Understanding and treating abdominal pain and spasms in organic gastrointestinal diseases: inflammatory bowel disease and biliary diseases.

Abdominal pain and spasms are common symptoms in organic gastrointestinal diseases, yet are associated with significant unmet need in terms of recognition and treatment. The aim of this review was to help physicians to understand the pathophysiology and impact to patients of abdominal pain and spasms in inflammatory bowel disease (IBD) and biliary diseases. This may in turn help in the selection of the most appropriate treatment to improve patients' overall daily functioning and quality of life in addition to reducing health resource utilization. Relative to the healthy colon, the mechanisms of pain generation in IBD include peripheral sensitization, including visceral hypersensitivity, central processing and modulation, and associated features or modifiers. Calcitonin gene related peptide, substance P, transient receptor potential vanilloid type, and serotonin biosynthesis in the colon are implicated in these processes. For biliary pain, important factors include pressure change or high pressure in the gallbladder, gallbladder ejection fraction, and change in the shape of gallbladder. Pain management is multifactorial and may involve psychological and physical methods and drugs (nonsteroidal anti-inflammatory agents, opioids, antispasmodics, with regional and epidural analgesia reserved for severe cases) after appropriate risk-benefit assessment. Antispasmodic agents may be effective in selected patients with IBD, especially those who are in remission and have mild/moderate chronic pain.