Mizuta Yohei, Shikuwa Saburo, Isomoto Hajime, Mishima Ryosuke, Akazawa Yuko, Masuda Jun-ichi, Omagari Katsuhisa, Takeshima Fuminao, Kohno Shigeru
Second Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
J Gastroenterol. 2006 Nov;41(11):1025-40. doi: 10.1007/s00535-006-1966-z. Epub 2006 Dec 8.
Functional gastrointestinal disorders, such as functional dyspepsia (FD) and irritable bowel syndrome, are common pathologies of the gut. FD is a clinical syndrome defined as chronic or recurrent pain or discomfort of unknown origin in the upper abdomen. The pathophysiological mechanisms responsible for FD have not been fully elucidated, but new ideas regarding its pathophysiology and the significance of the pathophysiology with respect to the symptom pattern of FD have emerged. In particular, there is growing interest in alterations in gastric motility, such as accommodation to a meal or gastric emptying, and visceral sensation in FD. The mechanisms underlying impaired gastroduodenal motor function are unclear, but possible factors include abnormal neurohormonal function, autonomic dysfunction, visceral hypersensitivity to acid or mechanical distention, Helicobacter pylori infection, acute gastrointestinal infection, psychosocial comorbidity, and stress. Although the optimum treatment for FD is not yet clearly established, acid-suppressive drugs, prokinetic agents, eradication of H. pylori, and antidepressants have been widely used in the management of patients with FD. The therapeutic efficacy of prokinetics such as itopride hydrochloride and mosapride citrate in the treatment of FD is supported by the results of relatively large and well-controlled studies. In addition, recent research has yielded new therapeutic agents and modalities for dysmotility in FD, including agonists/antagonists of various sensorimotor receptors, activation of the nitrergic pathway, kampo medicine, acupuncture, and gastric electric stimulation. This review discusses recent research on the pathophysiology of and treatment options for FD, with special attention given to digestive dysmotility.
功能性胃肠疾病,如功能性消化不良(FD)和肠易激综合征,是常见的肠道疾病。FD是一种临床综合征,定义为上腹部原因不明的慢性或复发性疼痛或不适。导致FD的病理生理机制尚未完全阐明,但关于其病理生理学以及该病理生理学与FD症状模式的相关性的新观点已经出现。特别是,人们对FD患者的胃动力改变(如进餐适应性或胃排空)和内脏感觉越来越感兴趣。胃十二指肠运动功能受损的潜在机制尚不清楚,但可能的因素包括神经激素功能异常、自主神经功能障碍、对酸或机械扩张的内脏高敏感性、幽门螺杆菌感染、急性胃肠道感染、心理社会合并症和压力。虽然FD的最佳治疗方法尚未明确确立,但抑酸药物、促动力剂、根除幽门螺杆菌以及抗抑郁药已广泛用于FD患者的治疗。相对大型且严格对照研究的结果支持了盐酸伊托必利和枸橼酸莫沙必利等促动力剂在治疗FD方面的疗效。此外,最近的研究产生了用于FD动力障碍的新治疗药物和方式,包括各种感觉运动受体的激动剂/拮抗剂、一氧化氮能途径的激活、汉方医学、针灸和胃电刺激。本综述讨论了FD病理生理学和治疗选择的最新研究,特别关注消化动力障碍。
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