Sanft T, Jones M P
Division of Gastroenterology, Northwestern University Feinberg, School of Medicine, Chicago, IL, USA.
Minerva Gastroenterol Dietol. 2005 Sep;51(3):225-34.
Dyspepsia is a symptom complex common both in the population and in clinical practice. Persons with dyspeptic symptoms who have not been evaluated are considered to have uninvestigated dyspepsia. If, after investigation, no structural or biochemical explanation is identified to explain the person's symptoms, the diagnosis of functional dyspepsia is made. While substantial efforts have been made to provide symptom-based criteria for the diagnosis of functional dyspepsia, the etiology and natural history of the disorder remains elusive. Population-based studies have often had difficulty distinguishing functional dyspepsia from irritable bowel syndrome. Clinically, there is clearly substantial overlap and many persons with functional dyspepsia either present with symptoms consistent with the irritable bowel syndrome or will develop such symptoms at a later date. Even if one can accept functional dyspepsia as an entity separate from irritable bowel syndrome, it is clearly a heterogeneous disorder. Unfortunately attempts using different strategies to subcategorize functional dyspepsia have not made progress with respect to elucidating pathophysiology or directing therapy. Importantly, most persons with functional dyspepsia experience symptom variability resulting in subgroup reassignment over time. Persons presenting with functional dyspepsia will likely remain symptomatic over time. Sadly, at the present time, gastroenterologists have little ability to predict what those symptoms will be, to understand the mechanism for their existence or to offer therapies that offer a reasonable likelihood of success based on a pathophysiologic rationale.
消化不良是一种在普通人群和临床实践中都很常见的症状复合体。有消化不良症状但未经评估的人被认为患有未经调查的消化不良。如果在调查后，没有发现结构或生化方面的解释来解释此人的症状，那么就会做出功能性消化不良的诊断。尽管已经做出了大量努力来提供基于症状的功能性消化不良诊断标准，但该疾病的病因和自然史仍然不清楚。基于人群的研究常常难以将功能性消化不良与肠易激综合征区分开来。临床上，两者显然有很大的重叠，许多功能性消化不良患者要么表现出与肠易激综合征一致的症状，要么在以后会出现此类症状。即使有人可以将功能性消化不良视为一种与肠易激综合征不同的实体，它显然也是一种异质性疾病。不幸的是，使用不同策略对功能性消化不良进行亚分类的尝试在阐明病理生理学或指导治疗方面并没有取得进展。重要的是，大多数功能性消化不良患者会经历症状变化，导致随着时间的推移亚组重新分配。患有功能性消化不良的人随着时间的推移可能仍然会有症状。遗憾的是，目前胃肠病学家几乎没有能力预测这些症状会是什么，理解其存在的机制，或提供基于病理生理原理且有合理成功可能性的治疗方法。
