Bruppacher R, Gyr N, Fisch T
Baillieres Clin Gastroenterol. 1988 Apr;2(2):275-92. doi: 10.1016/0950-3528(88)90004-8.
Non-specific abdominal complaints are a very frequent cause of discomfort. Even if only comparatively few are brought to the attention of the physician, they account for a considerable portion of the reasons for seeking medical care, both in acute and chronic conditions. On the other hand, few drugs are free of the suspicion of causing abdominal complaints, which make up between one-tenth and one-third of reported adverse reactions. A wide variety of possible alternative or concomitant causes makes a clear causative attribution to suspected drugs very difficult. This holds especially true for the ill-defined conditions of indigestion and anorexia. For nausea and vomiting, specific scales have been developed which facilitate differentiation between drugs causing these effects most frequently and most intensively. They have been applied in cytostatic therapy, where this is one of the most frequently encountered problems, but nausea and vomiting can seriously affect compliance in many other treatments. Somatic abdominal pain results in most instances from the irritation of the parietal peritoneum and is usually the effect of a lesion. This may or may not be caused by a drug, but this cause should be the first consideration. Visceral pain may result from functional disturbance of secretory glands or of the muscular coat, from drug action on bowel content or from irritation of the mucosa, all of which are frequently interrelated. Most frequently suspected pharmacological causes are drugs with anticholinergic action, antibiotics, potassium supplements and non-steroidal, anti-inflammatory agents. Drug-induced hyperinsulinism and porphyria are rare cases. Abuse of laxatives should always be considered because of its prevalence. A great number of other untoward drug effects have been described in the literature, but rarely merit first consideration. With the exception of promptly occurring or persistent emesis, gastrointestinal symptoms usually are not pathognomonic for drug effects and are the result of several factors. The usual approach to identifying an adverse drug effect is to delineate the functional or structural disorder, and to associate this diagnosis with possible pharmacodynamic aetiologies.
非特异性腹部不适是导致不适的常见原因。即使只有相对较少的此类情况引起医生的注意，但在急性和慢性疾病中，它们占寻求医疗护理原因的相当一部分。另一方面，几乎没有哪种药物能免于引起腹部不适的嫌疑，腹部不适占报告的不良反应的十分之一到三分之一。各种各样可能的替代或伴随原因使得明确将疑似药物归因于病因非常困难。这在消化不良和厌食等定义不明确的病症中尤其如此。对于恶心和呕吐，已经开发了特定的量表，这有助于区分最常和最强烈引起这些症状的药物。它们已应用于细胞毒性疗法，在这种疗法中这是最常遇到的问题之一，但恶心和呕吐在许多其他治疗中也会严重影响依从性。躯体性腹痛在大多数情况下是由壁腹膜受到刺激引起的，通常是病变的结果。这可能由药物引起，也可能不是，但药物应是首要考虑因素。内脏痛可能由分泌腺或肌层的功能紊乱、药物对肠内容物的作用或黏膜刺激引起，所有这些情况通常相互关联。最常被怀疑的药理原因是具有抗胆碱能作用的药物、抗生素、钾补充剂和非甾体抗炎药。药物性高胰岛素血症和卟啉症是罕见病例。由于泻药滥用很普遍，应始终予以考虑。文献中还描述了许多其他不良药物作用，但很少值得首要考虑。除了迅速发生或持续呕吐外，胃肠道症状通常并非药物作用的特征性表现，而是多种因素的结果。识别药物不良反应的通常方法是确定功能或结构紊乱，并将该诊断与可能的药效学病因联系起来。
