Walker Marjorie M, Talley Nicholas J
Faculty of Health & Medicine, University of Newcastle, Callaghan, 2305, NSW, Australia.
Australian Gastrointestinal Research Alliance (AGIRA), Callaghan, 2305, NSW, Australia.
Curr Gastroenterol Rep. 2019 Nov 13;21(10):54. doi: 10.1007/s11894-019-0722-5.
Functional dyspepsia is a common condition, and the condition is defined by symptoms using Rome IV criteria. This review addresses the issue of functional dyspepsia in elderly patients, epidemiology, investigation, and treatment.
Recent studies show that while the prevalence of dyspepsia declines in the elderly, it is still prevalant investigations to confirm the diagnosis (including mandatory upper gastrointestinal endoscopy) must exclude organic disease. These include ulcers (particularly associated with nonsteroidal antiinflammatory drugs), Helicobacter pylori pathologies, cancer, coeliac disease, and autoimmune gastritis. Recent research is unraveling pathophysiology beyond symptom-only definitions, focusing on the duodenum with innate immune disturbance (duodenal eosinophilia) and microbial disruption as possible cause. Management of functional dyspepsia includes making a secure diagnosis, treatment with first-line proton pump inhibitors (PPI), then tricyclic antidepressants, and careful choice of prokinetics. Herbal treatments (peppermint oil) and STW-5 have in this age group limited efficacy. Further studies are needed to define the prevalence of functional dyspepsia in the elderly and of prime importance, to exclude organic disease as a cause for symptoms of dyspepsia.
功能性消化不良是一种常见病症，其病症依据罗马IV标准通过症状来定义。本综述探讨老年患者功能性消化不良的问题、流行病学、检查及治疗。
近期研究表明，虽然消化不良在老年人中的患病率有所下降，但仍然普遍存在。确诊检查（包括必须进行的上消化道内镜检查）必须排除器质性疾病。这些疾病包括溃疡（特别是与非甾体抗炎药相关的溃疡）、幽门螺杆菌病变、癌症、乳糜泻和自身免疫性胃炎。近期研究正在揭示仅基于症状定义之外的病理生理学，将十二指肠的先天性免疫紊乱（十二指肠嗜酸性粒细胞增多）和微生物破坏作为可能病因进行重点研究。功能性消化不良的管理包括做出可靠诊断，先用一线质子泵抑制剂（PPI）治疗，然后使用三环类抗抑郁药，并谨慎选择促动力药。草药治疗（薄荷油）和STW-5在该年龄组疗效有限。需要进一步研究来确定老年人功能性消化不良的患病率，并且至关重要的是，排除器质性疾病作为消化不良症状的病因。
