Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000600014
Brazilian Journal of Anesthesiology
Review Article

Hiperalgesia visceral e dor abdominal crônica: abordagem diagnóstica e terapêutica

Visceral hyperalgesia and chronic abdominal pain: diagnostic and therapeutic approach

Durval Campos Kraychete; Ana Cristina Guimarães

http://dx.doi.org/10.1590/S0034-70942003000600014 Braz J Anesthesiol, vol.53, n6, p.833-853, 2003
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Resumo

JUSTIFICATIVA E OBJETIVOS: A dor abdominal crônica é uma das razões mais freqüentes para consulta médica. Não existe, entretanto, um protocolo bem estabelecido para a abordagem diagnóstica e, na maioria das vezes, essa investigação se torna uma prática médica onerosa e invasiva. A finalidade desta revisão é tentar esclarecer a fisiopatologia da dor visceral e estabelecer metas diagnósticas e terapêuticas, para portadores desta morbidade, baseada em critérios específicos. CONTEÚDO: A dor abdominal crônica inespecífica ou funcional representa uma interação complexa entre distúrbio de motilidade, hipersensibilidade visceral e respostas neuroendócrina e psicossocial inadequadas. Mecanismos periféricos e centrais de nocicepção parecem estar envolvidos na hiperalgesia visceral. A abordagem diagnóstica requer uma avaliação minuciosa da história e exame clínico, levando em consideração os critérios de Roma II. Baseado nos mecanismos fisiopatológicos conhecidos, ou supostos, novas drogas vêm sendo pesquisadas, e algumas utilizadas mais recentemente, como os agonistas dos receptores 5-HT4 e bloqueadores dos canais de sódio, para o controle da dor abdominal. CONCLUSÕES: Os mecanismos fisiopatológicos da dor abdominal crônica, ainda não estão esclarecidos. A abordagem terapêutica e diagnóstica requer o conhecimento de tais mecanismos, bem como dos critérios de Roma II. Por outro lado, uma boa relação médico-paciente e a atuação de equipe intermultidisciplinar parecem fundamentais para melhorar a resposta ao tratamento instituído e a qualidade de vida do paciente.

Palavras-chave

DOR, DOR

Abstract

BACKGROUND AND OBJECTIVES: Chronic abdominal pain is one of the most frequent reasons for medical consultation. There is, however, no well-established protocol for its diagnostic approach and, most of the times, investigation becomes an expensive and invasive medical practice. This review aimed at explaining visceral pain pathophysiology and establishing diagnostic and therapeutic goals for these patients, based on specific criteria. CONTENTS: Chronic nonspecific or functional abdominal pain is a complex interaction among impaired motility, visceral hypersensitivity and inadequate neuroendocrine and psychosocial responses. Peripheral and central nociception mechanisms seem to be involved in visceral hyperalgesia. Diagnosis requires detailed history and clinical evaluation, taking into consideration Rome II criteria. Based on known or assumed pathophysiological mechanisms, new drugs have been researched, and some have been more recently used to control abdominal pain, such as 5-HT4 receptor agonists and sodium channel blockers. CONCLUSIONS: Chronic pathophysiological abdominal pain mechanisms are still not well understood. Therapy and diagnosis require the understanding of such mechanisms, as well as of Rome II criteria. On the other hand, good patient-physician relationship and multidisciplinary team’s performance seem to be critical in improving treatment response and patients’ quality of life.

Keywords

PAIN, PAIN

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