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In this article, we propose a new diagnostic paradigm known as Chronic Abdominal Discomfort Syndrome (CADS). Patient's presentation centers around chronic abdominal pain not explained by acute pathology with or without accompanying dyspepsia, bloating, nausea and vomiting among other symptoms. The pathophysiology is noted to be neurogenic, possibly stemming from visceral sympathetic nerves or abdominal wall afferent nerves. Diagnosis is supported by signs or symptoms traversing clinical, diagnostic and functional criteria. Included is a tool which can assist clinicians in diagnosing patients with CADS per those domains. We hope to facilitate primary care physicians' and gastroenterologists' utilization of our criteria to provide guidance for selecting which patients may benefit from further interventions or evaluation by a pain physician. The pain physician may then offer interventions to provide the patient with relief.

Chronic Abdominal Discomfort Syndrome (CADS) is a recently proposed term that is a subclassification of Chronic Abdominal Pain, characterized by symptoms affecting clinical, diagnostic, and functional domains. Patients with CADS often have a history of abdominal surgery and experience chronic gastrointestinal symptoms such as nausea, bloating, vomiting, and dyspepsia. This review explores the underlying pathophysiology of CADS, emphasizing the role of the sympathetic and parasympathetic nervous systems in pain transmission. Various pharmacological treatments are discussed, including acid suppressants, antispasmodics, and analgesics, highlighting their effectiveness and limitations. Non-pharmacological approaches such as intrathecal pumps, nerve blocks, peripheral nerve stimulation, and spinal cord stimulation are also examined, providing insights into interventional pain management strategies. The review underscores the necessity of an individualized treatment algorithm due to the complexity of CADS and the multiple pain generators involved. Ultimately, this paper advocates for a structured approach to CADS treatment, incorporating both emerging and established therapeutic options.

Gastrointestinal (GI) discomfort is prevalent and known to be associated with impaired quality of life. Real-world information on factors of GI discomfort and solutions used by people is, however, limited. Social media, including online forums, have been considered a new source of information to examine the health of populations in real-life settings. The aims of this retrospective infodemiology study are to identify discussion topics, characterize users, and identify perceived determinants of GI discomfort in web-based messages posted by users of French social media. Messages related to GI discomfort posted between January 2003 and August 2018 were extracted from 14 French-speaking general and specialized publicly available online forums. Extracted messages were cleaned and deidentified. Relevant medical concepts were determined on the basis of the Medical Dictionary for Regulatory Activities and vernacular terms. The identification of discussion topics was carried out by using a correlated topic model on the basis of the latent Dirichlet allocation. A nonsupervised clustering algorithm was applied to cluster forum users according to the reported symptoms of GI discomfort, discussion topics, and activity on online forums. Users' age and gender were determined by linear regression and application of a support vector machine, respectively, to characterize the identified clusters according to demographic parameters. Perceived factors of GI discomfort were classified by a combined method on the basis of syntactic analysis to identify messages with causality terms and a second topic modeling in a relevant segment of phrases. A total of 198,866 messages associated with GI discomfort were included in the analysis corpus after extraction and cleaning. These messages were posted by 36,989 separate web users, most of them being women younger than 40 years. Everyday life, diet, digestion, abdominal pain, impact on the quality of life, and tips to manage stress were among the most discussed topics. Segmentation of users identified 5 clusters corresponding to chronic and acute GI concerns. Diet topic was associated with each cluster, and stress was strongly associated with abdominal pain. Psychological factors, food, and allergens were perceived as the main causes of GI discomfort by web users. GI discomfort is actively discussed by web users. This study reveals a complex relationship between food, stress, and GI discomfort. Our approach has shown that identifying web-based discussion topics associated with GI discomfort and its perceived factors is feasible and can serve as a complementary source of real-world evidence for caregivers.

Background Acute postoperative pain and chronic discomfort are reported after robotic or endoscopic thyroidectomy. The purpose of this prospective, randomized, and double-blinded clinical trial was to investigate whether intraoperative infusion of nefopam decreases acute postoperative pain and chronic discomfort following either a robotic or endoscopic thyroidectomy via the bilateral axillo-breast approach (BABA). Methods Patients were randomized into two groups: The control group ( n  = 29) or the nefopam group ( n  = 29). Patients in each group were infused with the same volume of saline or nefopam (0.2 mg/kg bolus, 120 μg/kg/h continuous infusion) during surgery. Acute postoperative pain, the need for rescue analgesics, and other postoperative adverse effects were assessed at 1, 6, 24, and 48 h postoperatively. Chronic pain and discomfort was recorded at 3 months after surgery. Results Patients in the nefopam group reported lower pain scores in the neck, as well as the axilla and anterior chest areas at 1, 6, 24, and 48 h postoperatively, when compared with the control group ( P  < 0.05 at each time points). Rescue analgesics were required less in the nefopam group than in the control group (1.4 [1] vs. 2.3 [1.5]; P  = 0.001). The degree of chronic pain and discomfort were relatively lower in the nefopam group ( P  < 0.05). Conclusion We report that intravenous nefopam infusion during surgery decreased acute postoperative pain and the need for rescue analgesics, as well as chronic discomfort, following BABA robotic or endoscopic thyroidectomy without adverse events.

