Self-perceived physical,psychologic, and general symptoms in survivors of testicular cancer 3 to 13 years after treatment

Due to the large group of patients with advanced testicular cancer now being cured, it is important to identify the men who are at risk of deteriorated health.The purposes of this study were: (1) to delineate and compare frequency of self-perceived physical, psychologic, and general symptoms in men treated for testicular cancer with those of a general population sample and (2) to compare self-perceived physical, psychologic, and general symptoms in relation to secondary Raynaud phenomena, sexual dysfunction, infertility, and self-perceived attractiveness in different treatment modalities. The subjects were 277 survivors of testicular cancer (M = 42.2 years) who had completed a self-reported questionnaire (75.5% response rate). A population survey comprising 392 men was used as a comparison group (M = 45 years).The result demonstrated that although survivors of testicular cancer as a group reported significantly less frequency of backache, leg pain, cough, and eye problems than did the general population sample, they described that they significantly more often felt cold. Men reporting secondary Raynaud phenomena, infertility, and/or feeling less attractive had experienced significantly more self-perceived symptoms. Oncologist nurses could play an important role in psychologic counseling for those men.     

血吸虫单抗夹心酶标法（S-ELISA）的建立及其检测循环抗原的实验研究

目的 建立血吸虫病循环抗原的检测方法.方法 用辣根过氧化物酶标记血吸虫单克隆抗体,建立夹心酶标法（S-ELISA）,并检测血吸虫病人及其它类型人群的血清.结果 S-ELISA对急性血吸虫病人的检出率为88.64%,OD值算术均数为0.372;慢性血吸虫患者和正常人的检出率分别为75.00%和6.00%,与肝吸虫和乙型肝炎血清的交叉反应为0,肺吸虫的交叉反应为10.39%.血吸虫不同感染度人群平均OD值无论是算术均数还是几何均数,均随着感染度的增加而呈现上升的趋势.结论 本方法操作简便,有较好的敏感性与特异性,适宜于对血吸虫病的检测.     

Gastric Helicobacter and upper gastrointestinal symptoms in chronic renal failure

We studied histologically antral biopsies from 89 consecutive patients with chronic renal failure for Helicobacter pylori (previously Campylobacter pylori). A dose-response gastric secretion test was also performed. The frequency of Helicobacter-positive subjects was low (15/89, 17%), corresponding to figures reported in the literature for young symptomless volunteers. Helicobacter-positive patients had significantly more frequently upper gastrointestinal symptoms than Helicobacter-negative individuals (P less than 0.05). Antral gastritis was more common in the Helicobacter-positive than in the Helicobacter-negative renal patients (P less than 0.01), but the incidence of body gastritis did not differ between them. The Helicobacter-positive patients had lower serum urea levels (P less than 0.01) and higher acid outputs (P less than 0.001) than Helicobacter-negative subjects. All patients had raised fasting serum gastrin levels, which possibly obscured the difference between Helicobacter-positive (283 pg/ml) and -negative (331 pg/ml) patients. We conclude that in chronic renal failure gastric colonization of Helicobacter pylori is not more frequent than usual. It correlates positively with antral gastritis, gastric acid output and upper gastrointestinal symptoms, but negatively with serum urea levels.     

Ambulatory combined pH, bile and manometric monitoring of the oesophagus in asymptomatic healthy volunteers

BACKGROUND: With the development of sophisticated equipment ambulatory studies of oesophageal motor function, pH and bilirubin have gained in popularity. The aim of the study was to present reference values for combined 24 h pH, bilirubin and manometric measurements of the oesophagus. METHODS: Twenty-six (15 male) healthy volunteers without symptoms of gastro-oesophageal reflux underwent a 24-h ambulatory oesophageal combined three-channel pressure, acid and bilirubin detection. RESULTS: The subjects were studied for a median of 20 h (16-22). The median per cent time with pH < 4 for the whole measured time was 3.1 (0.8-14; 5 and 95 percentiles). Bile was detected for a median of 0.05% (0.0-8.5; 5 and 95 percentiles) of the time. Eighty-one per cent of the contractions were peristaltic, 55% of which were complete. Of these, 53% had a pressure over 30 mmHg at all three pressure points, giving an efficient peristalsis in a median of 29% (13-46; 5 and 95 percentiles) of all registered contractile patterns. No difference between the genders could be observed. CONCLUSIONS: This study provides normative data for ambulatory oesophageal manometry, pH and bilirubin studies that can be used for comparing with patients with disease.     

