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New technologies in gastrointestinal research

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World Journal of Gastroenterology 2009年第2期15卷 129-130页

作者： asbjφrn mohr drewes Hans Gregersen Mech-Sense Department of Gastroenterology Aalborg University Hospital DK-9000 Aalborg Denmark

This issue presents different new techniques aiming to increase our understanding of the gastrointestinal system and to improve treatment. The technologies cover selected methods to evoke and assess gut pain, new methods for imaging and physiological measurements, histochemistry, pharmacological modelling etc. There is no doubt that the methods will revolutionize the diagnostic approach in near future.

关键词： Pain Gut Brain Sphincter Imaging Drug

Experimental human pain models in gastro-esophageal reflux disease and unexplained chest pain

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World Journal of Gastroenterology 2006年第18期12卷 2805-2817页

作者： asbjφrn mohr drewes Lars Arendt-Nielsen Peter Funch-Jensen Hans Gregersen Center for Visceral Biomechanics and Pain Department of GastroenterologyAalborg Hospitaland Center for Sensory-Motor InteractionsDepartment of Health Science and TechnologyAalborg UniversityDenmark Department of Surgical Gastroenterology L Aarhus HospitalDenmark

Methods related to experimental human pain research aim at activating different nociceptors, evoke pain from different organs and activate specific pathways and mechanisms. The different possibilities for using mechanical, electrical, thermal and chemical methods in visceral pain research are discussed with emphasis of combinations (e.g., the multimodal approach). The methods have been used widely in assessment of pain mechanisms in the esophagus and have contributed to our understanding of the symptoms reported in these patients. Hence abnormal activation and plastic changes of central pain pathways seem to play a major role in the symptoms in some patients with gastro-esophageal reflux disease and in patients with functional chest pain of esophageal origin. These findings may lead to an alternative approach for treatment in patients that does not respond to conventional medical or surgical therapy.

关键词： Pain Gut Experimental Chest pain Esophagitis

Pathophysiology of chronic pancreatitis

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World Journal of Gastroenterology 2013年第42期19卷 7231-7240页

作者： Christina Brock Lecia Mφller Nielsen Dina Lelic asbjφrn mohr drewes Department of Gastroenterology and Hepatology Aalborg University HospitalDK-9000 AalborgDenmark Center for Sensory-Motor Interactions (SMI) Department of Health Science and TechnologyAalborg UniversityDK-9220 AalborgDenmark

Chronic pancreatitis(CP)is an inflammatory disease of the pancreas characterized by progressive fibrotic destruction of the pancreatic secretory *** the heterogeneity in pathogenesis and involved risk factors,processes such as necrosis/apoptosis,inflammation or duct obstruction are *** fibrosing process ultimately leads to progressive loss of the lobular morphology and structure of the pancreas,deformation of the large ducts and severe changes in the arrangement and composition of the *** conditions lead to irreversible morphological and structural changes resulting in impairment of both exocrine and endocrine *** prevalence of the disease is largely dependent on culture and *** etiological risk-factors associated with CP are multiple and involve both genetic and environmental *** this review the M-ANNHEIM classification system will be used,comprising a detailed description of risk factors such as:alcohol-consumption,nicotineconsumption,nutritional factors,hereditary factors,efferent duct factors,immunological factors and miscellaneous and rare metabolic *** knowledge of the different etiological factors may encourage the use of further advanced diagnostic tools,which potentially will help clinicians to diagnose CP at an earlier ***,in view of the multi factorial disease and the complex clinical picture,it is not surprising that treatment of patients with CP is challenging and often unsuccessful.

关键词： Chronic pancreatitis Pathogenesis Risk factors Etiology

Nutrition in chronic pancreatitis

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World Journal of Gastroenterology 2013年第42期19卷 7267-7275页

作者： Henrik Hφjgaard Rasmussen φivind Irtun Sφren Schou Olesen asbjφrn mohr drewes Mette Holst Centre for Nutrition and Bowel Disease (CET) Department of Gastroenterology and HepatologyAalborg University HospitalFaculty of HealthAalborg University9000 AalborgDenmark Department of Gastroenterologic Surgery University Hospital North-Norway9013 Troms Norway Mech-Sense Department of Gastroenterology and HepatologyAalborg University Hospital9000 AalborgDenmark

The pancreas is a major player in nutrient *** chronic pancreatitis both exocrine and endocrine insufficiency may develop leading to malnutrition over *** is often a late complication of chronic pancreatic and depends on the severity of the underlying *** severity of malnutrition is correlated with two major factors:(1)malabsorption and depletion of nutrients(e.g.,alcoholism and pain)causes impaired nutritional status;and(2)increased metabolic activity due to the severity of the *** deficiencies negatively affect outcome if they are not *** assessment and the clinical severity of the disease are important for planning any nutritional *** nutritional practice includes screening to identify patients at risk,followed by a thoroughly nutritional assessment and nutrition plan for risk *** should be multidisciplinary and the mainstay of treatment is abstinence from alcohol,pain treatment,dietary modifications and pancreatic enzyme *** achieve energy-end protein requirements,oral supplementation might be *** nutrition may be used when patients do not have sufficient calorie intake as in pylero-duodenalstenosis,inflammation or prior to surgery and can be necessary if weight loss *** nutrition is very seldom used in patients with chronic pancreatitis and should only be used in case of GI-tract obstruction or as a supplement to enteral nutrition.

