Functional Dyspepsia and Gastroparesis
Functional Dyspepsia and Gastroparesis
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DOI：
10.1159/000445226
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发表时间：
2016-01-01
影响因子：
2.3
通讯作者：
Camilleri, Michael
中科院分区：
文献类型：
--
作者：
Camilleri, Michael
背景：上消化道疾病通常表现为常见症状。最相关的非粘膜疾病是胃轻瘫、功能性消化不良和反刍综合征。回顾了与这3种情况相关的文献。关键信息：胃轻瘫的特征是在没有胃机械性梗阻的情况下胃排空延迟。主要症状包括餐后饱胀（早饱）、恶心、呕吐和腹胀。这些症状最常见的原因是机械性梗阻（幽门狭窄）、医源性疾病、胃轻瘫、功能性消化不良、周期性呕吐和反刍综合征。胃轻瘫最常见的原因是神经性疾病，如糖尿病，特发性，迷走神经切断术后和硬皮病中的肌病。胃轻瘫的治疗原则包括排除影像学和医源性原因引起的机械性梗阻，谨慎用药和既往手术史。促动力药和止吐药是治疗的主要药物。功能性消化不良的特征在于与胃轻瘫相同的症状;除了胃排空延迟之外，病理生理异常包括胃排空加速、胃适应性受损以及胃或十二指肠对膨胀和营养物的超敏反应。新的治疗方法包括在胃排空正常的患者中使用三环类抗抑郁药、阿考替胺（乙酰胆碱酯酶抑制剂）和5-HT 1A受体激动剂（如丁螺环酮）。反刍综合征的特征是餐后几分钟内胃内容物反复反流。食欲不振通常在饭后持续1-2小时，并且食欲不振由部分消化的食物组成，其味道可识别。反胃通常是毫不费力的，或者在打嗝之前有一种感觉。这已经被总结为一个“吃饭，吃饭，一天，一天”的行为，数周或数月，区分反刍和胃轻瘫。患者通常有心理障碍或先前饮食失调的背景。治疗以行为矫正为基础。结论：准确识别上消化道症状的病因和病理生理学对于优化治疗至关重要。(C)2016 S. Karger AG，巴塞尔
Background: Upper gastrointestinal disorders typically present with common symptoms. The most relevant non-mucosal diseases are gastroparesis, functional dyspepsia and rumination syndrome. The literature pertaining to these 3 conditions was reviewed. Key Messages: Gastroparesis is characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach. The cardinal symptoms include postprandial fullness (early satiety), nausea, vomiting and bloating. The most frequently encountered causes of these symptoms are mechanical obstruction (pyloric stenosis), iatrogenic disease, gastroparesis, functional dyspepsia, cyclical vomiting and rumination syndrome. The most common causes of gastroparesis are neuropathic disorders such as diabetes, idiopathic, post-vagotomy and scleroderma among myopathic disorders. Principles of management of gastroparesis include exclusion of mechanical obstruction with imaging and iatrogenic causes with careful medication and past surgical history. Prokinetics and anti-emetics are the mainstays of treatment. Functional dyspepsia is characterized by the same symptoms as gastroparesis; in addition to delayed gastric emptying, pathophysiological abnormalities include accelerated gastric emptying, impaired gastric accommodation and gastric or duodenal hypersensitivity to distension and nutrients. Novel treatments include tricyclic antidepressants in patients with normal gastric emptying, acotiamide (acetyl cholinesterase inhibitor) and 5-HT1A receptor agonists such as buspirone. Rumination syndrome is characterized by repetitive regurgitation of gastric contents occurring within minutes after a meal. Episodes often persist for 1-2 h after the meal, and the regurgitant consists of partially digested food that is recognizable in its taste. Regurgitation is typically effortless or preceded by a sensation of belching. This has been summarized as a 'meal in, meal out, day in, day out' behavior for weeks or months, differentiating rumination from gastroparesis. Patients often have a background of psychological disorder or a prior eating disorder. Treatment is based on behavioral modification. Conclusion: Precise identification of the cause and pathophysiology of upper gastrointestinal symptoms is essential for optimal management. (C) 2016 S. Karger AG, Basel