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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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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PMID:Basic and clinical aspects of visceral hyperalgesia. 783 12

Internal abdominal hernias are rare and often are first seen when causing ileus. Three different internal hernias were operated on laparoscopically: a patient with a hernia duodeno-jejunalis causing recurrent pain in the upper bowel, vomitus and ileus; two patients with an intersigmoidal hernia and pelvic hernia causing ileus without prodroma. Each case was operated on laparoscopically during or short after ileus. In all cases the hernia could be assured and treated by retracting the gut into the abdominal cavity and either wide opening of the hernia's entrance or closing it by suture. It is concluded that internal hernias can be diagnosed and treated laparoscopically as well as in conventional operation techniques.
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PMID:[Laparoscopic therapy for internal hernias. Presentation of three cases]. 808 86

The aim of this study was to compare serum motilin levels in children with and without recurrent abdominal pain, based on the assumption that recurrent abdominal pain in children is a gut motility disorder. In this controlled study, 19 children between 6 and 15 years of age with recurrent non-organic abdominal pain and 20 control children between 6 and 15 years of age without abdominal pain or other functional somatic complaints were evaluated. No statistical significant difference was found in serum motilin levels between children with and without abdominal pain. Median difference between the groups was 11 pmol/l (95% confidence limits of median difference -9 to +33). This investigation could not support the assumption that motilin might be a pathogenic factor in children with recurrent abdominal pain. It is suggested, however, that future research should compare serum motilin levels during and between attacks of pain.
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PMID:Motilin in children with recurrent abdominal pain: a controlled study. 808 35

Gut motility disorders and altered pain perception were reported in patients with irritable bowel syndrome (IBS). To verify foregut involvement in IBS, we studied 30 patients using esophageal manometry and 24-hr pH monitoring of the distal esophagus. Two subgroups of patients underwent esophageal provocative tests (bethanechol 50 micrograms/kg subcutaneously and esophageal balloon distension test). Twelve healthy volunteers formed a control group. A pain threshold on esophageal distension significantly lower than in healthy subjects (11.5 +/- 1 ml vs 22.2 +/- 1.7 ml, P < 0.01) was found in IBS patients. On the other hand, no differences between patients and controls were detected in lower esophageal sphincter pressure and length, esophageal body motility, or GER pattern; furthermore, bethanechol stimulation elicited similar esophageal body motility changes. Our study could confirm no detectable basal or bethanechol-induced esophageal motility disorders in IBS patients, nor enhanced GER. Esophageal involvement in IBS consists of a lower pain threshold on esophageal distension, possibly reflecting an altered visceral receptor sensitivity or modulation throughout the gut.
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PMID:Altered esophageal pain threshold in irritable bowel syndrome. 809 69

Intestinal parasitosis is a major health problem in India. More than 3000 million people have one or more parasites in their gut at any given time. There have been various studies in India to elucidate the prevalence rate of intestinal parasitosis in health and disease. In present study, data from 8000 stool samples examined over a period of 4 years from April 1984 to March 1988 at All India Institute of Medical Sciences was processed and analysed in a computer. Of the 8000 samples screened more than 25% were positive for one or more parasites. Females predominated over males and the most affected age group was 20-29 years in both sexes. Pain abdomen was the leading clinical manifestation. Of the parasite positive samples 54.19% had one parasite, 26.05% two, 14.61% three, 4.40% four and 0.74% had five or more intestinal parasites. Amongst the various pathogenic protozoan parasites, Giardia lamblia was most frequently encountered, while hookworm was the commonest amongst helminthic parasites. The non-pathogenic protozoan parasites E. nana and E. coli were the most frequent in all groups.
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PMID:Parasitic gut flora in a north Indian population with gastrointestinal symptoms. 810 44

