Controversies in dyspepsia.
Controversies in dyspepsia.
复制标题
消化不良的争议。
DOI：
--
复制
发表时间：
2001
期刊：
影响因子：
--
通讯作者：
T. Hausken
中科院分区：
文献类型：
--
作者：
A. Berstad;S. Olafsson;S. Tefera;J. Hatlebakk;O. Gilja;T. Hausken
即使没有溃疡、癌症或食管炎等可见病变，功能性消化不良患者也可能会抱怨严重的消化不良症状，并且生活质量较差。其特点是，这些患者通常对自己的健康状况估计较低，并且对多个器官系统有抱怨。该病的病因尚不清楚。中枢神经系统和胃功能紊乱似乎都参与其中，但它们的相对重要性存在争议。抑酸或根除幽门螺杆菌没有明显的有益作用，尽管这种治疗的效果可能在较小的亚组中看到。新的研究结果强调了区分功能性消化不良和胃食管反流病的重要性，这两种疾病表现出与膳食完全不同的胃调节模式，并且具有非常不同的治疗潜力。三硝酸甘油、胰高血糖素、舒马曲坦和丁螺环酮等药物的作用均能同时改善症状和胃调节，这支持了功能性消化不良患者中胃调节异常对膳食的重要作用。提出了功能性消化不良发病机制的假设模型。它包含四种已确定的异常：各种心理异常、迷走神经张力低、胃松弛受损和内脏过敏，沿着脑肠轴逻辑相互作用。
Even in the absence of visible lesions like an ulcer, cancer or oesophagitis, patients with functional dyspepsia may complain of severe dyspeptic symptoms and have a poor quality of life. Characteristically, these patients also often have a low estimate of their own health and have complaints from several organ systems. The cause of the disease is not known. Both central nervous system and gastric disturbances appear to be involved, and their relative importance is controversial. There is no clear beneficial effect of acid suppression or H. pylori eradication although effects of such therapy may be seen in minor subgroups. New findings emphasise the importance of distinguishing between functional dyspepsia and gastro-oesophageal reflux disease, which exhibit completely different gastric accommodation patterns to a meal and have very different therapeutic potential. The effect of drugs like glyceryl trinitrate, glucagon, sumatriptan and buspirone which all concomitantly improve symptoms and gastric accommodation support the important role of abnormal gastric accommodation to meals in patients with functional dyspepsia. A hypothetical model for the pathogenesis of functional dyspepsia is presented. It incorporates four established abnormalities: various psychological abnormalities, low vagal tone, impaired gastric relaxation, and visceral hypersensitivity, in a logical interplay along the brain-gut axis.