University of North Carolina, Chapel Hill, NC, USA.
Am Fam Physician. 2020 Jan 15;101(2):84-88.
Functional dyspepsia is defined as at least one month of epigastric discomfort without evidence of organic disease found during an upper endoscopy, and it accounts for 70% of dyspepsia. Symptoms of functional dyspepsia include postprandial fullness, early satiety, and epigastric pain or burning. Functional dyspepsia is a diagnosis of exclusion; therefore, evaluation for a more serious disease such as an upper gastrointestinal malignancy is warranted. Individual alarm symptoms do not correlate with malignancy for patients younger than 60 years, and endoscopy is not necessarily warranted but should be considered for patients with severe or multiple alarm symptoms. For patients younger than 60 years, a test and treat strategy for Helicobacter pylori is recommended before acid suppression therapy. For patients 60 years or older, upper endoscopy should be performed. All patients should be advised to limit foods associated with increased symptoms of dyspepsia; a diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) is suggested. Eight weeks of acid suppression therapy is recommended for patients who test negative for H. pylori, or who continue to have symptoms after H. pylori eradication. If acid suppression does not alleviate symptoms, patients should be treated with tricyclic antidepressants followed by prokinetics and psychological therapy. The routine use of complementary and alternative medicine therapies has not shown evidence of effectiveness and is not recommended.
功能性消化不良的定义为在上消化道内镜检查中未发现器质性疾病的情况下至少存在 1 个月的上腹部不适,占消化不良的 70%。功能性消化不良的症状包括餐后饱胀、早饱、上腹痛或烧灼感。功能性消化不良是一种排除性诊断;因此,需要评估是否存在更严重的疾病,如上消化道恶性肿瘤。对于年龄小于 60 岁的患者,个体报警症状与恶性肿瘤不相关,不一定需要进行内镜检查,但对于有严重或多种报警症状的患者应考虑进行内镜检查。对于年龄小于 60 岁的患者,建议在进行抑酸治疗之前进行幽门螺杆菌检测和治疗。对于 60 岁或以上的患者,应进行上消化道内镜检查。应建议所有患者限制可能加重消化不良症状的食物;建议采用低 FODMAP(可发酵寡糖、双糖、单糖和多元醇)饮食。对于幽门螺杆菌检测阴性或幽门螺杆菌根除后仍有症状的患者,建议使用 8 周的抑酸治疗。如果抑酸治疗不能缓解症状,应先用三环类抗抑郁药治疗,然后用促动力药和心理治疗。常规使用补充和替代医学疗法尚未显示出有效性,因此不推荐使用。
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