Mc Namara D A, Buckley M, O'Morain C A
Adelaide & Meath Hospital, Trinity College, Dublin, Ireland.
Gastroenterol Clin North Am. 2000 Dec;29(4):807-18. doi: 10.1016/s0889-8553(05)70148-5.
NUD is a common heterogeneous condition with a multifactorial cause. NUD is a cause of considerable morbidity with an annual incidence of 8% and similar incidence of spontaneous resolution. Its economic effects are considerable. The estimated annual cost to the community of NUD is $431 per patient for the initial 6 months after diagnosis. The annual Health Maintenance Organization (HMO) expenditure on acid-related disorders in one Northern California HMO was estimated to be $59.4 million, of which NUD represented a significant proportion. The association of H. pylori infection with NUD is controversial. There are strong epidemiologic evidence and supportive pathophysiological mechanisms to implicate H. pylori causally in a subset of cases. Treatment studies are likewise conflicting. Evidence suggests that treatment cannot guarantee improvement in all cases of H. pylori-related NUD but that a subset would benefit with complete symptom resolution in the long term. It is not possible currently to predict which patients would or would not respond to eradication therapy. The strength of evidence is such that empiric eradication therapy, based on noninvasive H. pylori testing, can be advocated in young patients with dyspepsia safely and effectively with resultant financial savings.
非溃疡性消化不良（NUD）是一种常见的异质性疾病，病因多因素。NUD是导致相当高发病率的原因，年发病率为8%，自发缓解率相似。其经济影响相当大。诊断后最初6个月，社区中NUD患者的估计年度费用为每人431美元。北加利福尼亚州一家健康维护组织（HMO）每年在酸相关疾病上的支出估计为5940万美元，其中NUD占很大比例。幽门螺杆菌感染与NUD的关联存在争议。有强有力的流行病学证据和支持性病理生理机制表明，在一部分病例中幽门螺杆菌是病因。治疗研究同样存在矛盾。证据表明，治疗不能保证所有幽门螺杆菌相关NUD病例都得到改善，但一部分患者长期来看症状会完全缓解而受益。目前无法预测哪些患者对根除治疗有反应或无反应。现有证据的力度足以支持，基于非侵入性幽门螺杆菌检测的经验性根除治疗，可安全有效地用于年轻消化不良患者，从而节省费用。