Video recordings of free behavior and responses to mechanical facial stimulation were analyzed to assess whether chronic constriction injury (CCI) to the rat's infraorbital nerve (IoN) results in behavioral alterations indicative of neuropathic pain. A unilateral CCI was produced by placing loose chromic gut ligatures around the IoN. After CCI to the IoN, rats exhibited changes in both non-evoked and evoked behavior. Behavioral changes developed in two phases. Early after CCI (postoperative days 1-15), rats showed increased face-grooming activity with face-wash strokes directed to the injured nerve territory, while the responsiveness to stimulation of this area was decreased. Later after CCI (postoperative days 15-130), the prevalence of asymmetric face grooming was reduced but remained significantly increased compared to control rats. The early hyporesponsiveness was abruptly replaced by an extreme hyperresponsiveness: all stimulus intensities applied to the injured nerve territory evoked the "maximal" response (brisk head withdrawal, avoidance behavior plus directed face grooming). This response was never observed in control rats. Concurrently, IoN ligation rats showed a limited increase in the responsiveness to stimulation of the contralateral IoN territory, and around postoperative days 30-40 the responsiveness to stimulation of facial areas outside the IoN territories also increased. The hyperresponsiveness to stimulation of the ligated IoN territory slightly decreased from 60 d postoperative. Throughout the study, IoN ligation rats showed decreased exploratory behavior, displayed more freezing-like behavior, had a slower body weight gain, and a higher defecation rate, compared to control rats. The behavioral alterations observed after CCI to the IoN are indicative of severe sensory disturbances within the territory of the injured nerve: mechanical allodynia develops after a period of relative hypo-/anesthesia during which behavioral signs of recurrent spontaneous, aversive (possibly painful) sensations (paresthesias/dysesthesias) are maximal.
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PMID:Behavioral evidence of trigeminal neuropathic pain following chronic constriction injury to the rat's infraorbital nerve. 818 37

In clinical practice, exogenous pancreatic enzymes are administered for the treatment of pancreatogenic steatorrhea or with the intention to relieve pain due to chronic pancreatitis. Moreover, a large number of patients take pancreatin (i.e., exogenous pancreatic enzymes) for functional dyspepsia. The effect of exogenous pancreatic enzymes on the enteropancreatic axis is a complex issue. Intraduodenal but not intrajejunal protease activity appears to exert a dose-dependent negative feedback on exocrine pancreatic secretion. Only enzymes with a proteolytic activity but not amylase and lipase exert a control on pancreatic secretion. The mechanism responsible for this feedback regulation is debated, but the cholinergic system seems to play a major role. Intraduodenal pancreatic enzymes (pancreatin) lead to an increased release of pancreatic polypeptide but do not affect the release of insulin and glucagon. In addition, pancreatic enzymes have an influence on the release of some gastrointestinal hormones (i.e., cholecystokinin, motilin, gastric inhibitory polypeptide). Neither exogenous nor endogenous pancreatic enzymes seem to play a major role in the regulation of interdigestive gastrointestinal motility. However, an adequate rate of postprandial pancreatic output is required to control gastric emptying. Current knowledge on the effect of exogenous pancreatic enzymes on the enteropancreatic axis, gut peptide release and gastrointestinal motility are updated in the present article.
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PMID:Effect of exogenous pancreatic enzymes on gastrointestinal and pancreatic hormone release and gastrointestinal motility. 822 68

Cytomegalovirus (CMV) infection of the gastrointestinal (GI) tract can cause serious disease in immunocompromised patients. Recipients of solid organ and bone marrow transplants, persons with malignancies, and those receiving immunosuppressive medications are at risk. When CMV infection of the GI tract causes disease, symptoms include pain, ulceration, bleeding, diarrhea, and perforation. All levels of the GI tract, from the oropharynx to the anus, may be involved. Pathological examination of involved gut typically reveals diffuse ulcerations and necrosis with scattered CMV inclusions, although a variety of other abnormalities have been described. Before the introduction of antiviral therapy effective against CMV, mortality was high. However, the use of ganciclovir or foscarnet has improved the prognosis of CMV disease of the GI tract dramatically. CMV infection should be included in the differential diagnosis of GI disease in immunocompromised patients, and the clinician should pursue appropriate diagnostic and therapeutic interventions aggressively.
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PMID:Cytomegalovirus disease of the gastrointestinal tract in patients without AIDS. 826 45

