Mearin Fermín, Rey Enrique, Balboa Agustín
Instituto de Trastornos Funcionales y Motores Digestivos, Servicio de Aparato Digestivo, Centro Médico Teknon, Barcelona, España.
Gastroenterol Hepatol. 2011 Oct;34 Suppl 2:3-14. doi: 10.1016/S0210-5705(11)70016-4.
As in previous years, a huge number of studies were presented at the Congress of the American Gastroenterology Association (Digestive Diseases Week [DDW]), some of which were better than others. The present article attempts to extract and summarize the most interesting findings reported. In general terms, certain technological advances have been consolidated, with full incorporation into clinical practice, such as impedancemetry and high-resolution manometry. New physiopathological data are coming to light that increasingly indicate the inextricable link between organic and psychological factors (the biopsychosocial model) in functional gastrointestinal disorders (FGID). Despite the high hopes that the Rome III criteria would improve the diagnosis of FGID and especially that of functional dyspepsia, their practical application has been fairly discouraging. Moreover, at least two studies have demonstrated that these criteria cannot be used to differentiate subtypes of functional dyspepsia and that there is wide overlap with gastroesophageal reflux disease. New data were presented on the role of genetic, microinflammatory and psychological factors in the etiopathogenesis of the two main FGID: functional dyspepsia and irritable bowel syndrome (IBS). The results on the safety and efficacy of acotiamide in functional dyspepsia and of linaclotide and prucalopride in idiopathic and IBS-associated constipation were also presented. Several studies, and even meta-analyses, have demonstrated the utility of biofeedback in the treatment of constipation. Even so, the efficacy of this therapy has been questioned due to certain methodological deficiencies in some studies. In DDW 2011, studies confirming the utility of biofeedback, whether hospital- or home-based were presented, in dyssynergy constipation. The present article also mentions certain features of special interest in the diagnosis and treatment of rumination syndrome, thoracic pain of possible esophageal origin and cannabinoid-induced hyperemesis syndrome.
与往年一样，美国胃肠病学会大会（消化疾病周[DDW]）上展示了大量研究，其中一些研究比其他研究更出色。本文试图提炼并总结所报道的最有趣的研究结果。总体而言，某些技术进步已得到巩固，并全面融入临床实践，如阻抗测量法和高分辨率测压法。新的生理病理数据不断涌现，越来越多地表明功能性胃肠疾病（FGID）中器质性和心理因素（生物心理社会模型）之间存在不可分割的联系。尽管人们对罗马Ⅲ标准能改善FGID尤其是功能性消化不良的诊断寄予厚望，但其实际应用却相当令人沮丧。此外，至少有两项研究表明，这些标准不能用于区分功能性消化不良的亚型，且与胃食管反流病有很大重叠。会上还展示了关于遗传、微炎症和心理因素在两种主要FGID——功能性消化不良和肠易激综合征（IBS）发病机制中的作用的新数据。还展示了阿考替胺治疗功能性消化不良以及利那洛肽和普芦卡必利治疗特发性便秘和IBS相关便秘的安全性和有效性结果。多项研究甚至荟萃分析都证明了生物反馈疗法在治疗便秘方面的效用。即便如此，由于一些研究存在某些方法学缺陷，这种疗法的疗效受到了质疑。在DDW 2011上，展示了证实生物反馈疗法（无论是在医院还是在家中进行）对协同失调性便秘有用的研究。本文还提到了反刍综合征、可能源于食管的胸痛和大麻素引起的呕吐综合征在诊断和治疗方面的某些特别有趣的特征。
