Korean J Gastroenterol.  2021 Jun;77(6):277-284. 10.4166/kjg.2021.083.

Centrally Mediated Abdominal Pain Syndrome

• Kim HJ
• Kim HJ

• KMID: 2516888
• DOI: http://doi.org/10.4166/kjg.2021.083

Abstract

Centrally mediated abdominal pain syndrome (CAPS), known as functional abdominal pain syndrome in the Rome III criteria of functional gastrointestinal diseases, has a reported population prevalence of between 0.5% and 2.1%, with a female preponderance. The pathogenesis of CAPS has not been completely established, and various studies are being conducted. On the other hand, central nervous system sensitization with disinhibition of the pain signaling pathways appears to play a more important role than the up-regulation of peripheral afferent neuronal excitability. The diagnosis of CAPS is based on the Rome IV criteria (2016) and is established around the gastrointestinal symptoms combination. Various new treatment trials and effective patient-physician relationships showed progressive results.

Keyword

Centrally mediated abdominal pain syndrome; Rome IV; Function gastrointestinal disorders; Abdominal pain

Figure

• 

  Fig. 1 Abdominal pain pathways. A human has two pathways in the abdominal pain pathways. One is the sensory neuronal pathway of the vagus nerve, and the other is the sensory neuronal pathway of the sympathetic nerve. The types of sympathetic ganglion vary according to each organ.

• 

  Fig. 2 Peripheral and central sensitization. The spinothalamic tract consists of peripheral neurons and central neurons. The terminals of the peripheral nerves are called sensory receptors (nociceptors). These various sensitizations are called peripheral sensitization. The sensitization that occurs in the synapses in the dorsal horn, brain stem, and cerebral cortex is called central sensitization.

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  Fig. 3 Pain modulators and analgesics. Pain can be modulated by drugs acting on each level. Drugs that act on the nociceptors are called peripheral acting medicines, and those that act on higher levels (dorsal horn, brain stem, cerebral cortex) are called central acting medicines.

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