Sobin W Harley, Heinrich Thomas W, Drossman Douglas A
United Hospital System, Kenosha, Wisconsin, USA.
Department of Psychiatry, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Am J Gastroenterol. 2017 May;112(5):693-702. doi: 10.1038/ajg.2017.57. Epub 2017 Mar 28.
Patients with functional GI disorders (FGIDs) are commonplace in the gastroenterologist's practice. A number of these patients may be refractory to peripherally acting agents, yet respond to central neuromodulators. There are benefits and potential adverse effects to using TCAs, SSRIs, SNRIs, atypical antipsychotics, and miscellaneous central neuromodulators in these patients. These agents can benefit mood, pain, diarrhea, constipation, nausea, sleep, and depression. The mechanisms by which they work, the differences between classes and individual agents, and the various adverse effects are outlined. Dosing, augmentation strategies, and treatment scenarios specifically for painful FGIDs, FD with PDS, and chronic nausea and vomiting syndrome are outlined.
功能性胃肠病（FGIDs）患者在胃肠病学家的临床实践中很常见。这些患者中有许多可能对外周作用药物难治，但对中枢神经调节剂有反应。在这些患者中使用三环类抗抑郁药（TCAs）、选择性5-羟色胺再摄取抑制剂（SSRIs）、5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）、非典型抗精神病药和其他中枢神经调节剂有好处也有潜在不良反应。这些药物可改善情绪、疼痛、腹泻、便秘、恶心、睡眠和抑郁。文中概述了它们的作用机制、不同类别和个体药物之间的差异以及各种不良反应。还概述了针对疼痛性FGIDs、伴有餐后不适综合征（PDS）的功能性消化不良（FD）以及慢性恶心和呕吐综合征的给药方法、增效策略和治疗方案。
