Incidence of adenocarcinoma among patients with Barrett's esophagus.

Background: Accurate population-based data are needed on the incidence of esophageal adenocarcinoma and high-grade dysplasia among patients with Barrett's esophagus.

Methods: We conducted a nationwide, population-based, cohort study involving all patients with Barrett's esophagus in Denmark during the period from 1992 through 2009, using data from the Danish Pathology Registry and the Danish Cancer Registry. We determined the incidence rates (numbers of cases per 1000 person-years) of adenocarcinoma and high-grade dysplasia.

Mechanism-based evaluation and treatment of esophageal disorders.

The following on mechanism-based evaluation and treatment of esophageal disordered contains commentaries on multimodal stimulation to study esophageal function, the neurophysiological and autonomous assessment of sensory abnormalities, and the clinical value of the novel diagnostic combinations to propose a mechanically targeted treatment.

Distensibility testing of the esophagus.

The following contains commentaries on distensibility testing using the functional lumen imaging probe (FLIP); the use of the distention test of the esophageal body in the clinic diagnosis of noncardiac chest pain; the functional lumen imaging in gastroesophageal reflux disease-impaired esophagogastric junction; a multimodal pain model for the esophagus; the rationale for distensibility testing; and further developments in standardized distension protocols.

Barrett's esophagus: prevalence-incidence and etiology-origins.

Although the prevalence of Barrett's esophagus (BE) is rising no data exist for racial minorities on prevalence in the general population. Minorities have a lower prevalence than Caucasians, and yet age, smoking, abdominal obesity, and Helicobacter pylori are all risk factors. Metabolic changes induced by adipocytokines and the apparently strong association between obesity, central adiposity, and BE may lead to reconsideration of some aspects of the natural history of BE.

Brain activity in rectosigmoid pain: unravelling conditioning pain modulatory pathways.

Objective: Conditioning Pain Modulation (CPM) represents the various descending inhibitory mechanisms induced by a heterotopic noxious stimulation (previously termed DNIC). CPM-induced modulations in brain activity have not previously been investigated to visceral pain. Hence the aims were to assess the role of CPM in terms of: (1) psychophysics, (2) alterations in topography and amplitudes of evoked brain potentials and (3) modelling the brain activity.

Biomarkers for visceral hypersensitivity identified by classification of electroencephalographic frequency alterations.

Abdominal pain is frequently related to visceral hypersensitivity. This is associated with increased neuronal excitability in the central nervous system (CNS), which can be manifested as discrete electroencephalographic (EEG) alterations. In the current placebo-controlled study, visceral hypersensitivity was evoked by chemical irritation of the esophagus with acid and capsaicin perfusion.

Distension of the renal pelvis in kidney stone patients: sensory and biomechanical responses.

The pathogenesis of symptoms in urolithiasis is poorly understood. Traditionally increased endoluminal pressure is considered the main mechanism causing pain in the upper urinary tract but clinical data are sparse. The aim of the present study was to develop a new model related to mechanosensation in order to describe the geometric and mechanical properties of the renal pelvis in patients with kidney stone disease.

The pain system in oesophageal disorders: mechanisms, clinical characteristics, and treatment.

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.

Long-term complications to reflux disease in community practice. A 17-year cohort study of 4706 patients.

Objective: To examine the risk of developing strictures in patients with erosive and non-erosive gastroesophageal reflux disease in a community-based setting, since controlled trials indicate that the use of proton pump inhibitors renders the risk of strictures insignificant.

Material And Methods: A 17-year cohort study of 4706 patients referred to endoscopy due to upper GI symptoms, with a population comparison cohort of 47,060 individuals. All patients were followed and treated according to prevailing guidelines by their usual care provider.

[Tapentadol is a new, strongly efficative analgeticum with dual effect mechanisms].

Tapentadol exerts its analgesic effects through opioid receptor agonism and noradrenaline reuptake inhibition in the central nervous system. Clinical studies show that tapentadol effectively relieves moderate to severe pain in both post-operative and chronic pain. In these trials with equianalgesic doses of tapentadol and oxycodone, treatment with tapentadol was associated with significantly fewer gastrointestinal-related adverse events.

Pregabalin reduces pain in patients with chronic pancreatitis in a randomized, controlled trial.

Background & Aims: Pain is a disabling symptom for patients with chronic pancreatitis (CP) and difficult to treat. Evidence from basic science and human studies indicates that pain processing by the central nervous system is abnormal and resembles that observed in patients with neuropathic pain disorders. We investigated whether agents used to treat patients with neuropathic pain are effective in CP.

Spectral and dynamic electroencephalogram abnormalities are correlated to psychometric test performance in hepatic encephalopathy.

Objective: Alterations of the electroencephalogram (EEG) have been reported in patients with hepatic encephalopathy (HE). However, previous methods have not assessed transient phenomena in the EEG signal (dynamics) and associations to psychometric test performance have in general been poor. The aims were to quantify spectral and dynamic EEG abnormalities in patients with HE and to correlate putative findings to psychometric test performances.

Altered brain microstructure assessed by diffusion tensor imaging in patients with chronic pancreatitis.

