Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan.
Keio J Med. 2021 Mar 25;70(1):7-18. doi: 10.2302/kjm.2020-0006-OA. Epub 2020 Jul 1.
In 2016, the Rome criteria were updated as Rome IV, and only minor changes were introduced for functional dyspepsia (FD). The major symptoms of FD now include not only postprandial fullness, but also epigastric pain and burning, and early satiation at above the "bothersome" level. Investigations into the effect of meal ingestion on symptom generation have indicated that not only postprandial fullness and early satiety but also epigastric pain and burning sensation and nausea (not vomiting) may increase after meals. Helicobacter pylori infection is considered to be the cause of dyspepsia if successful eradication leads to sustained resolution of symptoms for more than 6 months, and such a condition has been termed H. pylori-associated dyspepsia. Prompt esophagogastroduodenoscopy and H. pylori "test and treat" may be beneficial, especially in regions with a high prevalence of gastric cancer, such as east Asia. In terms of treatment, acotiamide, tandospirone, and rikkunshito are newly listed in Rome IV as treatment options for FD. Clinical studies in the field of FD should be strictly based on the Rome IV criteria until the next Rome V is published in 2026.
2016 年，罗马标准被更新为罗马 IV 标准，仅对功能性消化不良（FD）进行了微小的修改。FD 的主要症状现在不仅包括餐后饱胀，还包括上腹痛和烧灼感，以及早饱感达到“令人困扰”的程度。对餐后症状发生的影响的研究表明，不仅餐后饱胀和早饱感，而且上腹痛和烧灼感以及恶心（无呕吐）可能会在餐后增加。如果成功根除幽门螺杆菌感染能导致症状持续缓解超过 6 个月，则认为其为消化不良的病因，这种情况被称为幽门螺杆菌相关性消化不良。及时进行食管胃十二指肠镜检查和幽门螺杆菌“检测和治疗”可能是有益的，特别是在胃癌高发地区，如东亚。在治疗方面，阿考替胺、坦度螺酮和瑞巴派特在罗马 IV 中被新列为 FD 的治疗选择。在 2026 年发布下一个罗马 V 标准之前，FD 领域的临床研究应严格基于罗马 IV 标准。