Co‐occurrence and associations of pain and fatigue in a community sample of Dutch adults

Widespread pain and chronic fatigue are common in the general population. Previous research has demonstrated co‐occurrence of syndromes that are associated with pain and fatigue (fibromyalgia and chronic fatigue syndrome), but there is limited existing data on the co‐occurrence of these symptoms in general. This study investigates the co‐occurrence of pain and fatigue, and characterises people with these symptoms individually, and in combination. A postal questionnaire was sent to a random sample of 4741 community dwelling Dutch adults registered with five general practices. There were 2447 participants (adjusted response = 53.5%). Persistent fatigue was reported by 60% of the 451 subjects with chronic widespread pain. Chronic widespread pain was reported by 33% of the 809 responders with persistent fatigue. Anxiety and depression were more common in subjects who reported both symptoms than those who reported either one or neither. Participants who had chronic disease, high body mass index, low activity levels or did not perceive ability to influence health had higher adjusted odds of reporting both symptoms (but not one alone) than subjects not having these characteristics. Pain and fatigue occur more often than would be expected by chance and there are a number of reasons for this. Clinicians should be aware that co‐occurrence of the symptoms is common, especially in people who have high BMI or chronic disease, and that people with both symptoms are often anxious or depressed. Further work should address longitudinal associations of pain and fatigue.     

Alcohol consumption, clinical findings and retrospective psycho social data in a random sample of men in suburban Stockholm

A sample of 200 men from the general population of suburban Stockholm was investigated regarding alcohol consumption, with the aim of studying psychosocial factors in relation to consumption. Three symptoms related to heavy drinking were studied: (1) Inability to cut down or stop drinking, referred to here as subjective, relative loss of control over drinking; (2) morning shakes and malaise relieved by drinking, termed morning drinks; and (3) amnesia induced by alcohol, referred to as blackouts. The subjects were divided into three groups: (I) 41 men with low alcohol consumption without any symptom of alcoholism, (II) 106 men with low, moderate or high alcohol consumption with different numbers of such symptoms and (III) 53 heavy-drinking men with two or three symptoms. There was a higher frequency of psycho-somatic problems in group III (51%) (p less than 0.01) than in group I (22%). The children of group III had greater problems at school. Group III had more often been judged guilty of crimes (26%) (p less than 0.01) than groups II (12%) and I (5%). Group III had a significantly higher frequency of nervous problems (61%) than the other groups, and 8% of group III had been in-patients at a clinic for treatment of alcoholics.     

Gastric Helicobacter and Upper Gastrointestinal Symptoms in Chronic Renal Failure

We studied histologically antral biopsies from 89 consecutive patients with chronic renal failure for Helicobacter pylori (previously Campylobacter pylori). A dose-response gastric secretion test was also performed. The frequency of Helicobacter-positive subjects was low (15/89, 17%), corresponding to figures reported in the literature for young symptomless volunteers. Helicobacter-positive patients had significantly more frequently upper gastrointestinal symptoms than Helicobacter-negative individuals (P < 0.05). Antral gastritis was more common in the Helicobacter-positive than in the Helicobacter-negatice renal patients (P < 0.01), but the incidence of body gastritis did not differ between them. The Helicobacter-positive patients had lower serum urea levels (P < 0.01) and higher acid outputs (P < 0.001) than Helicobacter-negative subjects. All patients had raised fasting serum gastrin levels, which possibly obscured the difference between Helicobacter-positive (283 pg/ml) and-negative (331 pg/ml) patients. We conclude that in chronic renal failure gastric colonization of Helicobacter pylori is not more frequent than usual. It correlates positively with antral gastritis, gastric acid output and upper gastrointestinal symptoms, but negatively with serum urea levels.     

