Skip Navigation


British Medical Bulletin Advance Access originally published online on July 19, 2009
British Medical Bulletin 2009 91(1):123-136; doi:10.1093/bmb/ldp026
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
91/1/123    most recent
ldp026v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in BMB
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Farmer, A. D.
Right arrow Articles by Aziz, Q.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Farmer, A. D.
Right arrow Articles by Aziz, Q.
Related Collections
Right arrow Gastroenterology and Hepatology
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2009. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Visceral pain hypersensitivity in functional gastrointestinal disorders

A. D. Farmer and Q. Aziz*

Neurogastroenterology Group, The Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Whitechapel, London E1 2AJ, UK

* Correspondence to: Prof. Q. Aziz, Neurogastroenterology Group, The Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 26 Ashfield Street, Whitechapel, London E1 2AJ, UK. E-mail: q.aziz{at}qmul.ac.uk

Introduction: Functional gastrointestinal disorders (FGIDs) are a highly prevalent group of heterogeneous disorders whose diagnostic criteria are symptom based in the absence of a demonstrable structural or biochemical abnormality. Chronic abdominal pain or discomfort is a defining characteristic of these disorders and a proportion of patients may display heightened pain sensitivity to experimental visceral stimulation, termed visceral pain hypersensitivity (VPH).

Sources of data: We examined the most recent literature in order to concisely review the evidence for some of the most important recent advances in the putative mechanisms concerned in the pathophysiology of VPH.

Areas of agreement: VPH may occur due to anomalies at any level of the visceral nociceptive neuraxis. Important peripheral and central mechanisms of sensitization that have been postulated include a wide range of ion channels, neurotransmitter receptors and trophic factors. Data from functional brain imaging studies have also provided evidence for aberrant central pain processing in cortical and subcortical regions. In addition, descending modulation of visceral nociceptive pathways by the autonomic nervous system, hypothalamo–pituitary–adrenal axis and psychological factors have all been implicated in the generation of VPH.

Areas of controversy: Particular areas of controversy have included the development of efficacious treatment of VPH. Therapies have been slow to emerge, mainly due to concerns regarding safety.

Growing points: The burgeoning field of genome wide association studies may provide further evidence for the pleiotropic genetic basis of VPH development.

Areas timely for developing research: Tangible progress will only be made in the treatment of VPH when we begin to individually characterize patients with FGIDs based on their clinical phenotype, genetics and visceral nociceptive physiology.

Keywords: visceral pain hypersensitivity • functional gastrointestinal disorders • irritable bowel syndrome • peripheral sensitization • central sensitization • functional brain imaging

Accepted for publication June 26, 2009.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?

Related articles in BMB:

Editor's Choice
Norman Vetter
BMB 2009 91: 1-6. [Extract] [Full Text]  





Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.