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Basic and clinical aspects of gastrointestinal pain
Authors:Charles H. Knowles  Qasim Aziz
Affiliation:1. Neurogastroenterology Group, Centres for Academic Surgery, Barts and the London NHS Trust and the Homerton, University NHS Foundation Trust, 3rd Floor Alexandra Wing, Royal London Hospital, London E1 1BB, UK;2. Gastroenterology, Wingate Institute of Neurogastroenterology, Barts and the London, Queen Mary’s School of Medicine and Dentistry, Whitechapel, London, UK
Abstract:The gastrointestinal (GI) tract is a system of organs within multicellular animals which facilitates the ingestion, digestion, and absorption of food with subsequent defecation of waste. A complex arrangement of nerves and ancillary cells contributes to the sensorimotor apparatus required to subserve such essential functions that are with the exception of the extreme upper and lower ends of the GI tract normally subconscious. However, it also has the potential to provide conscious awareness of injury. Although this function can be protective, when dysregulated, particularly on a chronic basis, the same system can lead to considerable morbidity. The anatomical and molecular basis of gastrointestinal nociception, conditions associated with chronic unexplained visceral pain, and developments in treatment are presented in this review.
Keywords:ACC, anterior cingulated cortex   ASIC, acid-sensing ion channel   ATP, adenosine triphosphate   ANS, autonomic nervous system   CGRP, calcitonin gene-related peptide   CCK, cholecystokinin   CRH, corticotrophin-releasing hormone   CS, central sensitisation   ENS, enteric nervous system   5HT, 5-hydroxy-trypamine   FGID, functional gastrointestinal disorders   GI, gastrointestinal   GINMD, gastrointestinal neuromuscular disease   GCPR, G-protein-coupled receptor   HAP, hypothalamo&ndash  pituitary axis   IB4, isolectin-B4   IGLE, intraganglionic laminar ending   NGF, nerve growth factor   LC, locus cereleus   NDMA, N-methyl-d-aspartate   NK, neurokinin   PAG, peri-aquaductal grey   PG, prostaglandin   PAR, protease-activated receptor   SP, substance-P   SNS, sacral nerve stimulation   SST, somatostain   TTX, tetrodotoxin   TRP, transient receptor potential   VH, visceral hypersensitivity   VGSC, voltage-gated sodium channel
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