To estimate the age-specific disability weight of chronic schistosomiasis japonica in China. Between October 2004 and January 2005, residents from two schistosome-endemic counties were screened for Schistosoma japonicum infection using an enzyme-linked immunosorbent assay. Disability and morbidity were assessed in seropositive individuals using the European quality of life questionnaire with an additional cognitive dimension (known as the \"EQ-5D plus\") and ultrasonography. The age-specific disability weight of chronic schistosomiasis was estimated based on participants self-rated health scores on the visual analogue scale of the questionnaire; the relationships between health status, morbidity and disability weight were explored using multilevel regression models. Of 2843 seropositive individuals, 1419 (49.9%) were classified as having chronic schistosomiasis. Hepatomegaly was found in 76.3% (1082/1419); hepatic fibrosis was found in 73.3% (1040/1419); and splenomegaly was found in 18.6% (264/1419). Diarrhoea was the most common self-reported symptom (46.0%; 653/1419), followed by abdominal pain (32.6%; 463/1419), impaired capacity to work or study (30.7%; 436/1419), and blood in the stool (11.1%; 157/1419). More than half of the respondents reported impairments in at least one dimension of the EQ-5D plus questionnaire, particularly pain or discomfort (47.9%; 675/1410) and anxiety or depression (39.4%; 555/1410). The overall disability weight was 0.191, and age-specific weights ranged from 0.095 among those aged 5-14 years to 0.246 among those aged > 60 years. Multilevel regression models indicated that the disability weight was significantly associated with the participants sex, grade of hepatic fibrosis, the presence of hepatomegaly, abdominal pain, blood in the stool, impaired capacity to work or study, and cognition. The disability weight attributable to chronic schistosomiasis japonica is high and increases with age. Our findings call for a reappraisal of the disability weights due to chronic schistosomiasis mansoni and schistosomiasis haematobia as well as a re-estimation of the global burden of schistosomiasis.

Purpose The Tisseel/Tissucol for mesh fixation in Lichtenstein hernia repair (TIMELI) study showed that mesh fixation with human fibrin sealant during inguinal hernia repair significantly reduced moderate–severe complications of pain 12 months post-operatively compared with sutures. Further analyses may assist surgeons by investigating predictors of post-surgical complications and identifying patients that may benefit from Tisseel/Tissucol intervention. Methods Univariate and multivariate analyses identified risk factors for combined pain, numbness and groin discomfort (PND) visual analogue scale (VAS) score 12 months post-operatively. Variables tested were: fixation method, age, employment status, physical activity, nerve handling, PND VAS score at pre-operative visit and 1 week post-operatively. The effect of fixation technique on separate PND outcomes 12 months post-surgery was also assessed. Analyses included the intention-to-treat (ITT) population and a subpopulation with pre-operative PND VAS > 30 mm. Results 316 patients were included in the ITT, with 130 patients in the subpopulation with pre-operative PND VAS > 30. Multivariate analysis identified mesh fixation with sutures, worsening pre-operative PND and worsening PND 1 week post-surgery as significant predictors of 12-month PND in the ITT population; mesh fixation with sutures was a significant predictor of 12-month PND in the pre-operative PND VAS > 30 subpopulation ( p  < 0.05). Mesh fixation with Tisseel/Tissucol resulted in significantly less numbness and a lower intensity of groin discomfort compared with sutures at 12 months; there was no difference in pain between the treatment groups. Conclusions Pre-operative discomfort may be an important predictor of post-operative pain, numbness and discomfort. Tisseel/Tissucol may improve long-term morbidity over conventional sutures in these patients.

Background Chronic groin symptoms after inguinal hernia repair are recognised as a frustrating problem for patients and surgeons alike. The aim of our study was to determine the frequency and severity of groin symptoms 5–7 years after a ‘modified’ mesh-plug inguinal hernia repair. Methods Male patients undergoing a ‘modified’ mesh plug inguinal hernioplasty in 2002 and 2004 were investigated by means of a ‘patient friendly’ questionnaire evaluating the frequency and severity of groin ‘discomfort’ and ‘pain’. Results Two hundred consecutive unselected men who had a hernia repair in 2002 ( n  = 89) and 2004 ( n  = 111) were sent a questionnaire of which 57% and 78%, respectively, replied. Significant groin discomfort, irrespective of frequency was described by three (6%) and four (5%) patients, respectively. Significant groin pain of varying severity and frequency was documented by five (6%) patients 5 years after operation and in two or 4% of patients 7 years after surgery. Overall, only four patients (3%) said their symptoms restricted their daily activity. Excluding 13 patients who had already had inguinal surgery on the other side, over 99% (105/106) of our respondents would undergo a similar future procedure on the opposite groin. This included all but one of those who had described discomfort or pain after their hernioplasty. Conclusion Significant restricting groin symptoms were uncommon. None of our patients would decline similar surgery on a contralateral hernia, suggesting a negligible impact of symptoms on their daily lives. A well dissected ‘modified’ mesh plug inguinal hernioplasty is associated with minimal chronic groin symptoms 5–7 years later.

Irritable bowel syndrome (IBS) is the most common chronic functional disorder. IBS is diagnosed using clinical criteria due to the lack of biomarkers and physiological abnormalities. According to Rome III criteria, IBS is characterized by recurrent abdominal pain or discomfort (for at least three day a month during the last three months) and disturbed bowel habit (predominantly diarrhea, predominantly constipation or both).

Chronic diarrhea is a common and a challenging problem for clinicians. The differential diagnosis is vast and a systematic approach is required. Precise diagnosis should be achievable in most patients with true diarrhea. Acute or chronic diarrhea, osmotic or secretory diarrhea, large‐volume or small‐volume diarrhea, bloody or non‐bloody diarrhea, and associated features will help to narrow down the investigations, so that the wide range of investigations available are not used in a haphazard manner.

This chapter contains sections titled: Sources of abdominal pain Evaluation of abdominal symptoms Visceral pain arising from cancer Visceral pain arising from the gastrointestinal tract Visceral pain arising from the hepatobiliary system and pancreas Visceral pain arising from urologic organs Visceral pain arising from reproductive organs Other disorders with abdominal pain as a symptom Future research priorities General recommendations related to therapeutics Conclusion References