Functional dyspepsia, H-pylori and post infectious FD
Functional dyspepsia, H-pylori and post infectious FD
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DOI：
10.1111/j.1440-1746.2011.06649.x
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发表时间：
2011-04-01
影响因子：
4.1
通讯作者：
Fock, Kwong Ming
中科院分区：
文献类型：
--
作者：
Fock, Kwong Ming
背景：罗马III将功能性消化不良定义为存在一种或多种慢性消化不良症状，但不存在任何可能解释这些症状的器质性、全身性或代谢性疾病。在功能性消化不良患者的亚组中，胃排空延迟、胃窦运动不足和肠运动改变、胃适应性降低、幽门螺杆菌感染、内脏敏感性增强、十二指肠对酸的敏感性异常、碳水化合物消化不良和心理因素均已被确定。pylori感染与功能性消化不良的关系存在争议。少数FD患者存在幽门螺杆菌感染。症状和功能异常，如胃排空，并没有一致地显示与幽门螺杆菌感染有关。然而，荟萃分析显示，FD患者的幽门螺杆菌根除治疗对幽门螺杆菌阳性FD的影响较小，但具有统计学显著性（相对风险降低10%）。因此，幽门螺杆菌感染指南强烈建议在幽门螺杆菌阳性FD患者中进行幽门螺杆菌根除治疗。感染后消化不良已被描述为一个独特的临床实体，基于一项大型回顾性研究，该研究显示了一个消化不良患者子集，这些患者有感染后消化不良的病史。在一项前瞻性研究中，西班牙的研究人员发现，急性沙门氏菌胃肠炎后1年，消化不良的发生增加了5倍。在感染后FD患者中，经常报告早饱、体重减轻、恶心和呕吐，同时胃调节受损的患病率较高。最近，已发现感染性FD与急性感染后几个月内十二指肠中持续的局灶性T细胞聚集、CD4+细胞减少和巨噬细胞计数增加有关。这表明急性损伤后免疫系统终止炎症反应的能力受损。幽门螺杆菌感染以及其他肠道感染与FD患者的一个子集有关。潜在感染的治疗可能会导致这组患者的改善。
Background:Functional Dyspepsia has been defined by Rome III as the presence of one or more chronic dyspepsia symptoms in the absence of any organic, systemic, or metabolic disease that is likely to explain the symptoms. Delayed gastric emptying, antral hypomotility and altered intestinal motility, decreased gastric accommodation, H.pylori infection, enhanced visceral sensitivity, abnormal duodenal sensitivity to acid, carbohydrate maldigestion and psychological factors have all been identified in subgroups of patients with functional dyspepsia.Relationship between H.pylori, FD and post infectious FD:The relationship between H. pylori infection and functional dyspepsia is controversial. H.pylori infection is present in a minority of patients with FD. Symptoms and abnormalities of function such as gastric emptying have not been consistently shown to be related to H.pylori infection. However, meta-analysis has shown that H.pylori eradication therapy in FD results in a small but statistically significant effect in H.pylori positive FD (relative risk reduction 10%). Guidelines for Helicobacter pylori infection have therefore strongly recommended H.pylori eradication therapy in H.pylori positive FD patients. Post-infectious dyspepsia has been described as a distinct clinical entity, based on a large retrospective study that showed a subset of dyspeptic patients who had a history suggestive of post-infectious dyspepsia. In a prospective study, investigators in Spain have found that development of dyspepsia was increased fivefold at 1 year after acute Salmonella gastroenteritis. In post-infectious FD patients, early satiety, weight loss, nausea, and vomiting are frequently reported together with a higher prevalence of impaired gastric accommodation. More recently, infectious FD has been found to be associated with persisting focal T-cell aggregates, decreased CD4+ cells and increased macrophage counts in the duodenum for several moths after acute infection. This suggests impaired ability of the immune system to terminate the inflammatory response after acute insult.Conclusion:In conclusion, H. pylori infections, as well as other gut infections, have been associated with a subset of FD patients. Treatment of underlying infections can potentially lead to improvement in this group of patients.