United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis
United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis
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DOI：
10.1111/nmo.14237
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发表时间：
2021-08-01
影响因子：
3.5
通讯作者：
Tack, Jan
中科院分区：
文献类型：
--
作者：
Schol, Jolien;Wauters, Lucas;Tack, Jan
背景胃轻瘫是一种以上腹部症状和胃排空延迟（GE）为特征的疾病，无任何机械性梗阻。由于缺乏有关胃轻瘫诊断和管理的指导，这种情况在临床实践中具有挑战性。方法采用德尔菲法，由来自19个欧洲国家的40名专家对89份声明进行文献总结和投票。证据的质量通过建议评估、发展和评价标准的分级进行评价。25个声明达成共识（定义为>= 80%的一致性）。结果欧洲共识将胃轻瘫定义为在没有机械性梗阻的情况下出现与延迟性胃排空相关的症状。恶心和呕吐被确定为主要症状，通常与消化不良的餐后窘迫综合征症状共存。胃轻瘫的真正流行病学尚不清楚，但糖尿病、胃手术、某些神经和结缔组织疾病以及某些药物的使用被认为是危险因素。虽然专家组一致认为这些患者存在胃运动功能严重受损，但对基础病理生理学尚未达成共识。专家组一致认为，诊断需要进行上消化道内窥镜检查和GE测试。在重度体重减轻的情况下，除了营养支持外，仅饮食疗法、多巴胺-2拮抗剂和5-HT 4受体激动剂被认为是适当的疗法。对于质子泵抑制剂、其他类型的止吐药或促动力药、神经调节剂、补充治疗、心理治疗或更具侵入性的治疗，尚未达成共识。最后，人们一致认为胃轻瘫对生活质量和医疗费用有不利影响，胃轻瘫的长期预后取决于病因。一个由欧洲专家组成的多国小组总结了目前关于胃轻瘫定义、症状特征、病理生理学、诊断和治疗的共识。
Background Gastroparesis is a condition characterized by epigastric symptoms and delayed gastric emptying (GE) rate in the absence of any mechanical obstruction. The condition is challenging in clinical practice by the lack of guidance concerning diagnosis and management of gastroparesis. Methods A Delphi consensus was undertaken by 40 experts from 19 European countries who conducted a literature summary and voting process on 89 statements. Quality of evidence was evaluated using grading of recommendations assessment, development, and evaluation criteria. Consensus (defined as >= 80% agreement) was reached for 25 statements. Results The European consensus defined gastroparesis as the presence of symptoms associated with delayed GE in the absence of mechanical obstruction. Nausea and vomiting were identified as cardinal symptoms, with often coexisting postprandial distress syndrome symptoms of dyspepsia. The true epidemiology of gastroparesis is not known in detail, but diabetes, gastric surgery, certain neurological and connective tissue diseases, and the use of certain drugs recognized as risk factors. While the panel agreed that severely impaired gastric motor function is present in these patients, there was no consensus on underlying pathophysiology. The panel agreed that an upper endoscopy and a GE test are required for diagnosis. Only dietary therapy, dopamine-2 antagonists and 5-HT4 receptor agonists were considered appropriate therapies, in addition to nutritional support in case of severe weight loss. No consensus was reached on the use of proton pump inhibitors, other classes of antiemetics or prokinetics, neuromodulators, complimentary, psychological, or more invasive therapies. Finally, there was consensus that gastroparesis adversely impacts on quality of life and healthcare costs and that the long-term prognosis of gastroparesis depends on the cause. Conclusions and Inferences A multinational group of European experts summarized the current state of consensus on definition, symptom characteristics, pathophysiology, diagnosis, and management of gastroparesis.