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Late sequelae to cancer treatment of the pelvic organs are common. Gastrointestinal symptoms including chronic diarrhoea, faecal urgency, and faecal incontinence are some of the most disabling with a negative impact on quality of life. By investigating and treating the gastrointestinal symptoms in specialised late adverse effects clinics more than half of the patients can be helped. The treatment is individually tailored depending on the patients' main symptoms and underlying pathophysiology performed in collaboration between gastroenterologists, surgeons, oncologists, dieticians, and specialised nurses, as argued in this review.

Abdominal pain, nausea, vomiting, diarrhoea, constipation, and faecal incontinence are common symptoms of diabetic gastroenteropathy and often have a major impact on quality of life. The symptoms are usually caused by widespread dysfunction of the gastrointestinal tract. Hence, diagnosis requires panenteric assessment. The general principles of management are glycaemic control, diet, prokinetics, laxatives, and in selected cases, gastric electrical stimulation, which is summarised in this review.

In recent years, the use of opioids in Denmark has been under scrutiny due to various government measures to reduce consumption, greater media focus and Denmark's relatively larger consumption of opioids compared with the Nordic neighbours. Consequently, opioid prescriptions in Denmark have declined since 2017. A more nuanced approach to opioid treatment for non-malignant chronic pain, which includes individualised treatment as well as enhanced interdisciplinary collaboration, is required as argued in this review.

Acromegaly is a rare and disabling disease with a plethora of symptoms and signs attributed to sustained elevations and actions of growth hormone and insulin-like growth factor 1. Acromegaly is characterised by excessive somatic growth and multiple comorbidities in addition to occasional compression of the optic nerve and hypopituitarism due to the underlying adenoma. The course of the disease is insidious, and a diagnostic delay of 5-10 years is typical, and this pre-diagnostic period is also associated with increased morbidity. Effective treatment is available, once the diagnosis is established.

In this case report, a 72-year-old woman presented with symptoms attributed to arthritis, and MRI indicated sacroiliitis. However, the patient also experienced enlargement of hands and feet in addition to sweating and snoring, which in combination with coarse facial features suggested acromegaly. This diagnosis was biochemically confirmed, and MRI revealed a pituitary adenoma, which was successfully removed by transsphenoidal surgery. Symptom relief and reduced swelling occurred immediately post-operatively. Acromegaly can masquerade as arthritis or osteoarthritis, which may delay diagnosis.

Tapentadol exerts its analgesic effects through opioid receptor agonism and noradrenaline reuptake inhibition in the central nervous system. Clinical studies show that tapentadol effectively relieves moderate to severe pain in both post-operative and chronic pain. In these trials with equianalgesic doses of tapentadol and oxycodone, treatment with tapentadol was associated with significantly fewer gastrointestinal-related adverse events. Furthermore, in a placebo-controlled study, tapentadol has shown good efficacy in painful diabetic polyneuropathy.

Flank pain is common and often associated with stone colics. Similar pain characteristics can, however, be observed in other diseases. Stone colics have all the characteristics of visceral pain. The pain is diffuse, often referred to the body wall and accompanied by autonomic reflexes. In patients with recurrent stones, the colics may be more intense due to sensitisation of the nervous system. Furthermore, painful diseases in the reproductive organs can enhance stone colics. Non-steroidal anti-inflammatory drugs are the first choice for stone colics because they act by reducing the renal pelvic pressure.

The article gives a review of new methods in gastroenterology. The >>functional lumen imaging probe<< is a method used to evaluate the competence of sphincter regions during distension. The axial force probe can measure forces in the oesophagus during swallowing and give new information about patients with motor disorders of the oesophagus. The >>multimodal probe<< measures the sensory response to electrical, mechanical, thermal and chemical stimuli. Together with advanced modeling of the brain activity, these methods have increased our knowledge about the pathogenesis of sensory symptoms.

This article reviews the basic anatomy and physiology of the normal pain system. During recent years, our knowledge of the pain system has been expanded, with increasing insight into the peripheral and central mechanisms underlying both acute and chronic pain. Several differences in the pain system exist for superficial and deep pain. Descending control mechanisms seem to be important in controlling pain, and neuroplastic changes with central reorganisation are frequently seen in patients suffering from pain. This new knowledge will help in understanding and treating patients with chronic pain syndromes.

Abdominal and pelvic pain are the most common causes of referral to a gastroenterologist or gynaecologist, and the understanding of visceral pain mechanisms may contribute to a better diagnosis and treatment. Visceral pain is often perceived as a deep, dull and vague sensation with referral to somatic and other visceral structures, but when the peritoneum is involved the pain is more distinct and localised. Long duration or recurrence of the pain may produce permanent changes in the central nervous system, resulting in an increased sensitivity to external stimuli. These changes often involve other organs and somatic structures in the referred pain area. Finally, options for treating visceral pain are described.

This paper reviews our current understanding of the clinical symptoms and pain mechanisms in patients with gallstone disease. Although most patients have classical pain attacks, the pain localisation can be atypical due to convergence phenomena between somatic and visceral afferents. Furthermore, central neuroplastic changes induced by the recurrent pain attacks are probably of major importance for our understanding of the clinical symptoms. Finally, recommendations for pharmacological treatment of the pain are provided.