Gisbert Javier P, Calvet Xavier, Ferrándiz Juan, Mascort Juan, Alonso-Coello Pablo, Marzo Mercè
Servicio de Aparato Digestivo, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España.
Aten Primaria. 2012 Dec;44(12):727.e1-727.e38. doi: 10.1016/j.aprim.2012.05.003. Epub 2012 Oct 1.
The aim of the Clinical Practice Guideline (CPG) on the Management of Patients with Dyspepsia is to generate recommendations on the optimal approach to dyspepsia in the primary care and specialized outpatient setting. The main objective of this CPG is to help to optimize the diagnostic process, identifying patients with a low risk of a serious organic disease (mainly tumoral), who could be safely managed without the need for invasive diagnostic tests and/or referral to a specialist. The importance of this aim lies in the need to accurately diagnose patients with esophagogastric cancer and correctly treat peptic ulcer while, at the same time, reduce negative endoscopies in order to appropriately use the available healthcare resources. This CPG reviews the initial strategies that can be used in patients with uninvestigated dyspepsia and evaluates the possible decision to begin empirical therapy or to investigate the existence of a lesion that could explain the symptoms. This CPG also discusses functional dyspepsia, which encompasses all patients with dyspepsia with no demonstrable cause on endoscopy. Recommendations for the diagnosis and treatment of peptic ulcer and Helicobacter pylori infection are also made. To classify the scientific evidence and strengthen the recommendations, the GRADE (Grading of Recommendations Assessment, Development and Evaluation Working Group) system has been used (http://www.gradeworkinggroup.org/).
《消化不良患者管理临床实践指南》的目的是就基层医疗和专科门诊环境中消化不良的最佳处理方法提出建议。本临床实践指南的主要目标是帮助优化诊断流程，识别严重器质性疾病（主要是肿瘤）风险较低的患者，这些患者无需进行侵入性诊断检查和/或转诊至专科医生即可得到安全管理。这一目标的重要性在于需要准确诊断食管胃癌患者并正确治疗消化性溃疡，同时减少不必要的内镜检查，以便合理利用现有的医疗资源。本临床实践指南回顾了可用于未经检查的消化不良患者的初始策略，并评估开始经验性治疗或调查是否存在可解释症状的病变的可能决策。本临床实践指南还讨论了功能性消化不良，其涵盖在内镜检查中未发现明显病因的所有消化不良患者。同时也给出了消化性溃疡和幽门螺杆菌感染的诊断与治疗建议。为了对科学证据进行分类并强化建议，采用了GRADE（推荐分级评估、制定与评价工作组）系统（http://www.gradeworkinggroup.org/）。