关键词： Chronic pancreatitis Malnutrition Nutritional risk Malabsorption Nutritional risk screening Metabolism Nutritional assessment Nutrition therapy

Multimodal pain stimulation of the gastrointestinal tract

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World Journal of Gastroenterology 2006年第16期12卷 2477-2486页

作者： asbjφrn mohr drewes Hans Gregersen Center for Biomechanics and Pain Department of GastroenterologyAalborg Hospital & Center for Sensory-Motor Interactions (SMI)Department of Health Science and TechnologyAalborg UniversityAalborgDenmark Center for Biomechanics and Pain Department of GastroenterologyAalborg Hospital

Understanding and characterization of pain and other sensory symptoms are among the most important issues in the diagnosis and assessment of patient with gastrointestinal disorders. Methods to evoke and assess experimental pain have recently developed into a new area with the possibility for multimodal stimulation （e.g., electrical, mechanical, thermal and chemical stimulation） of different nerves and pain pathways in the human gut. Such methods mimic to a high degree the pain experienced in the clinic. Multimodal pain methods have increased our basic understanding of different peripheral receptors in the gut in health and disease. Together with advanced muscle analysis, the methods have increased our understanding of receptors sensitive to mechanical, chemical and temperature stimuli in diseases, such as systemic sclerosis and diabetes. The methods can also be used to unravel central pain mechanisms, such as those involved in allodynia, hyperalgesia and referred pain. Abnormalities in central pain mechanisms are often seen in patients with chronic gut pain and hence methods relying on multimodal pain stimulation may help to understand the symptoms in these patients. Sex differences have been observed in several diseases of the gut, and differences in central pain processing between males and females have been hypothesized using multimodal pain stimulations. Finally, multimodal methods have recently been used to gain more insight into the effect of drugs against pain in the GI tract. Hence, the multimodal methods undoubtedly represents a major step forward in the future characterization and treatment of patients with various diseases of the gut.

关键词： Pain Gut Experimental Allodynia Hyperalgesia Neurophysiology

Pain and chronic pancreatitis: A complex interplay of multiple mechanisms

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World Journal of Gastroenterology 2013年第42期19卷 7282-7291页

作者： Jakob Lykke Poulsen Sφren Schou Olesen Lasse Paludan Malver Jens Brφndum Frφkjr asbjφrn mohr drewes Mech-Sense Department of Gastroenterology and HepatologyAalborg University HospitalDK-9000 AalborgDenmark Mech-Sense Department of RadiologyAalborg University HospitalDK-9000 AalborgDenmark Center for Sensory-Motor Interactions (SMI) Department of Health Science and TechnologyAalborg UniversityDK-9000 AalborgDenmark

Despite multiple theories on the pathogenesis of pain in chronic pancreatitis,no uniform and consistently successful treatment strategy exists and abdominal pain still remains the dominating symptom for most patients and a major challenge for *** theories focussed on a mechanical cause of pain related to anatomical changes and evidence of increased ductal and interstitial *** observations form the basis for surgical and endoscopic drainage procedures,but the outcome is variable and often *** underscores the fact that other factors must contribute to pathogenesis of pain,and has shifted the focus towards a more complex neurobiological understanding of pain *** other explanations for pain,experimental and human studies have provided evidence that pain perception at the peripheral level and central pain processing of the nociceptive information is altered in patients with chronic pancreatitis,and resembles that seen in neuropathic and chronic pain ***,pain due to e.g.,complications to the disease and adverse effects to treatment must not be overlooked as an additional source of *** review outlines the current theories on pain generation in chronic pancreatitis which is crucial in order to understand the complexity and limitations of current therapeutic ***,it may also serve as an inspiration for further research and development of methods that can evaluate the relative contribution and interplay of different pain mechanisms in the individual patients,before they are subjected to more or less empirical treatment.

关键词： Chronic pancreatitis Abdominal pain Pain mechanisms Neuropathy Sensitization

Evaluation of the biliary tract in patients with functional biliary symptoms

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World Journal of Gastroenterology 2006年第18期12卷 2839-2845页

作者： Peter Funch-Jensen asbjφrn mohr drewes László Madácsy Surgical Gastroenterological Department L Aarhus University HospitalAarhusDenmark Center for Visceral Biomechanics and Pain Department of GastroenterologyAalborg Sygehus and Center of Sensory Motor Interaction (SMI)University of AalborgDenmark First Department of Internal Medicine and OMCH Endoscopy Unit Fejér Megyei Szent Gyrgy HospitalSzékesfehérvárHungary

The aim of this paper was to describe functional biliary syndromes and methods for evaluation of the biliary tract in these patients. Functional biliary symptoms can be defined as biliary symptoms without demonstrable organic substrate. Two main syndromes exist： Gallbladder dysfunction and sphincter of Oddi dysfunction. The most important investigative tools are cholescintigraphy and endoscopic sphincter of Oddi manometry. In gallbladder dysfunction a scintigraphic gallbladder ejection fraction below 35% can select patients who will benefit from cholecystectomy. Endoscopic sphincter of Oddi manometry is considered the gold standard in sphincter of Oddi dysfunction but recent development in scintigraphic methods is about to change this. Thus, calculation of hilum-to-duodenum transit time and duodenal appearance time on cholescintigraphy have proven useful in these patients. In conclusion, ambient methods can diagnose functional biliary syndromes. However, there are still a number of issues where further knowledge is needed. Probably the next step forward will be in the area of sensory testing and impedance planimetric methods.

