The Pain System in Oesophageal Disorders: Mechanisms, Clinical Characteristics, and Treatment

Abstract

Pain is common in gastroenterology. This review aims at giving an overview of pain mechanisms, clinical features, and treatment options in oesophageal disorders. The oesophagus has sensory receptors specific for different stimuli. Painful stimuli are encoded by nociceptors and communicated via afferent nerves to the central nervous system. The pain stimulus is further processed and modulated in specific pain centres in the brain, which may undergo plastic alterations. Hence, tissue inflammation and long-term exposure to pain can cause sensitisation and hypersensitivity. Oesophageal sensitivity can be evaluated ,for example, with the oesophageal multimodal probe. Treatment should target the cause of the patient's symptoms. In gastro-oesophageal reflux diseases, proton pump inhibitors are the primary treatment option, surgery being reserved for patients with severe disease resistant to drug therapy. Functional oesophageal disorders are treated with analgesics, antidepressants, and psychological therapy. Lifestyle changes are another option with less documentation.

Patients with Barrett's esophagus are hypersensitive to acid but hyposensitive to other stimuli compared with healthy controls

“…An afferent nerve defect in the asymptomatic patients is also unlikely, since most receptors are polymodal and this defect thus would affect all sensory modalities. Noticeably, electrical stimulation bypasses the peripheral receptors, reaching the central nervous system directly.…”

Opioid-Induced Constipation and Bowel Dysfunction: A Clinical Guideline

“…OIBD symptoms are potentially difficult to localize and distinguish from each other due to the complex organization of the visceral sensory system; visceral afferents show diffuse termination over many segments of the spinal cord [ 50 – 52 ]. It is therefore plausible that colonic distension due to OIC may also be felt in the upper abdomen.…”

Randomized clinical trial: efficacy and safety of PPC-5650 on experimental esophageal pain and hyperalgesia in healthy volunteers

“…GERD is associated with symptoms such as heart burn, pain, gastrointestinal discomfort, and accordingly reduced quality of life [1,2]. The drug of choice is proton pump inhibitors (PPIs).…”

“…In the case of treatment failure, surgery can be an alternative, which can be more effective than medical treatment. However, side effects and complications related to surgery should be taken into consideration [2,3]. Therefore, new treatment alternatives are highly warranted.…”