Recently, it has been reported that loosely constrictive chromic gut ligatures around the sciatic nerve produce behavioral evidence of neuropathic pain in rats. It has been shown that axonal swelling after ligation results in a constriction injury associated with a decrease in the number of both large-diameter myelinated and small-diameter unmyelinated axons, but the mechanism(s) producing spontaneous pain and thermal hyperalgesia remain largely unknown. The present study systematically evaluated potential mechanisms involved in development of the behavioral changes produced by chromic gut ligatures loosely tied around the sciatic nerve. Four ligatures of either silk (4-0), plain gut (4-0), or chromic gut (4-0, 3-0, or 2-0) were placed loosely around the left sciatic nerve of male Sprague-Dawley rats. An additional group of rats had 8 x 0.5 cm sections of 4-0 chromic gut laid adjacent to the left sciatic nerve. The right sciatic nerve was exposed in all rats for sham surgery. The posture and gait of all rats was qualitatively assessed before (day 0) and for 20-30 days after surgery. Rats were tested for evidence of thermal and mechanical hyperalgesia prior to surgery, and on postoperative days 3, 5, 10, 20 and, in some groups, on day 30. Chromic gut, but not plain gut or silk, ligatures placed around or laid next to the sciatic nerve produced an alteration in the posture of rats such that most of the pressure was placed on the heel and medial aspect of the left (ligated) hind paw with the toes held together and plantar-flexed while pressure appeared to be evenly distributed on the right (sham) hind paw. As a result, a pronounced limp was evident, often with the left hind paw held in the air for prolonged periods of time during the first few days after surgery. These postural changes were most pronounced in the 2-0 and 3-0 chromic gut-treated rats. Chromic gut sutures (4-0, 3-0, or 2-0) tied loosely around the left sciatic nerve also produced a 'dose-dependent' decrease in thermal withdrawal latency that was maximal on postoperative day 3 (25%, 39%, and 41%, respectively). The magnitude of the thermal hyperalgesia declined over time such that a return to baseline was observed by postoperative day 20 in 4-0 and 3-0 chromic gut-treated rats.(ABSTRACT TRUNCATED AT 400 WORDS)
Pain 1993 Jul
PMID:Possible chemical contribution from chromic gut sutures produces disorders of pain sensation like those seen in man. 815 36

Adrenal medullary transplants in the spinal subarachnoid space, by providing a continual source of opioid peptides and catecholamines, offer a potentially important adjunct in the management of chronic pain. While previous studies have shown that this approach is effective against high-intensity phasic stimuli, adrenal medullary implants need to be evaluated against long-term and abnormal pain syndromes before transplantation can be used for human chronic pain. Using a recently developed model of painful peripheral neuropathy, the effects of adrenal medullary chromaffin cells transplanted into the subarachnoid space was evaluated. Peripheral mononeuropathy was induced by loosely tying 4 ligatures (4-0 chromic gut) around the right sciatic nerve. This procedure produces various pain symptoms including allodynia, hyperalgesia and dysesthesia. Rats were given either adrenal medullary tissue or control striated muscle transplants. Animals with adrenal medullary tissue transplants showed markedly decreased allodynia to innocuous cold as early as 1 week post-transplantation. In addition, hyperalgesia to a noxious thermal stimulus was eliminated by adrenal medullary, but not control, transplants. Touch-evoked allodynia was only slightly reduced by adrenal medullary transplants. In addition, indicators of spontaneous pain appeared reduced in animals with adrenal medullary transplants. These findings indicate that adrenal medullary transplants may be effective in reducing neuropathic pain.
Pain 1993 Feb
PMID:Reduced pain-related behavior by adrenal medullary transplants in rats with experimental painful peripheral neuropathy. 838 60


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