Barrett's oesophagus: a clinical study of 52 patients

This paper reports a series of 52 patients with Barrett's (or columnar-lined) oesophagus from one medical unit diagnosed over a six-year period. The commonest associated symptoms were heartburn, regurgitation and dysphagia but 10 patients had no oesophageal symptoms and two had no symptoms at all. Gastrointestinal bleeding (overt or occult) was observed in almost one-third of patients. At diagnosis, 26 patients had oesophagitis, 23 had oesophageal ulceration and 10 had benign oesophageal strictures. An association between oesophageal ulceration and non-steroidal anti-inflammatory drug ingestion was suggested by the data and patients with oesophageal ulceration were significantly older than patients with uncomplicated Barrett's oesophagus. No patient had adenocarcinoma of the oesophagus at diagnosis and neither carcinoma nor dysplasia were seen during a mean period of 16.4 months. However, 17 per cent of patients in the series had malignancies in other sites. Most patients did well on medical treatment and only two were referred for anti-reflux surgery (both for non-healing oesophageal ulcers). Barrett's oesophagus was seen in 10 per cent of patients with gastro-oesophageal reflux at endoscopy. Oesophageal ulceration in patients with Barrett's oesophagus made up 21 per cent of oesophageal ulcers seen and benign oesophageal stricture in patients with Barrett's oesophagus constituted 13 per cent of all benign strictures seen. Barrett's oesophagus is common in our population and despite complications, it can be managed successfully, at least in the short term, by conservative means.     

Vagal function in achalasia of the cardia

Autonomic nervous function in achalasia of the cardia was assessed by measuring the response of the lower oesophageal sphincter to abdominal compression, the gastric secretory response to insulin-induced hypoglycaemia and the pulse rate variability with deep respiration. Twenty-eight patients with symptomatic achalasia and 24 age and sex-matched control subjects were studied. Rise in intra-abdominal pressure normally causes a rise in lower oesophageal pressure through a vagally-mediated mechanism. Before treatment this response was unimpaired in eight of 10 patients with achalasia. A sub-normal response was found in eight of 10 patients who had previously had pneumatic dilatation of the cardia and in three of four who had had a cardiomyotomy. These abnormalities reflected the effect of treatment in disrupting the sphincter rather than impairment of its innervation. The gastric acid secretory response to insulin-induced hypoglycaemia, expressed as a ratio of that to pentagastrin, was normal in each of the nine patients studied. Pulse rate variability with deep respiration, a test of cardiac vagal function, was normal in 22 of 25 patients studied. It is concluded that in achalasia the vagal trunks appear functionally intact and that the myenteric plexus lesion rarely affects the responsiveness of the lower oesophageal sphincter to increase in intra-abdominal pressure.     

Recurrent headache and migraine as a public health problem--a population-based study in Sweden

OBJECTIVE: To study the prevalence of recurrent headache and/or self-considered migraine (RH/M) and its association with self-rated health, other symptoms, and use of health care and medication in the general population. METHODS: The study comprised a random population sample of 43,770 men and women aged 18 to 79 years covering an area of 58 municipalities in Sweden. The data were obtained using a postal survey questionnaire during March to May 2000. The overall response rate was 65%. RESULTS: The overall prevalence of self-reported RH/M was 10% among men and 23% among women. RH was more common (15%) than migraine (4%). The prevalence of RH was highest in the younger age groups (18 to 34 years) and decreased with increasing age. The prevalence of migraine was highest (6%) among 35 to 49 years old. Subjects with RH/M had poorer self-rated health compared to subjects with no reported headache independent of age. Poor self-rated health was most common among subjects with both RH and M. Musculoskeletal pain and psychosomatic symptoms were more common among those with RH/M. The association between RH/M and poor self-rated health was partly explained by these symptoms. Those with RH/M utilized more health care at all levels than those with no RH/M. In addition, subjects with RH/M reported two to three times more often that they had been in need of medical care but not sought it. About two-thirds of the subjects with RH/M had used analgesic during the last 2 weeks compared with less than one-third among subjects with no RH/M. CONCLUSION: RH/M constitutes a substantial public health problem that mainly affects young and middle aged adults. It is associated with poor self-rated health, musculoskeletal and psychosomatic symptoms, increased use of health care and medication as well as unmet needs of health care.     

Suggestibility and Headache Reports in Schoolchildren: A Problem in Epidemiology

SYNOPSIS
In a sample from the general population of school children of 15 years of age, we studied whether receiving information about the prevalence of headaches had any effect on their subsequent headache report. Sixty children in the fourth year at four secondary schools were allocated at random to two conditions: a biased condition emphasizing the high prevalence of headaches and a neutral condition. Subjects in the biased condition reported more headaches but they did not report more other physical symptoms than the subjects in the neutral condition. The results are discussed in terms of Pennebaker's theory on reporting symptoms. It is concluded that epidemiological research using the general population should deal more explicitly with the way in which subjects are motivated to participate.     

