TARGID (Translational Research Center for Gastrointestinal Disorders), University of Leuven, Herestraat 49, Leuven 3000, Belgium.
Nat Rev Gastroenterol Hepatol. 2013 Mar;10(3):134-41. doi: 10.1038/nrgastro.2013.14. Epub 2013 Feb 12.
Dyspepsia refers to a heterogeneous group of symptoms that are localized in the epigastric region. Typical dyspeptic symptoms include postprandial fullness, early satiation, epigastric pain and epigastric burning, but other upper gastrointestinal symptoms such as nausea, belching or abdominal bloating often occur. Functional dyspepsia is defined as the presence of dyspeptic symptoms in the absence of an organic cause that readily explains them. The Rome III consensus proposed the subdivision of functional dyspepsia into postprandial distress syndrome (PDS), characterized by postprandial fullness and early satiation, and epigastric pain syndrome (EPS), characterized by epigastric pain or burning. Epidemiological studies in the USA and Europe confirmed the presence of both subgroups, with good separation between EPS and PDS. By contrast, other studies have found major overlap between EPS and PDS in patients with functional dyspepsia in specialist care centres in Europe and Asia. Preliminary pathophysiological studies suggest that PDS might be characterized by a higher prevalence of impaired gastric accommodation than EPS and raised duodenal eosinophil counts. Whether different treatment approaches are needed for EPS and PDS is currently unclear; only acotiamide, a new drug for the treatment of functional dyspepsia, has been found to be efficacious in PDS but not in EPS. Further randomized controlled trials testing treatment response by subgroup are urgently needed.
消化不良是指一组发生于上腹部的症状，具有异质性。典型的消化不良症状包括餐后饱胀、早饱、上腹痛和上腹部烧灼感，但也常出现其他上胃肠道症状，如恶心、嗳气或腹胀。功能性消化不良的定义为存在消化不良症状，而无易于解释这些症状的器质性病因。Rome III 共识提出将功能性消化不良分为餐后不适综合征（PDS）和上腹疼痛综合征（EPS），前者的特征为餐后饱胀和早饱，后者的特征为上腹疼痛或烧灼感。美国和欧洲的流行病学研究证实了这两个亚组的存在，EPS 和 PDS 之间有较好的区分。相比之下，其他研究在欧洲和亚洲的专科医疗中心发现，功能性消化不良患者中 EPS 和 PDS 之间存在较大重叠。初步的病理生理学研究表明，与 EPS 相比，PDS 可能具有更高的胃容纳功能受损发生率和十二指肠嗜酸性粒细胞计数升高。目前尚不清楚 EPS 和 PDS 是否需要不同的治疗方法；只有一种治疗功能性消化不良的新药——阿考替胺，被发现对 PDS 有效，而对 EPS 无效。迫切需要进一步的随机对照试验来检验亚组的治疗反应。
