Clinical Approach to Abdominal Pain as Functional Origin

Han Seung Ryu; Suck Chei Choi

doi:10.4166/kjg.2018.71.2.89

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Ryu and Choi: Clinical Approach to Abdominal Pain as Functional Origin

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The Korean Journal of Gastroenterology 2018; 71(2): 89-93.

Published online: 23 February 2018

DOI: https://doi.org/10.4166/kjg.2018.71.2.89

Clinical Approach to Abdominal Pain as Functional Origin

Han Seung Ryu, Suck Chei Choi

Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea.

Correspondence to: Suck Chei Choi, Division of Gastroenterology, Department of Internal Medicine, Wonkwang University Hospital, 895 Muwang-ro, Iksan 54538, Korea. Tel: +82-63-859-2563, Fax: +82-63-855-2025, medcsc@wonkwang.ac.kr

Received 13 February 2018 Revised 14 February 2018 Accepted 18 February 2018

Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Abdominal pain and treatment should be administered in accordance with the causes. A meticulous history taking and physical examination are highly useful in making a diagnosis, and blood tests, imaging modalities, and endoscopy are useful for confirming diagnosis. However, in many cases, patients have functional disorders with no obvious abnormal findings obtained even if many diagnostic tests are performed. Patients with functional disorders usually complain the vague abdominal pain located in the center and other portions of the abdominal area. Although the most representative disease is irritable bowel syndrome, functional abdominal pain syndrome is currently researched as a new disease entity of functional abdominal pain. As various receptors related to functional abdominal pain have been discovered, drugs associated with those receptors are used to treat the disorders, and additional new drugs are vigorously developed. In addition, medical therapy with pharmacological or non-pharmacological psychiatric treatment is effective for treating functional abdominal pain.

Keywords: Abdominal pain, Functional gastrointestinal disorders, Rome criteria

Figures and Tables

Table 1

Rome Diagnostic Criteria for Functional Abdominal Pain Syndrome (FAPS) and Centrally Mediated Abdominal Pain Syndrome (CAPS)

^aCriteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis; ^bCriteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis; ^cCAPS is typically associated with psychiatric comorbidity, but there is no specific profile that can be used for diagnosis; ^dSome degree of gastrointestinal dysfunction may be present; ^eDaily function could include impairments in work, intimacy, social/leisure, family life, and caregiving for self or others.

Notes

^{Financial support} None.

^{Conflict of interest} None.

References

1. Woodwell DA, Cherry DK. National ambulatory medical care survey: 2002 summary. Adv Data. 2004; (346):1–44.

2. Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin North Am. 2003; 21:61–72. vi

3. Gebhart GF. Visceral pain-peripheral sensitisation. Gut. 2000; 47:Suppl 4. iv54–iv54.

4. Buéno L, Fioramonti J, Garcia-Villar R. Pathobiology of visceral pain: molecular mechanisms and therapeutic implications. III. Visceral afferent pathways: a source of new therapeutic targets for abdominal pain. Am J Physiol Gastrointest Liver Physiol. 2000; 278:G670–GG67.

5. Akbar A, Walters JR, Ghosh S. Review article: visceral hypersensitivity in irritable bowel syndrome: molecular mechanisms and therapeutic agents. Aliment Pharmacol Ther. 2009; 30:423–435.

6. Anand P, Aziz Q, Willert R, van Oudenhove L. Peripheral and central mechanisms of visceral sensitization in man. Neurogastroenterol Motil. 2007; 19:1 Suppl. 29–46.

7. Knowles CH, Aziz Q. Visceral hypersensitivity in non-erosive reflux disease. Gut. 2008; 57:674–683.

8. Sikandar S, Dickenson AH. Visceral pain: the ins and outs, the ups and downs. Curr Opin Support Palliat Care. 2012; 6:17–26.

9. Davis MP. Drug management of visceral pain: concepts from basic research. Pain Res Treat. 2012; 2012:265605.

10. Ryu HS, Choi SC. Diagnostic approach to abdominal pain. Korean J Med. 2012; 83:553–561.

11. Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008; 77:971–978.

12. Kannampalli P, Sengupta JN. Role of principal ionotropic and metabotropic receptors in visceral pain. J Neurogastroenterol Motil. 2015; 21:147–158.

13. Chu LF, Angst MS, Clark D. Opioid-induced hyperalgesia in humans: molecular mechanisms and clinical considerations. Clin J Pain. 2008; 24:479–496.

14. Staahl C, Christrup LL, Andersen SD, Arendt-Nielsen L, Drewes AM. A comparative study of oxycodone and morphine in a multi-modal, tissue-differentiated experimental pain model. Pain. 2006; 123:28–36.

15. Stasi C, Bellini M, Bassotti G, Blandizzi C, Milani S. Serotonin receptors and their role in the pathophysiology and therapy of irritable bowel syndrome. Tech Coloproctol. 2014; 18:613–621.

16. Lazaraki G, Chatzimavroudis G, Katsinelos P. Recent advances in pharmacological treatment of irritable bowel syndrome. World J Gastroenterol. 2014; 20:8867–8885.

17. Vanuytsel T, Tack JF, Boeckxstaens GE. Treatment of abdominal pain in irritable bowel syndrome. J Gastroenterol. 2014; 49:1193–1205.

18. Ong J, Kerr DI. Clinical potential of GABAB receptor modulators. CNS Drug Rev. 2005; 11:317–334.

19. de Carvalho Rocha HA, Dantas BP, Rolim TL, Costa BA, de Medeiros AC. Main ion channels and receptors associated with visceral hypersensitivity in irritable bowel syndrome. Ann Gastroenterol. 2014; 27:200–206.

20. Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology. 2016; 150:1262–1279.

21. Thompson WG, Irvine EJ, Pare P, Ferrazzi S, Rance L. Functional gastrointestinal disorders in Canada: first population-based survey using Rome II criteria with suggestions for improving the questionnaire. Dig Dis Sci. 2002; 47:225–235.

22. Drossman DA, Li Z, Andruzzi E, et al. US householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993; 38:1569–1580.

23. Sperber AD, Drossman DA. Review article: the functional abdominal pain syndrome. Aliment Pharmacol Ther. 2011; 33:514–524.

24. Sperber AD, Drossman DA. Functional abdominal pain syndrome: constant or frequently recurring abdominal pain. Am J Gastroenterol. 2010; 105:770–774.

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