Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium.
Aliment Pharmacol Ther. 2019 May;49(9):1134-1172. doi: 10.1111/apt.15191. Epub 2019 Mar 28.
BACKGROUND: Functional dyspepsia, consisting of epigastric pain syndrome and postprandial distress syndrome, is a prevalent functional gastrointestinal disorder. To date, only limited treatment options are available and conflicting results in terms of efficacy have been reported. Consequently, nonpharmacological treatment options are increasingly being explored for functional dyspepsia. AIM: To provide an overview of current pharmacological and nonpharmacological treatment options for functional dyspepsia. METHODS: A literature search was conducted on Pubmed and other sources to identify relevant studies. RESULTS: Acid suppressive therapy reduced symptoms in 30%-70% of the patients, with higher benefit in epigastric pain syndrome and superior effectiveness for proton pump inhibitors compared to H -antagonists. Prokinetic agents, primarily used to treat postprandial distress syndrome, showed variable efficiency: 59%-81% responder rate for dopamine receptor antagonists, 32%-91% for serotonin-4-receptor agonists and 31%-80% for muscarinic receptor antagonists. H Pylori eradication, recommended in infected patients, was effective in 24%-82%. Refractory symptoms are addressed with neuromodulators. However, their efficacy in functional dyspepsia remains incompletely elucidated, available data showing symptom reduction in 27%-71% of the patients. Regarding herbal agents, peppermint oil reduced symptoms in 66%-91%, rikkunshito in 29%-34% and iberogast in 20%-95%. Lastly, acupuncture, cognitive behavioural therapy and hypnotherapy may help to provide symptom control, but research on their efficacy remains sparse. CONCLUSIONS: None of the available therapies is effective in the majority of patients without being associated with major side effects. Developing new treatment options is challenging due to the heterogeneity of functional dyspepsia, the lack of readily identified target mechanisms and the poor association between pathophysiological disturbances and symptoms.
背景:功能性消化不良(FD)包括餐后不适综合征和上腹痛综合征,是一种常见的功能性胃肠疾病。迄今为止,仅有有限的治疗选择,并且在疗效方面存在相互矛盾的结果。因此,越来越多的人在探索功能性消化不良的非药物治疗选择。
目的:提供功能性消化不良的当前药物和非药物治疗选择概述。
方法:在 Pubmed 和其他来源上进行文献检索以确定相关研究。
结果:抑酸治疗可使 30%-70%的患者症状得到缓解,在上腹痛综合征中获益更高,质子泵抑制剂比 H2 受体拮抗剂更有效。促动力药主要用于治疗餐后不适综合征,其疗效不一:多巴胺受体拮抗剂的应答率为 59%-81%,5-羟色胺 4 受体激动剂为 32%-91%,毒蕈碱受体拮抗剂为 31%-80%。推荐用于感染患者的 H. pylori 根除有效率为 24%-82%。对于难治性症状,使用神经调节剂。然而,它们在功能性消化不良中的疗效仍不完全明确,现有数据显示,患者的症状缓解率为 27%-71%。关于草药制剂,薄荷油可使症状缓解 66%-91%,荜茇胃痛颗粒可使症状缓解 29%-34%,Iberogast 可使症状缓解 20%-95%。最后,针灸、认知行为疗法和催眠疗法可能有助于控制症状,但对其疗效的研究仍然很少。
结论:没有一种现有的治疗方法对大多数患者有效,且不伴有严重的副作用。由于功能性消化不良的异质性、缺乏易于识别的靶机制以及病理生理紊乱与症状之间的关联较差,开发新的治疗选择具有挑战性。
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