Gastrointestinal pain
Gastrointestinal pain
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DOI：
10.1038/s41572-019-0135-7
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发表时间：
2020-01-06
影响因子：
81.5
通讯作者：
Olesen, Soren S.
中科院分区：
文献类型：
--
作者：
Drewes, Asbjorn M.;Olesen, Anne E.;Olesen, Soren S.
胃肠道 (GI) 疼痛是内脏疼痛的一种形式，在某些疾病中很常见，例如肠易激综合征、克罗恩病和胰腺炎。然而，确定胃肠道疼痛的原因通常是一个诊断挑战，因为伴随的自主神经和躯体症状常常使临床表现变得模糊。此外，胃肠道疼痛可能是伤害性的、神经性的并与癌症相关，但在许多情况下，单个患者的多种病因并存。胃肠道疼痛的机制很复杂，包括外周和中枢敏化以及自主神经系统的参与，自主神经系统在产生经常伴随疼痛的症状方面发挥着作用。胃肠道疼痛的治疗取决于疼痛的确切类型和患者的原发疾病，但可以包括例如药物治疗、认知行为治疗、侵入性外科手术、内窥镜手术和生活方式改变。由于器官受累、疾病机制和个体因素之间存在重大差异，治疗总是需要个性化，一些数据表明胃肠道疼痛的表型分析和随后的个体化治疗可能是未来的选择。胃肠道疼痛在某些疾病中很常见，例如克罗恩病和胰腺炎。本入门文章讨论了确定病因的挑战，特别是对于多种病因共存的患者，以及治疗方案。
Gastrointestinal (GI) pain - a form of visceral pain - is common in some disorders, such as irritable bowel syndrome, Crohn's disease and pancreatitis. However, identifying the cause of GI pain frequently represents a diagnostic challenge as the clinical presentation is often blurred by concomitant autonomic and somatic symptoms. In addition, GI pain can be nociceptive, neuropathic and associated with cancer, but in many cases multiple aetiologies coexist in an individual patient. Mechanisms of GI pain are complex and include both peripheral and central sensitization and the involvement of the autonomic nervous system, which has a role in generating the symptoms that frequently accompany pain. Treatment of GI pain depends on the precise type of pain and the primary disorder in the patient but can include, for example, pharmacological therapy, cognitive behavioural therapies, invasive surgical procedures, endoscopic procedures and lifestyle alterations. Owing to the major differences between organ involvement, disease mechanisms and individual factors, treatment always needs to be personalized and some data suggest that phenotyping and subsequent individual management of GI pain might be options in the future.Gastrointestinal pain is common in some disorders, such as Crohn's disease and pancreatitis. This Primer discusses the challenges in identifying the causes, particularly in patients in which multiple aetiologies coexist, as well as the treatment options.