Mearin Fermín, Rey Enrique, Balboa Agustín
Instituto de Trastornos Funcionales y Motores Digestivos, Servicio de Aparato Digestivo, Centro Médico Teknon, Barcelona, Spain.
Gastroenterol Hepatol. 2012 Sep;35 Suppl 1:3-11. doi: 10.1016/S0210-5705(12)70029-8.
We summarize and discuss the studies presented at the congress of the American Association of Gastroenterology (Digestive Disease Week) that, in our opinion, are of greatest interest. Both clinically and physiopathologically, functional gastrointestinal (GI) disorders are highly complex. A single cause is unlikely to explain symptoms as heterogeneous as those of functional dyspepsia and irritable bowel syndrome (IBS). Therefore, it is easier (and more useful) to try to understand functional GI disorders using a bio-psycho-social model. Moreover, data supporting the combined importance of genetic, organic and psychological factors in the onset and persistence of functional GI disorders are increasingly convincing. This year, new data have been provided on pharmacogenetics in gastroparesis, on microinflammation or alterations in the modulation of somatic and visceral sensitivity in functional dyspepsia, and on the impact of psychological factors in IBS. From the therapeutic point of view, further information has been provided on the role of probiotics, the antinociceptive effect of linaclotide (demonstrated in several studies presented this year), and on the high efficacy of hypnotherapy in patients with IBS. Finally, data on the clinical management of patients with constipation due to pelvic floor dyssynergia and on the safety and efficacy of prucalopride in patients with severe constipation were also of interest.
我们总结并讨论了在美国胃肠病学会大会(消化疾病周)上发表的研究,我们认为这些研究最具价值。无论是在临床还是病理生理方面,功能性胃肠(GI)疾病都极为复杂。单一病因不太可能解释像功能性消化不良和肠易激综合征(IBS)这样症状各异的情况。因此,使用生物 - 心理 - 社会模型来理解功能性胃肠疾病更容易(也更有用)。此外,支持遗传、器质性和心理因素在功能性胃肠疾病的发病和持续存在中共同重要性的数据越来越有说服力。今年,关于胃轻瘫的药物遗传学、功能性消化不良中微炎症或躯体与内脏敏感性调节改变以及心理因素对IBS的影响都有了新数据。从治疗角度来看,关于益生菌的作用、利那洛肽的抗伤害感受作用(在今年发表的多项研究中得到证实)以及催眠疗法对IBS患者的高效性都有了更多信息。最后,关于盆底失协调导致便秘患者的临床管理以及普芦卡必利对严重便秘患者的安全性和有效性的数据也很有价值。