Cremonini Filippo, Delgado-Aros Silvia, Talley Nicholas J
Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Mayo Clinic College of Medicine, Charlton 8-138, 200 First Street SW, Rochester MN 55905, USA.
Best Pract Res Clin Gastroenterol. 2004 Aug;18(4):717-33. doi: 10.1016/j.bpg.2004.04.003.
The therapeutic management of functional dyspepsia remains a major challenge for the gastroenterologist. Current therapies available are based on putative underlying pathophysiologic mechanisms, including gastric acid sensitivity, slow gastric emptying and Helicobacter pylori infection, but only a small proportion of patients achieve symptomatic benefit from these therapeutic approaches. Relatively novel mechanistic concepts under testing include impaired gastric accomodation, visceral hypersensitivity, and central nervous system dysfunction. Serotonergic modulators (e.g. the 5-HT4 agonist tegaserod, the 5-HT3 antagonist alosetron and the 5-HT1P agonist sumatriptan), CCK-1 antagonists (e.g. dexloxiglumide), opioid agonists (e.g. asimadoline), N-methyl-D-aspartate (NMDA) receptor antagonists (e.g dextromethorphan), neurokinin antagonists (e.g. talnetant), capsaicin-like agents and antidepressants are among the agents currently under investigation. It seems unlikely, however, that targeting a single mechanism with an individual drug will result in complete symptom remission in most cases.
功能性消化不良的治疗管理仍然是胃肠病学家面临的一项重大挑战。目前可用的治疗方法基于假定的潜在病理生理机制，包括胃酸敏感性、胃排空缓慢和幽门螺杆菌感染，但只有一小部分患者能从这些治疗方法中获得症状改善。正在测试的相对新颖的机制概念包括胃容纳功能受损、内脏超敏反应和中枢神经系统功能障碍。血清素能调节剂（如5-HT4激动剂替加色罗、5-HT3拮抗剂阿洛司琼和5-HT1P激动剂舒马曲坦）、CCK-1拮抗剂（如右氯谷胺）、阿片类激动剂（如阿西马朵林）、N-甲基-D-天冬氨酸（NMDA）受体拮抗剂（如右美沙芬）、神经激肽拮抗剂（如他林坦）、辣椒素样药物和抗抑郁药都在目前的研究之列。然而，在大多数情况下，用单一药物针对单一机制进行治疗似乎不太可能使症状完全缓解。
