Background/Aims: To better understand the relationship between cortical plasticity and visceral pain, we developed a pain-induced model of altered esophageal cortico-bulbar excitability. Methods: In 8 healthy volunteers cortico-esophageal EMG responses were recorded via an intra-luminal catheter, following magnetic stimulation of the right sensorimotor cortex using peri-threshold intensities. Cortico-thenar responses were also acquired as control. Responses were assessed both before and for up to 1 hour after either painful or non-painful balloon distension of esophagus (frequency=1 Hz, dwell time=200 ms, duration=10 minutes), each being delivered to each subject in random order. Results: Painful esophageal distension (mean volume=11±3 ml) induced a profound increase in esophageal responses compared to baseline levels (at 30 minutes: 141±22 vs. 91±19 µV, p<0.01), whereas non-painful esophageal distension (mean volume=4±2 ml) showed a decrease (at 30 minutes: 72±8 vs. 88±12 µV, p<0.03). Thenar responses were unaffected. Conclusions: Painful and non-painful stimuli induce different patterns of esophageal cortico-bulbar excitability suggesting a physiological link between cortical plasticity and visceral pain.