Recreational drug overdose-related cardiac arrests: Break on through to the other side

IntroductionThe annual rate of recreational overdose (OD)-related death is increasing exponentially, making unintentional overdose the leading cause of injury-related death in America. Unfortunately, little attention in the resuscitation community has focused on the post-arrest care of this rapidly growing population.MethodsWe included patients presenting between January 2009 and February 2014 after out-of-hospital cardiac arrest (OHCA) and abstracted baseline clinical characteristics and neurological outcomes. We considered an arrest to be an OD OHCA if toxicology screens were positive and not explained by therapeutic medication administration or home medications; or if there was a history strongly suggestive of OD. We compared the baseline clinical characteristics and outcomes between the OD and non-OD cohorts.ResultsIn total, 591 OHCA patients were admitted, of which 85 (14%) arrests were OD-related. OD OHCA patients were significantly younger, had fewer medical comorbidities, were more likely to present with non-shockable rhythms and had worse baseline neurological function. However, overall survival, neurological outcomes and length of stay did not vary between groups. OD OHCA patients who survived to discharge had a significantly higher rate of favorable discharge dispositions (83% of OD OHCA survivors discharged to home or acute rehabilitation vs 62% of non-OD OHCA (P = 0.03)).ConclusionPatients who have suffered an OD OHCA make up a significant proportion of the overall OHCA population. Despite poor baseline prognostic factors, survival after OD OHCA was no worse than after non-OD OHCA, and among survivors a majority had a good neurological outcome.     

Efficacy and Tolerability of Famotidine in Preventing Heartburn and Related Symptoms of Upper Gastrointestinal Discomfort

This randomized, double-blind, placebo-controlled, four-way crossover trial was designed to compare the efficacy of famotidine and placebo in preventing meal-provoked upper gastrointestinal symptoms. One hundred twenty-one subjects (58 men and 63 women), aged 20--61 years, were randomly assigned to one of four treatment sequences which included single oral doses of placebo, famotidine 5 mg, famotidine 10 mg, and famotidine 20 mg, spaced approximately 7 days apart. To be eligible for randomization, subjects had to have at least a 2-month history of heartburn and acid/sour stomach occurring at least three times per week. Treatment was administered 1 h prior to ingestion of test meals (chili and wine). Rescue antacid medication (Maalox((R))) was available for subjects who required additional relief. Heartburn severity. acid/sour stomach, and overall discomfort were evaluated on a six-point scale immediately prior to each test meal and every 15 min thereafter for 5 h. A global evaluation of the test medication, using a five-point scale, was performed prior to rescue medication use or at the end of each treatment session. Heartburn and peak acid/sour stomach were rated as significantly milder following prophylactic treatment with famotidine 5, 10, and 20 mg compared to placebo. Treatment with all three doses of famotidine was rated as "good" or "excellent" by significantly more subjects (58--63%) than following treatment with placebo (38%). In addition, rescue medication was used by significantly fewer subjects following famotidine (17--18%) compared to placebo (37%). Famotidine was generally well tolerated in this trial, with type and frequency of reported adverse experiences similar to that observed following placebo. These results indicated that famotidine doses of 5, 10, and 20 mg were significantly more effective than placebo in preventing symptoms of upper gastrointestinal distress when administered 1 h in advance of meal provocation.     

Vagal Function in Achalasia of the Cardia

Autonomic nervous function in achalasia of the cardia was assessedby measuring the response of the lower oesophageal sphincterto abdominal compression, the gastric secretory response toinsulin-induced hypoglycaemia and the pulse rate variabilitywith deep respiration. Twenty-eight patients with symptomaticachalasia and 24 age and sex-matched control subjects were studied. Rise in intra-abdominal pressure normally causes a reise inlower oesophageal pressure through a vagally-mediated mechanism.Before treatment this response was unimpaired in eight of 10patients with achalasia. A sub-normal response was found ineight of 10 patients who had previously had pneumatic dilatationof the cardia and in three of four who had had a cardiomyotomy.These abnormalities reflected the effect of treatment in disruptingthe sphincter rather than impairment of its innervation. Thegastric acid secretory response to insulin-induced hypoglycaemia,expressed as a ratio of that to pentagastrin, was normal, ineach of the nine patients studied. Pulse rate variability withdeep respiration, a test of cardiac vegal function, was normalin 22 of 25 patients studied. It is concluded that in achalasia the vagal trunks appear functionallyintact and that the myenteric plexus lesion rarely affects theresponsiveness of the lower oseophageal sphincter to increasein intra-abdominal pressure.     

Health-related quality of life in persons with traumatic spinal cord lesion in Helsinki.

