Chronic episodic pain is the commonest presenting complaint in functional gastrointestinal disorders (FGD) such as functional dyspepsia, irritable bowel syndrome (IBS), and noncardiac chest pain (NCCP). These conditions are characterized by recurrent, unexplained symptoms for which extensive investigations often fail to identify a cause. FGD are among the most common medical conditions seen in primary care as well as gastroenterology clinics. Symptoms often lead to recurrent attendances in hospital, poor patient satisfaction, and significant morbidity. Health care costs are estimated to be around $34 billion in the seven largest western economies (1,2). Despite intense research, our understanding of the mechanisms of pain in these patients remains far from complete.
Understanding the mechanisms leading to the development and maintenance of visceral pain requires an appreciation of the neuroanatomical structures and neurophysiological processes involved, and these have been previously described. It is important to appreciate that the complex physiological processes involved in pain transmission from the gut to the brain are highly dynamic and subject to change depending on the stresses imposed by the internal or external environment. As a result, pain transmission is modifiable, and as will be discussed, this may be relevant to the symptoms of chronic pain in FGD patients.
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Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.