes
                Corresponding author: Stefan-Lucian Popa, Second Department, Clinicilor Street, No. 2-4, RO 400006, Cluj-Napoca, Cluj Napoca, Romania, Mobile: +40755 855 262, Email: popa.stefan@ 123456umfcluj.ro
                Article
                JMedLife-12-316
                10.25122/jml-2019-0111
                6993284
                fce709c1-159f-486f-9d5f-30eb4aabc83f
                ©Carol Davila University Press

                This article is distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use and redistribution provided that the original author and source are credited.

                History
                : 3 October 2019
                : 20 November 2019
                Categories
                Review

                Medicine
                functional gastrointestinal disorders,fgid,brain-gut interaction,sensitization,visceral hypersensitivity,asics - acid-sensing ion channels,chs - cannabinoid hyperemesis syndrome,cns - central nervous system,cnvs - chronic nausea vomiting syndrome,cvs - cyclic vomiting syndrome,eps- epigastric pain syndrome,fgid - functional gastrointestinal disorders,gnb3 - g-protein-coupled receptor in the brain-gut axis,hpa - hypothalamic-pituitary-adrenal,nmda n-methyl-d-aspartate receptor,pds - postprandial distress syndrome,ptsd - posttraumatic stress disorder,trpv1 - the transient receptor potential vanilloid 1.

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