OBJECTIVE: To estimate the health-related quality of life (HRQoL) of persons with spinal cord lesion. DESIGN: The study design was cross-sectional. SUBJECTS: All adult citizens in Helsinki with traumatic spinal cord lesion were identified. The final study group comprised 117 subjects, corresponding to a participation rate of 77%. METHODS: HRQoL was assessed by a generic 15-dimensional self-administered instrument (15D). Clinical examination was based on the manual of the American Spinal Injury Association. Examinations were performed on all subjects by the same experienced physician and physiotherapist. RESULTS: The average 15D score of the study group was significantly lower (p<0.001) than that measured in the age-matched general population sample. Subjects with spinal cord lesion had significantly more problems due to the neurological lesion but also on the dimensions of sleeping, discomfort and symptoms and vitality. In regression analysis of the study group the only variable explaining HRQoL was the neurological level of the lesion. Spinal cord lesion caused more depression and distress in persons with motor incomplete lesion than those with motor complete lesion. CONCLUSION: Persons with spinal cord lesion had lower HRQoL than the population in general. The results indicate that spinal cord lesion may cause problems in the areas of sleeping, discomfort and symptoms or vitality, in particular. More attention should be paid to finding ways of improving the situation of persons with motor incomplete lesion, especially in terms of psychological function.     

The influence of sociodemographic characteristics on well-being and symptoms in a Swedish community. Results from a postal questionnaire survey

STUDY OBJECTIVE: To assess the influence of sociodemographic characteristics on self-reported well-being and symptoms. DESIGN: A postal questionnaire was sent to a representative population sample drawn from the population census. SETTING: The municipality of H?bo, Sweden. PARTICIPANTS: Out of 1312 subjects in the population sample, 827 (63%) participated in the study, i.e. answered the questionnaire. RESULTS: Sociodemographic characteristics significantly influenced most well-being variables and symptoms. The prevalence of symptoms in the categories depression and tension, as well as headache, decreased while most other symptoms increased with age. Women had more symptoms than men. Married subjects, compared to others, had higher social and mental but lower physical well-being. Subjects from households with up to three persons, and subjects with comprehensive school only, had lower physical well-being than other subjects. Working subjects generally had a higher well-being than non-working subjects. CONCLUSION: Sociodemographic characteristics had a significant influence on most well-being variables and symptoms.     

The effect of economic deprivation on oesophageal and gastric cancer in a UK cancer network

Aims: The National Health Service (NHS) Cancer Plan aims to eliminate economic inequalities in healthcare provision and cancer outcomes. This study examined the influence of economic status upon the incidence, access to treatment and survival from oesophageal and gastric cancer in a single UK cancer network. Methodology: A total of 3619 patients diagnosed with either oesophageal or gastric cancer in a London Cancer Network (population = 1.48 million) were identified from the Thames Cancer Registry (1993–2002). Patients were ranked into economic quintiles using the income domain of the Multiple Index of Deprivation. Statistical analysis was performed using a χ² test. Survival analysis was performed using a Cox’s proportional hazards model. Results: Between 1993–1995 and 2000–2002, the incidence of oesophageal cancer in the most affluent males rose by 51% compared with a 2% rise in the least affluent males. The incidence of gastric cancer in most affluent males between 1993–1995 and 2000–2002 fell by 32% compared with a 7% fall in the least affluent males. These changes were less marked in females. Economic deprivation had no effect on the proportion of patients undergoing either resectional surgery or chemotherapy; the least affluent oesophageal cancer patients with a higher incidence of squamous cell carcinoma received significantly more radiotherapy. Economic deprivation had no effect upon survival for either oesophageal or gastric cancer. Conclusions: There has been an increase in oesophageal cancer and a decrease in gastric cancer incidence among more affluent males in the last 10 years. Economic status did not appear to influence access to treatment or survival.     

The diagnostic value of oesophageal radionuclide transit in patients admitted for but without acute myocardial infarction

