Review article: current treatment options and management of functional dyspepsia.
Review article: current treatment options and management of functional dyspepsia.
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DOI：
10.1111/j.1365-2036.2012.05128.x
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发表时间：
2012-07
影响因子：
7.6
通讯作者：
Prather C
中科院分区：
文献类型：
--
作者：
Lacy BE;Talley NJ;Locke GR 3rd;Bouras EP;DiBaise JK;El-Serag HB;Abraham BP;Howden CW;Moayyedi P;Prather C
功能性消化不良（FD）是一种常见的功能性胃肠道疾病，根据罗马III标准，FD的定义为在过去3个月内出现上腹部疼痛或不适（FD的患病率为89-90%）、餐后饱胀（75-88%）和早饱（50-82%）的症状，且症状发作至少提前6个月。患者不能有任何结构性疾病的证据来解释症状，胃食管反流的主要症状是排除性的。FD的症状是非特异性的，病理生理学是多种多样的，这部分解释了为什么FD的普遍有效的治疗仍然难以捉摸。介绍FD治疗的当前管理选项（可用时记录治疗增益/缓解率）。幽门螺杆菌根除治疗FD的效用不大（6-14%的治疗增益），而质子泵抑制剂（PPI）的治疗效果（7-10%治疗增益），组胺2型受体拮抗剂（8-35%治疗增益），促动力剂（18-45%），三环类抗抑郁药（TCA）（反应率为64-70%），5-羟色胺再摄取抑制剂（并不比安慰剂好）是有限的，并受到数据不足的阻碍。这篇综述讨论了饮食干预和分析研究，涉及补充和替代药物，心理治疗。根据目前的证据，合理的治疗方法是在H中开始每日PPI治疗。幽门阴性FD患者。如果症状持续，可以开始三环类抗抑郁药的治疗试验。如果症状持续，临床医生可能会开始使用抗伤害剂，促动力剂或某种形式的补充和替代药物进行治疗，尽管支持这种方法的前瞻性研究证据有限。
Functional dyspepsia (FD), a common functional gastrointestinal disorder, is defined by the Rome III criteria as symptoms of epigastric pain or discomfort (prevalence in FD of 89–90%), postprandial fullness (75–88%), and early satiety (50–82%) within the last 3 months with symptom onset at least 6 months earlier. Patients cannot have any evidence of structural disease to explain symptoms and predominant symptoms of gastroesophageal reflux are exclusionary. Symptoms of FD are non-specific and the pathophysiology is diverse, which explains in part why a universally effective treatment for FD remains elusive. To present current management options for the treatment of FD (therapeutic gain/response rate noted when available). The utility of Helicobacter pylori eradication for the treatment of FD is modest (6–14% therapeutic gain), while the therapeutic efficacy of proton pump inhibitors (PPI) (7–10% therapeutic gain), histamine-type-2-receptor antagonists (8–35% therapeutic gain), prokinetic agents (18–45%), tricyclic antidepressants (TCA) (response rates of 64–70%), serotonin reuptake inhibitors (no better than placebo) is limited and hampered by inadequate data. This review discusses dietary interventions and analyses studies involving complementary and alternative medications, and psychological therapies. A reasonable treatment approach based on current evidence is to initiate therapy with a daily PPI in H. pylori-negative FD patients. If symptoms persist, a therapeutic trial with a tricyclic antidepressant may be initiated. If symptoms continue, the clinician can possibly initiate therapy with an antinociceptive agent, a prokinetic agent, or some form of complementary and alternative medications, although evidence from prospective studies to support this approach is limited.
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