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饮食、食物摄入与功能性消化不良症状发病机制中的生理紊乱

Diet, food intake, and disturbed physiology in the pathogenesis of symptoms in functional dyspepsia.

作者信息

Feinle-Bisset Christine, Vozzo Rosalie, Horowitz Michael, Talley Nicholas J

机构信息

Department of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

出版信息

Am J Gastroenterol. 2004 Jan;99(1):170-81. doi: 10.1111/j.1572-0241.2004.04003.x.


DOI:10.1111/j.1572-0241.2004.04003.x
PMID:14687160
Abstract

Functional dyspepsia (FD) remains a relatively poorly characterized gastrointestinal disorder of unknown etiology that is frequently difficult to manage. A systematic review of the literature relating to food intake and FD is summarized here. Many patients with FD report symptoms after meal ingestion, including fullness, bloating, epigastric pain, nausea, and vomiting, and this has been interpreted as indicative of an underlying "motor disorder of the stomach or small intestine." Such hypotheses are, however, still largely unsubstantiated, and the data that do exist are inconclusive, particularly as few studies have directly examined the temporal relationships between dyspeptic symptoms, meal ingestion, and disordered gastric motility. Moreover, studies attempting to relate symptoms to specific disturbances in gastric motor function have, in most cases, not evaluated symptoms concurrently with the function test, and/or have used suboptimal symptom scoring to quantify symptoms. Furthermore, the term "early satiety" has been used loosely as a symptom, rather than a quantitative measure of food intake. Currently, the most widely accepted mechanism underlying FD is visceral hypersensitivity, which may contribute to both enhanced motor and symptomatic responses to food ingestion. However, the possible contribution of food and dietary habits to the induction and/or exacerbation of dyspeptic symptoms represents a relatively new area-despite frequent reports by patients that their symptoms are often related to food ingestion; this association has not been formally assessed. Dietary assessments have frequently implicated fatty foods in symptom induction, and these findings are supported by laboratory-based studies, particularly the demonstration that FD patients more often experience symptoms after intraduodenal infusions of fat, than glucose. Further studies into the potential role of dietary factors in the induction of dyspeptic symptom are required to establish whether dietary therapies have any place in the management of FD.

摘要

功能性消化不良(FD)仍然是一种病因不明、特征相对不明确的胃肠道疾病,常常难以治疗。本文总结了有关食物摄入与FD的文献系统综述。许多FD患者在进食后会出现症状,包括饱腹感、腹胀、上腹部疼痛、恶心和呕吐,这被解释为潜在的“胃或小肠运动障碍”的迹象。然而,这些假设在很大程度上仍未得到证实,现有的数据也尚无定论,尤其是很少有研究直接考察消化不良症状、进食与胃动力紊乱之间的时间关系。此外,大多数试图将症状与胃运动功能的特定紊乱联系起来的研究,并未在进行功能测试的同时评估症状,和/或使用了欠佳的症状评分来量化症状。此外,“早饱”一词一直被宽泛地用作一种症状,而不是对食物摄入量的定量衡量。目前,FD最被广泛接受的潜在机制是内脏高敏感性,这可能导致对食物摄入的运动和症状反应增强。然而,食物和饮食习惯对消化不良症状的诱发和/或加重可能产生的影响是一个相对较新的领域——尽管患者经常报告他们的症状通常与食物摄入有关;这种关联尚未得到正式评估。饮食评估经常表明高脂肪食物会诱发症状,这些发现得到了基于实验室研究的支持,特别是有证据表明,FD患者在十二指肠内注入脂肪后比注入葡萄糖后更常出现症状。需要进一步研究饮食因素在诱发消化不良症状中的潜在作用,以确定饮食疗法在FD治疗中是否有一席之地。

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