Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Nat Rev Gastroenterol Hepatol. 2013 Mar;10(3):168-74. doi: 10.1038/nrgastro.2013.9. Epub 2013 Jan 29.
Functional dyspepsia is the most common reason for patients to experience chronic epigastric pain or discomfort. The causes of functional dyspepsia are multifactorial but Helicobacter pylori infection is one likely candidate. Infection with this bacterial pathogen clearly results in chronic mucosal inflammation in the stomach and duodenum, which, in turn, might lead to abnormalities in gastroduodenal motility and sensitivity. Chronic gastritis might also affect a variety of endocrine functions of the stomach including the production of the gastrointestinal hormones and neurotransmitters somatostatin, gastrin and ghrelin. Although these abnormalities might generate symptoms in some patients with functional dyspepsia, the clinical evidence needs to be critically evaluated before this hypothesis can be confirmed. A Cochrane review reported that eradication of H. pylori in these patients had a small but statistically significant long-term effect on symptom relief when compared with placebo, lasting at least 12 months after 1 week of eradication therapy. The efficacy of eradication therapy was seen in all symptom subtypes of functional dyspepsia, but was more marked in Asian than Western patients. This evidence has led to alterations in most of the major guidelines throughout the world, which now recommend H. pylori eradication in patients with functional dyspepsia if they test positive for this bacterium.
功能性消化不良是患者出现慢性上腹痛或不适的最常见原因。功能性消化不良的病因是多因素的，但幽门螺杆菌感染是一个可能的候选因素。这种细菌病原体的感染显然会导致胃和十二指肠的慢性黏膜炎症，进而导致胃十二指肠运动和敏感性的异常。慢性胃炎也可能影响胃的多种内分泌功能，包括胃肠道激素和神经递质生长抑素、胃泌素和胃饥饿素的产生。尽管这些异常可能会在一些功能性消化不良患者中产生症状，但在确认这一假设之前，需要对临床证据进行批判性评估。一项 Cochrane 综述报告称，与安慰剂相比，这些患者中幽门螺杆菌的根除治疗在缓解症状方面具有较小但具有统计学意义的长期效果，在根除治疗后至少 12 个月仍能持续缓解症状。根除治疗的疗效在功能性消化不良的所有症状亚型中均可见，但在亚洲患者中比在西方患者中更为显著。这一证据导致全球大多数主要指南发生了改变，现在建议对功能性消化不良患者进行幽门螺杆菌根除治疗，如果他们的这种细菌检测呈阳性。
