Newest Drugs for Chronic Unexplained Nausea and Vomiting.
Newest Drugs for Chronic Unexplained Nausea and Vomiting.
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治疗慢性不明原因恶心和呕吐的最新药物。
DOI：
10.1007/s11938-016-0110-2
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Hasler,WilliamL
中科院分区：
文献类型：
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作者：
Hasler,WilliamL
意见陈述慢性不明原因恶心和呕吐(CUNV)是指以恶心和/或呕吐为特征的一种症状复合体，具有正常的诊断测试，包括解剖评估(包括上消化道内窥镜检查)和上肠道功能测量(例如胃排空测试)。这种情况下的恶心和呕吐被认为是由异常的外周或中枢神经体液活动引起的。有相当一部分患者满足这一诊断，因为超过一半的受试者表现出正常的胃排空率。CUNV没有进行任何药物治疗的随机、安慰剂对照试验。然而，在CUNV中具有潜在治疗益处的药物包括止吐药物、被认为通过降低胃敏感度起作用的神经调节治疗，以及具有推进作用的药物以刺激上肠推进。最近批准的具有止吐能力的药物包括具有新给药方式的5-羟色胺拮抗剂和具有或不具有额外的5-羟色胺能阻断能力的神经激肽拮抗剂。现有的具有偶然止吐益处的抗精神病药和止痛神经调节疗法正在考虑用于治疗这种疾病。此外，目前的研究将确定通过作用于胃十二指肠5-羟色胺、胃动素和Ghrelin受体来刺激胃排空的药物的潜在治疗作用。这项目前的研究可能会拓宽不明原因恶心和呕吐的难治性病例的治疗选择。
Opinion statementChronic unexplained nausea and vomiting (CUNV) refers to a symptom complex defined by nausea and/or vomiting with normal diagnostic testing, including anatomic assessments (including upper endoscopy) and measures of upper gut function (e.g., gastric emptying testing). Nausea and vomiting in this condition are postulated to result from aberrant peripheral or central neurohumoral activity. A substantial subset of patients satisfies this diagnosis as more than half of individuals referred for scintigraphic testing exhibit normal gastric emptying rates. No randomized, placebo-controlled trials of any medication treatment have been performed in CUNV. However, agents with potential therapeutic benefits in CUNV include antiemetic drugs, neuromodulatory treatments which are proposed to act by reducing gastric sensitivity, and medications with prokinetic action to stimulate upper gut propulsion. Recently approved drugs with antiemetic capability include serotonin antagonists with novel modes of delivery and neurokinin antagonists with or without additional serotonergic blocking capabilities. Existing neuroleptics and pain-modifying neuromodulatory therapies with fortuitous antiemetic benefits are being considered for their benefits in this disorder. Furthermore, current investigations will define potential therapeutic actions of agents that stimulate gastric emptying via action on gastroduodenal serotonin, motilin, and ghrelin receptors. This current research may broaden the treatment options for refractory cases of unexplained nausea and vomiting.