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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Physiology of pain is a manifold and very complex phenomenon that is far from being understood. It cannot be explained without reference to psychosocial conditions. Pain has the function of a warning system, but the system is far from perfect, because a number of chronic diseases (e.g., arterial hypertension or malignant neoplasms) begin slowly and nearly painless. The role of pain in internal medicine will be exemplified by thoracic and abdominal pain. With regard to diagnoses both types of pain represent ambiguous symptoms. Their anatomic and physiologic substrates often cannot be ascertained completely by anamnestic means (according to localization, quality, trigger factors, time structure, and concomitant symptoms of pain). Visceral pain is regularly characterized by the phenomenon of the so-called "transferred pain": that means that the perception of pain is not restricted to the place of its origin but is also found in distant regions of the body, primarily in well defined dermatomes ("Head's areas"). This makes the differential diagnosis of internal diseases very difficult because of the parallel connection of nociceptive afferences from the skin and deeper-seated strata on identical spinal segments. Statements according to the pharmacotherapeutic aspects of pain primarily focus on the causal therapy of the prethoracic pain. In this regard differential-therapeutic aspects of angina pectoris, pericarditis, pleurisy, gastro-esophageal reflux, and vertebragenic, myogenic, and neurogenic disturbances are well to the fore.
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PMID:[Pain--from the physiological and internal medicine viewpoint]. 852 23

The Rome IV Committee introduced a major change in the classification of functional gastrointestinal disorders, proposing a more restrictive definition of gastroesophageal reflux disease (GERD). It was suggested that hypersensitive esophagus (HE) may sit more firmly within the functional realm. It was suggested that GERD diagnosis should be based upon abnormal acid exposure time (AET) only, implying no advantage of impedance-pH over pH monitoring. Symptom association probability (SAP), symptom index (SI) and heartburn relief with proton pump inhibitor (PPI) therapy were regarded as unreliable, whereas a lack of response to PPI was considered as evidence of functional heartburn. These assumptions are contradicted by numerous studies showing the clinical relevance of weakly acidic refluxes and the diagnostic utility of SAP, SI and new impedance parameters, namely the post-reflux swallow-induced peristaltic wave (PSPW) index and the mean nocturnal baseline impedance (MNBI). The PSPW index and MNBI provide significant diagnostic advantage, particularly in patients with normal AET who can be classified as HE when both parameters are abnormal, even though SAP and SI are negative. Visceral pain modulators are recommended by the Rome IV Committee despite scanty evidence of efficacy, but a positive outcome with medical or surgical anti-reflux treatment has been reported by several studies of HE patients. Therefore, we believe that patients with endoscopy-negative heartburn should be investigated by means of impedance-pH monitoring with analysis of PSPW index and MNBI: such an approach provides accurate identification of HE cases, who remain, in our opinion, within the realm of GERD and should be treated accordingly.
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PMID:Critical appraisal of Rome IV criteria: hypersensitive esophagus does belong to gastroesophageal reflux disease spectrum. 2933 61