关键词： Functional biliary pain Scintigraphy Manometry Pain Sphincter of Oddi Gallbladder

Imaging of the gastrointestinal tract-novel technologies

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World Journal of Gastroenterology 2009年第2期15卷 160-168页

作者： Jens Brφndum Frφkjr asbjφrn mohr drewes Hans Gregersen Mech-Sence Aalborg HospitalDK-9000 Aalborg Denmark Department of Radiology Aalborg Hospital DK-9000 Aalborg Denmark Mech-Sence Aalborg Hospital DK-9000 Aalborg Denmark Mech-Sense Department of Medical Gastroenterology Aalborg University Hospital DK-9000 Aalborg Denmark National Center for Ultrasound in Gastroenterology Haukeland University Hospital Bergen Norway Center for Sensory-Motor Interaction (SMI) Department of Health Science and Technology Aalborg University Denmark Center for Sensory-Motor Interaction (SMI) Department of Health Science and Technology Aalborg University DK-9000 Aalborg Denmark

Imaging of the gastrointestinal tract is very useful for research and clinical studies of patients with symptoms arising from the gastrointestinal tract and in visualising anatomy and pathology. Traditional radiological techniques played a leading role in such studies for a long time. However, advances in non-invasive modalities including ultrasound (US), computed tomography (CT), positron emission tomography (PET), magnetic resonance imaging (MRI), etc, have in the last decades revolutionised the way in which the gastrointestinal tract is studied. The resolution of imaging data is constantly being improved and 3D acquisition, tools for fi ltering, enhancement, segmentation and tissue classif ication are continually being developed. Additional co-registration techniques allow multimodal data acquisition with improved classif ication of tissue pathology. Furthermore, new functional imaging techniques have become available. Altogether, the future of gastrointestinal imaging looks very promising which will be of great benef it in clinical and research studies of gastrointestinal diseases. The purpose of this review is to highlight the capabilities of the newest techniques to explore the detailed morphology, biomechanical properties, function and pathology of the gastrointestinal tract.

关键词： Computed tomography Gastrointestinaltract Imaging Magnetic resonance Radiology Ultrasound

Sensory testing of the human gastrointestinal tract

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World Journal of Gastroenterology 2009年第2期15卷 151-159页

作者： Christina Brock Lars Arendt-Nielsen Oliver Wilder-Smith asbjφrn mohr drewes Mech-Sense Department of Gastroenterology Aalborg Hospital DK-9000 Aalborg Denmark Center for Sensory-Motor Interactions Department of Health Science and Technology Aalborg University DK-9000 Aalborg Denmark Pain and Nociception Research Group Department of Anaesthesiology Radboud University Nijmegen Medical Centrethe Netherlands Mech-Sense Department of Gastro-enterology Aalborg Hospital DK-9000 Aalborg Denmark Author

The objective of this appraisal is to shed light on the various approaches to screen sensory information in the human gut. Understanding and characterization of sensory symptoms in gastrointestinal disorders is poor. Experimental methods allowing the investigator to control stimulus intensity and modality, as well as using validated methods for assessing sensory response have contributed to the understanding of pain mechanisms. Mechanical stimulation based on impedance planimetry allows direct recordings of luminal cross-sectional areas, and combined with ultrasound and magnetic resonance imaging, the contribution of different gut layers can be estimated. Electrical stimulation depolarizes free nerve endings non-selectively. Consequently, the stimulation paradigm （single, train, tetanic） influences the involved sensory nerves. Visual controlled electrical stimulation combines the probes with an endoscopic approach, which allows the investigator to inspect and obtain small biopsies from the stimulation site. Thermal stimulation （cold or warm） activates selectively mucosal receptors, and chemical substances such as acid and capsaicin （either alone or in combination） are used to evoke pain and sensitization. The possibility of multimodal （e.g. mechanical, electrical, thermal and chemical） stimulation in different gut segments has developed visceral pain research. The major advantage is involvement of distinctive receptors, various sensory nerves and different pain pathways mimicking clinical pain that favors investigation of central pain mechanisms involved in allodynia, hyperalgesia and referred pain. As impairment of descending control mechanisms partly underlies the pathogenesis in chronic pain, a cold pressor test that indirectly stimulates such control mechanisms can be added. Hence, the methods undoubtedly represent a major step forward in the future characterization and treatment of patients with various diseases of the gut, which provides knowledge to dinicians

关键词： Endoscopy Intestine Experimental Neurophysiology Pain