Objective: In patients with painful chronic pancreatitis (CP) there is increasing evidence of abnormal pain processing in the central nervous system. Using magnetic resonance (MR) diffusion tensor imaging, brain microstructure in areas involved in processing of visceral pain was characterised and these findings were correlated to clinical pain scores.

Methods: 23 patients with CP pain and 14 controls were studied in a 3T MR scanner.

Validated tools for evaluating opioid-induced bowel dysfunction.

Adverse effects on the gastrointestinal system are problematic for pain patients receiving opioid treatment. Opioid-induced bowel dysfunction (OIBD) is often misinterpreted as constipation as this is the most frequently reported symptom of OIBD; however, it actually comprises the whole gut with symptoms such as nausea, reflux, bloating, and anorexia being very prevalent as well. Validated methods to evaluate these symptoms are essential before the action of a drug on bowel dysfunction can be evaluated, but only the effect on the most frequently reported symptom, constipation, has been evaluated systematically.

Slowed EEG rhythmicity in patients with chronic pancreatitis: evidence of abnormal cerebral pain processing?

Background And Aim: Intractable pain usually dominates the clinical presentation of chronic pancreatitis (CP). Slowing of electroencephalogram (EEG) rhythmicity has been associated with abnormal cortical pain processing in other chronic pain disorders. The aim of this study was to investigate the spectral distribution of EEG rhythmicity in patients with CP.

[Flank pain in renal and ureteral calculus].

Flank pain is common and often associated with stone colics. Similar pain characteristics can, however, be observed in other diseases. Stone colics have all the characteristics of visceral pain.

Pain-associated adaptive cortical reorganisation in chronic pancreatitis.

Background/aims: In various chronic pain conditions cortical reorganisation seems to play a role in the symptomatology. The aims of this study were to investigate cortical reorganisation in patients with pain caused by chronic pancreatitis (CP) and to correlate putative cortical reorganisation to clinical pain scores.

Methods: 24 patients suffering from CP and 14 healthy volunteers were included.

Multichannel matching pursuit validation and clustering--a simulation and empirical study.

Introduction: Multichannel matching pursuit (MMP) is a relatively new method that can be applied to electroencephalogram (EEG) signals in combination with inverse modelling. However, limitations of MMP have not been adequately tested. The aims of this study were to investigate how the accuracy of MMP algorithm is altered due to increased number of brain sources and increased noise level, and to implement and test a modified K-means clustering algorithm in order to group similar MMP atoms in time-frequency and space between subjects together.

Support vector machine classification of multi-channel EEG traces: a new tool to analyze the brain response to morphine treatment.

The analgesic effect of morphine is highly individual, calling for objective methods to predict the subjective pain relief. Such methods might be based on alteration of brain response caused by morphine during painful stimuli. The study included 11 healthy volunteers subjectively quantifying perception of painful electrical stimulations in the esophagus.

Gastrointestinal symptoms in type-1 diabetes: is it all about brain plasticity?

Background And Aims: Autonomic neuropathy seems to play a central role in the development of gastrointestinal symptoms in diabetes. In order to explore the neuronal mechanisms behind the symptoms we evaluated the brain processing of painful visceral stimuli.

Methods: Evoked brain potentials were recorded to assess the response to painful oesophageal electrical stimuli in 15 healthy volunteers and 14 type-1 diabetes patients with autonomic neuropathy and related gastrointestinal symptoms.

Abnormal brain processing in hepatic encephalopathy: evidence of cerebral reorganization?

Background And Aim: Hepatic encephalopathy (HE) is a severe and frequent complication of liver cirrhosis characterized by abnormal cerebral function. Little is known about the underlying neural mechanisms in HE and human data are sparse. Electrophysiological methods such as evoked brain potentials after somatic stimuli can be combined with inverse modeling of the underlying brain activity.

Different effects of morphine and oxycodone in experimentally evoked hyperalgesia: a human translational study.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT * Previous studies using short-lasting experimental pain stimulations in healthy volunteers have shown differences in opioid effects regarding visceral pain stimulations. However, these differences can be more pronounced in patients due to a sensitized pain system. Therefore, the aim of the present study was to mimic the clinical situation by investigating opioid effects on experimental pain in healthy volunteers after experimentally evoked hyperalgesia.

Visceral pain originating from the upper urinary tract.

Pain originating from the upper urinary tract is a common problem and stone colic is one of the most intense pain conditions that can be experienced in the clinic. The pain is difficult to alleviate and often leads to medical attention. In humans, pain mechanisms of the upper urinary tract pain are still poorly understood, which often leads to a trial and error approach in clinical pain management.

Descending inhibitory pain modulation is impaired in patients with chronic pancreatitis.

Background & Aims: Pain is a prominent symptom in chronic pancreatitis (CP), but the underlying mechanisms are incompletely understood. We investigated the role of descending pain modulation from supraspinal structures as well as central nervous system sensitization in patients with pain from CP.

Methods: Twenty-five patients with CP and 15 healthy volunteers were included.

Acid hypersensitivity in patients with eosinophilic oesophagitis.

Objective: Painful symptoms are prevalent in patients with eosinophilic oesophagitis but experimental data are sparse. The aim of this study was to compare the pain response to experimental oesophageal stimulation in 14 patients with eosinophilic oesophagitis and 15 healthy volunteers.

Material And Methods: A multimodal probe was placed in the oesophagus.