Carmona-Sánchez R, Gómez-Escudero O, Zavala-Solares M, Bielsa-Fernández M V, Coss-Adame E, Hernández-Guerrero A I, Huerta-Iga F, Icaza-Chávez M E, Lira-Pedrín M A, Lizárraga-López J A, López-Colombo A, Noble-Lugo A, Pérez-Manauta J, Raña-Garibay R H, Remes-Troche J M, Tamayo J L, Uscanga L F, Zamarripa-Dorsey F, Valdovinos Díaz M A, Velarde-Ruiz Velasco J A
Práctica privada, San Luis Potosí, San Luis Potosí, México.
Clínica de Gastroenterología, Endoscopia Digestiva y Motilidad Gastrointestinal, Hospital Ángeles Puebla, Puebla, Puebla, México.
Rev Gastroenterol Mex. 2017 Oct-Dec;82(4):309-327. doi: 10.1016/j.rgmx.2017.01.001. Epub 2017 Apr 14.
Since the publication of the 2007 dyspepsia guidelines of the Asociación Mexicana de Gastroenterología, there have been significant advances in the knowledge of this disease. A systematic search of the literature in PubMed (01/2007 to 06/2016) was carried out to review and update the 2007 guidelines and to provide new evidence-based recommendations. All high-quality articles in Spanish and English were included. Statements were formulated and voted upon using the Delphi method. The level of evidence and strength of recommendation of each statement were established according to the GRADE system. Thirty-one statements were formulated, voted upon, and graded. New definition, classification, epidemiology, and pathophysiology data were provided and include the following information: Endoscopy should be carried out in cases of uninvestigated dyspepsia when there are alarm symptoms or no response to treatment. Gastric and duodenal biopsies can confirm Helicobacter pylori infection and rule out celiac disease, respectively. Establishing a strong doctor-patient relationship, as well as dietary and lifestyle changes, are useful initial measures. H2-blockers, proton-pump inhibitors, prokinetics, and antidepressants are effective pharmacologic therapies. H.pylori eradication may be effective in a subgroup of patients. There is no evidence that complementary and alternative therapies are beneficial, with the exception of Iberogast and rikkunshito, nor is there evidence on the usefulness of prebiotics, probiotics, or psychologic therapies. The new consensus statements on dyspepsia provide guidelines based on up-to-date evidence. A discussion, level of evidence, and strength of recommendation are presented for each statement.
自墨西哥胃肠病学协会2007年消化不良指南发布以来，对该疾病的认识有了显著进展。我们在PubMed（2007年1月至2016年6月）上对文献进行了系统检索，以回顾和更新2007年指南，并提供新的循证推荐。纳入了所有高质量的西班牙语和英语文章。使用德尔菲法制定并投票表决各项声明。根据GRADE系统确定每项声明的证据水平和推荐强度。共制定、投票表决并分级了31项声明。提供了新的定义、分类、流行病学和病理生理学数据，包括以下信息：对于未经调查的消化不良患者，出现报警症状或治疗无反应时应进行内镜检查。胃活检和十二指肠活检可分别确诊幽门螺杆菌感染和排除乳糜泻。建立牢固的医患关系以及改变饮食和生活方式是有用的初始措施。H2受体阻滞剂、质子泵抑制剂、促动力药和抗抑郁药是有效的药物治疗方法。根除幽门螺杆菌可能对部分患者有效。除伊比罗加斯特和理气和中汤外，没有证据表明补充和替代疗法有益，也没有证据表明益生元、益生菌或心理疗法有用。关于消化不良的新共识声明提供了基于最新证据的指南。对每项声明都进行了讨论、证据水平和推荐强度的阐述。