The use of radionuclide transit (RT) as a screening test for chest pain of oesophageal origin has been debated. The aim of this study was to determine the value of RT as a screening test for oesophageal disorders in comparison with oesophageal manometry in patients admitted with acute chest pain but without acute myocardial infarction (non-AMI patients), and to assess the frequency of oesophageal disease present in these patients. A total of 222 non-AMI patients entered the study. An extensive examination programme comprised noninvasive cardiac studies, pulmonary studies, a careful physical examination of the musculoskeletal system, and oesophago-gastric examinations including endoscopy, pH monitoring of the oesophagus and a Bernstein test. In 91% of the patients one or more diagnoses were obtained. Based on clinical and laboratory data a `consensus' diagnosis was made. With manometry as the reference RT had a poor sensitivity (35%) but an acceptable specificity (82%). With the consensus diagnosis as the gold standard the sensitivities of both manometry and RT were poor (29%), whereas the specificity of RT, but not of manometry, was very high (97%). Gastrointestinal diagnoses were found in 57% of the patients. In conclusion, none of the applied oesophageal examinations are valuable as single screening tests. Both RT and manometry have low sensitivities. RT may be used as a cheap, noninvasive and rapid supplementary examination. When positive, it strongly supports further invasive studies of the oesophagus in non-AMI patients with unexplained chest pain.     

Schellong test in orthostatic dysregulation: a comparison with tilt-table testing

OBJECTIVE: To evaluate the role of the Schellong test (ST) in forms of orthostatic dysregulation in comparison with the tilt-table test (TT). METHODS: 67 young males (mean age 22 +/- 4 years) from the military service, representing two different cohorts, were examined by ST and TT, which served as gold standard. 32 of the 67 subjects were asymptomatic while 35 had sought medical advice because of orthostatic complaints. The subjects subsequently were classified into four categories according to the TT: normal TT, orthostatic hypotension (OH), postural orthostatic tachycardia syndrome (POTS), and neurocardiogenic syncope (NCS). Chi-square test was used to calculate the sensitivity and specificity of ST in detecting forms of orthostatic dysregulation (OH, POTS and NCS). RESULTS: In total, TT detected 23 recruits with POTS, 16 with NCS and 2 with OH. Out of the 32 asymptomatic subjects only one was diagnosed having POTS by TT and ST, the rest had a normal ST and TT. For detecting POTS, ST sensitivity was 61% and specificity was 100% compared with TT. For detecting NCS, ST sensitivity was 31% and specificity 100% compared with the reference test, the TT. The data concerning OH could not be analyzed because of the small number of cases. CONCLUSIONS: In conclusion the results of our study indicate that ST can be used in first line in the diagnosis of patients with orthostatic symptoms by the medical practitioner. If the ST is normal, further examination by TT is indispensable, because sensitivity of ST concerning POTS and NCS is relatively low.     

Multi-modal induction and assessment of allodynia and hyperalgesia in the human oesophagus

BACKGROUND AND AIMS: Experimental pain models based on single stimuli have to some degree limited visceral pain studies in humans. Hence, the aim of this study was to investigate the effect of multi-modal visceral pain stimuli of the oesophagus in healthy subjects before and after induction of visceral hyperalgesia. We used a multi-modal psychophysical assessment regime and a neurophysiological method (nociceptive reflex) for the characterisation of the experimentally induced hyperalgesia. METHODS: A probe for multi-modal (cold, warm, electrical, and mechanical) visceral stimulation was positioned in the lower part of the oesophagus in eleven healthy subjects. Mechanical stimuli were applied as distensions with a bag, which also had electrodes mounted for electrical stimulation. Thermal stimulation with temperatures from 0 to 60 degrees C was applied with re-circulating water in the bag. To assess the interaction between visceral and somatic pathways, the nociceptive withdrawal reflex to electrical stimuli at the ankle was measured with and without simultaneous mechanical oesophageal distension to painful levels. Finally, the oesophageal sensitisation was induced by perfusion with hydrochloric acid. Multimodal responses (pain threshold, stimulus response function, size of nociceptive reflex, and referred pain areas) were assessed before and after the induced hyperalgesia. RESULTS: The multi-modal psychophysical responses and reflex sizes were assessed twice before sensitisation, and the parameters were reproducible. Sensitisation of the oesophagus resulted in hyperalgesia to electrical and mechanical stimuli (29 and 35% decrease in pain threshold) and allodynia to cold and warmth stimuli (11% increase in sensory rating). After sensitisation, the referred pain area to mechanical stimuli increased more than 300% with a change in the localisation of the referred pain to all stimuli, and the amplitude of nociceptive reflex increased 100%, all indicating the presence of central hyperexcitability. CONCLUSIONS: Visceral hyperalgesia/allodynia can be induced experimentally and assessed quantitatively by the newly introduced multi-modal psychophysical assessment approach. The significant changes of the experimentally evoked referred pain patterns and of the nociceptive reflex evoked from a distant somatic structure indicate that even short-lasting visceral hyperalgesia can generate generalised sensitisation.