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[功能性和运动性消化障碍]

[Functional and motor digestive disorders].

作者信息

Mearin Fermín, Rey Enrique, Balboa Agustín

机构信息

Instituto de Trastornos Funcionales y Motores Digestivos, Servicio de Aparato Digestivo, Centro Médico Teknon, Barcelona, España.

出版信息

Gastroenterol Hepatol. 2013 Oct;36 Suppl 2:3-14. doi: 10.1016/S0210-5705(13)70048-7.

Abstract

This article discusses the most interesting studies on functional and motility gastrointestinal disorders presented in Digestive Diseases Week (DDW) in 2013. New data were reported on the clinical importance of functional gastrointestinal disorders (FGID) and on how they can produce numerous disturbances such as inflammatory bowel disease. These disturbances are associated with somatic functional disease and particularly with fatigue. In addition, new data have emerged on the physiopathology of these disorders, with some studies reporting that environmental factors and events in early infancy can favor their development. Data were also presented on how bile acids can increase susceptibility to diarrhea in patients with irritable bowel syndrome (IBS) and on how the type of food intake can favor the development of symptoms. More data are available on the presence of underlying celiac disease in patients with IBS, which should prompt us to investigate this disease in our patients. Likewise, indiscriminate application of a gluten-free diet in patients with IBS has been shown not to produce a clear improvement. Regarding the physiopathology of functional dyspepsia (FD), results have been presented on how psychological factors can modify gastric accommodation and how this is in turn related to visceral hypersensitivity and gastric emptying. Regarding therapy, mirtazapine can improve symptoms and lead to weight gain in patients with severe FD and substantial weight loss. Results were presented on new drugs for IBS such as ibodutant and on old drugs with new applications such as mesalazine and ebastine. The antinociceptive effect of linaclotide is now better understood and a meta-analysis has shown its effectiveness in IBS with constipation as the main symptom. In patients with constipation, pelvic floor dysynergy can be diagnosed by a simple clinical interview and rectal touch. More data are available on the efficacy of prucalopride (which has been shown to accelerate colon transit time) and data were provided on plecanatide, a potential new drug that could be useful in constipation. Finally, results were presented on the use of botulinum toxin injection in patients with spastic motility disorders of the esophagus. Also worthy of mention is a study confirming a higher frequency of esophageal cancer patients with achalasia who receive treatment.

摘要

本文讨论了2013年消化疾病周(DDW)上展示的关于功能性胃肠疾病和胃肠动力障碍的最有趣的研究。报告了关于功能性胃肠疾病(FGID)临床重要性的新数据,以及它们如何引发诸如炎症性肠病等多种紊乱。这些紊乱与躯体功能性疾病相关,尤其是与疲劳有关。此外,关于这些疾病的生理病理学也有了新数据,一些研究报告称环境因素和婴儿早期经历可能促进其发展。还展示了胆汁酸如何增加肠易激综合征(IBS)患者腹泻易感性以及食物摄入类型如何促进症状发展的数据。关于IBS患者潜在的乳糜泻存在情况有了更多数据,这应促使我们对患者进行该疾病的调查。同样,已表明在IBS患者中不加区分地应用无麸质饮食并不能带来明显改善。关于功能性消化不良(FD)的生理病理学,展示了心理因素如何改变胃容纳功能以及这又如何与内脏高敏感性和胃排空相关的结果。在治疗方面,米氮平可改善重度FD且体重显著减轻患者的症状并导致体重增加。展示了IBS新药如依波度坦以及有新应用的老药如美沙拉嗪和依巴斯汀的结果。利那洛肽的镇痛作用现在有了更好的理解,一项荟萃分析表明其对以便秘为主要症状的IBS有效。在便秘患者中,通过简单的临床问诊和直肠触诊可诊断盆底协同失调。关于普芦卡必利的疗效有了更多数据(已表明其可加速结肠转运时间),还提供了可能对便秘有用的潜在新药普卡那肽的数据。最后,展示了肉毒杆菌毒素注射在食管痉挛性动力障碍患者中的应用结果。同样值得一提的是一项研究证实接受治疗的贲门失弛缓症食管癌患者频率更高。

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