Department of Gastroenterology, Ren ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Institute of Digestive Disease, Shanghai, China.
J Dig Dis. 2013 Dec;14(12):623-5. doi: 10.1111/1751-2980.12094.
The management of functional dyspepsia (FD) is a challenge for gastroenterologists in clinical practice. The eradication of Helicobacter pylori (H. pylori) and the utility of antacids, prokinetics and antidepressants are recommended as treatment choices for FD by consensus. Unlike in Europe and the USA, H. pylori eradication in Asia can lead to a higher proportion of FD patients with symptom relief and a higher symptom response rate to prokinetics. Moreover, response rates to anti-secretory drugs such as proton pump inhibitors deviate considerably from those in the Western world. Digestive enzymes and probiotics have also been reported to be used for the treatment of FD but evidence of their effectiveness is not adequate. Anti-anxiety drugs and antidepressants are reported to have peculiar effects on FD, especially in refractory FD, in which tricyclic antidepressants and selective serotonin reuptake inhibitors at small doses are most often recommended. When these drugs are selected to treat FD, clinicians should also consider their roles in treating mental disorders as well as the direct effects of neurotransmitters on gastroenterological disorders. However, their effects need to be further verified by prospective double-blinded randomized clinical trials with a large sample size. Distinguishing among different symptom subtypes has limited significance in guiding the medical choice for FD and individualized drug treatment should be recommended in its management.
功能性消化不良（FD）的管理对临床实践中的胃肠病学家来说是一个挑战。共识推荐根除幽门螺杆菌（H. pylori）以及使用抗酸剂、促动力药和抗抑郁药作为 FD 的治疗选择。与欧洲和美国不同，亚洲根除 H. pylori 可导致更多的 FD 患者症状缓解，对促动力药的症状缓解率更高。此外，抗分泌药物（如质子泵抑制剂）的反应率与西方世界有很大的差异。消化酶和益生菌也被报道用于治疗 FD，但它们的疗效证据不足。抗焦虑药和抗抑郁药被报道对 FD 有特殊作用，特别是在难治性 FD 中，通常推荐使用三环类抗抑郁药和小剂量选择性 5-羟色胺再摄取抑制剂。当选择这些药物治疗 FD 时，临床医生还应考虑它们在治疗精神障碍方面的作用以及神经递质对胃肠道疾病的直接影响。然而，它们的效果需要通过前瞻性、双盲、随机临床试验来进一步验证，该试验需要有大量的样本。区分不同的症状亚型对指导 FD 的医学选择意义有限，应推荐个体化药物治疗。
