Thijs J C, Kleibeuker J H
Department of Gastroenterology, Bethesda Hospital, Hoogeveen, The Netherlands.
Minerva Gastroenterol Dietol. 2005 Sep;51(3):213-24.
Dyspepsia is very common in western countries, where 10-40% of the population experience upper abdominal pain or discomfort over the course of one year. Mostly it is a chronic relapsing problem. Prompt endoscopy is imperative in all patients with sinister symptoms (including the first appearance of symptoms after the age of 50-55). In other patients endoscopy is unlikely to contribute to medical management. In those a ''test and treat'' strategy implying non invasive testing for Helicobacter pylori (H. pylori) and treatment of the infection if present seems to be the best approach under current conditions (H. pylori prevalence among dyspeptics 28-61% in recent studies). If the patient is H. pylori-negative and in case of persisting symptoms after successful H. pylori eradication, empirical treatment with an antisecretory drug is justified. Endoscopy is reserved for those patients in whom this approach fails. With a continuing decrease in H. pylori prevalence the accuracy of the used non-invasive H. pylori test needs to be high and urea breath tests are to be preferred, the faecal antigen test being a reasonable alternative. At a very low prevalence of H. pylori in the dyspeptic population (below 10%) non invasive testing for H. pylori loses its significance and empirical treatment with an antisecretory drug becomes a rational first step. The physician involved in the care for dyspeptic patients needs to be aware of the current H. pylori prevalence.
消化不良在西方国家非常常见，在这些国家，10%至40%的人口在一年中会经历上腹部疼痛或不适。大多数情况下，这是一个慢性复发性问题。对于所有有可疑症状的患者（包括50至55岁后首次出现症状的患者），及时进行内镜检查至关重要。在其他患者中，内镜检查不太可能有助于医疗管理。在这些患者中，一种“检测和治疗”策略，即对幽门螺杆菌（H. pylori）进行非侵入性检测，并对存在感染的患者进行治疗，似乎是当前情况下的最佳方法（近期研究中消化不良患者中幽门螺杆菌的患病率为28%至61%）。如果患者幽门螺杆菌检测呈阴性，且在成功根除幽门螺杆菌后仍有持续症状，使用抗分泌药物进行经验性治疗是合理的。内镜检查仅适用于这种方法失败的患者。随着幽门螺杆菌患病率的持续下降，所使用的非侵入性幽门螺杆菌检测的准确性需要很高，尿素呼气试验是首选，粪便抗原检测是一种合理的替代方法。在消化不良人群中幽门螺杆菌患病率非常低（低于10%）时，对幽门螺杆菌进行非侵入性检测就失去了意义，使用抗分泌药物进行经验性治疗成为合理的第一步。参与消化不良患者护理的医生需要了解当前幽门螺杆菌的患病率。
