Division of Gastroenterology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, 15213, USA,
Dig Dis Sci. 2014 Jun;59(6):1088-98. doi: 10.1007/s10620-014-3144-0. Epub 2014 Apr 9.
Dyspeptic symptoms are common with most patients suffering functional disorders that remain a therapeutic challenge for medical practitioners. Within the last three decades, gastric infection, altered motility, and hypersensitivity have gained and lost traction in explaining the development of functional dyspepsia. Considering these shifts, the aim of this review was to analyze changing understanding of and approaches to dyspepsia over a longer time period. Monographs, textbooks, and articles published during the last three centuries show that our understanding of normal gastric function has improved dramatically. With increased insight came new ideas about disease mechanisms, diagnostic options, and treatments. Despite shifts over time, the importance of functional abnormalities was recognized early on and explained in the context of societal influences and stressors, anxieties, and biological influences, thus resembling the contemporary biopsychosocial model of illness. Symptoms were often attributed to changes in secretion, motility, and sensation or perception with technological innovation often influencing proposed mechanisms and treatments. Many of the principles or even agents applied more than a century ago are still part of today's approach. This includes acid suppression, antiemetics, analgesics, and even non-pharmacologic therapies, such as gastric decompression or electrical stimulation of the stomach. This historical information does not only help us understand how we arrived at our current state of knowledge and standards of care, it also demonstrates that enthusiastic adoption of various competing explanatory models and the resulting treatments often did not survive the test of time. In view of the benign prognosis of dyspepsia, the data may function as a call for caution to avoid the potential harm of overly aggressive approaches or treatments with a high likelihood of adverse effects.
消化不良症状在大多数功能性疾病患者中很常见，这对医学从业者来说仍然是一个治疗挑战。在过去的三十年中，胃感染、运动改变和超敏反应在解释功能性消化不良的发病机制方面得到了重视，又失去了重视。考虑到这些变化，本综述的目的是分析在较长时间内对消化不良的理解和方法的变化。在过去三个世纪中出版的专着、教科书和文章表明，我们对正常胃功能的理解有了显著提高。随着认识的提高，关于疾病机制、诊断选择和治疗的新想法也出现了。尽管随着时间的推移发生了变化，但早在早期就认识到了功能性异常的重要性，并从社会影响和压力、焦虑以及生物影响的角度解释了这种异常，因此类似于当代的生物心理社会疾病模型。症状通常归因于分泌、运动和感觉或感知的变化，技术创新通常会影响提出的机制和治疗方法。一个多世纪前应用的许多原则甚至药物仍构成当今治疗方法的一部分。这包括酸抑制、止吐药、镇痛药，甚至非药物治疗，如胃减压或胃电刺激。这些历史信息不仅帮助我们了解我们如何达到当前的知识状态和护理标准，还表明，对各种竞争的解释模型的热情采用以及由此产生的治疗方法往往没有经受住时间的考验。鉴于消化不良的良性预后，这些数据可能是一种谨慎的呼吁，以避免过度激进的方法或治疗方法可能带来的潜在危害，这些方法或治疗方法很可能会产生不良影响。
