Department of Medicine, Veterans Affairs Medical Center and Baylor College of Medicine Houston, Texas, USA.
J Clin Gastroenterol. 2010 Mar;44(3):167-72. doi: 10.1097/MCG.0b013e3181c64c69.
The main issue regarding the approach to the patient with uninvestigated dyspepsia is whether the symptoms are the result of an important clinical illness, which then determines the appropriate management strategy for the treatment of the symptoms. An initial trial of empiric antisecretory drugs is recommended for those without Helicobacter pylori infection and no alarm symptoms, whereas H. pylori eradication is recommended for those with an active H. pylori infection. Treatment expectations for H. pylori infections should theoretically be similar to other common infectious diseases. In most regions, clarithromycin resistance has undermined traditional triple therapy so that it is no longer a suitable choice as an empiric therapy. Four drug therapies, such as sequential, concomitant, and bismuth-quadruple therapy are generally still acceptable choices as empiric therapies. Posteradication testing is highly recommended to provide early identification of otherwise unrecognized increasing antimicrobial resistance. However, despite the ability to successfully cure H. pylori infections, a symptomatic response can be expected in only a minority of those with dyspepsia not associated with ulcers (so called nonulcer dyspepsia). Overall, from the patients stand point, symptomatic relief is often difficult to achieve and physicians must rely on reassurance along with empiric and individualized care.
对于未经调查的消化不良患者，主要的问题是症状是否是重要临床疾病的结果，这决定了治疗症状的适当管理策略。对于没有幽门螺杆菌感染且没有警报症状的患者，建议初始试用经验性抗分泌药物，而对于有活动性幽门螺杆菌感染的患者，建议进行幽门螺杆菌根除治疗。从理论上讲，幽门螺杆菌感染的治疗预期应与其他常见传染病相似。在大多数地区，克拉霉素耐药性破坏了传统的三联疗法，因此它不再是经验性治疗的合适选择。四联药物治疗，如序贯、同时和铋剂四联疗法，通常仍然是经验性治疗的可接受选择。强烈建议进行 posteradication 检测，以尽早发现否则未被识别的不断增加的抗生素耐药性。然而，尽管能够成功治愈幽门螺杆菌感染，但在与溃疡无关的消化不良患者（所谓的非溃疡性消化不良）中，只有少数患者可以预期有症状缓解。总的来说，从患者的角度来看，症状缓解往往难以实现，医生必须依靠安慰以及经验性和个体化的护理。
