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功能性消化不良:诊断与治疗方法。

Functional Dyspepsia: Diagnostic and Therapeutic Approaches.

机构信息

Division of Gastroenterology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8124, St Louis, MO, 63110, United States.

Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.

出版信息

Drugs. 2020 Sep;80(13):1319-1336. doi: 10.1007/s40265-020-01362-4.


DOI:10.1007/s40265-020-01362-4
PMID:32691294
Abstract

Functional dyspepsia is a common functional gastrointestinal (GI) disorder of gastroduodenal origin, diagnosed clinically in the presence of prototypical symptoms of epigastric pain and meal-related symptoms, and without structural explanation. The most recent diagnostic criteria provide for two functional dyspepsia subtypes, epigastric pain syndrome (EPS) and post-prandial distress syndrome (PDS) based on the predominant symptom pattern. The evaluation of dyspepsia should keep laboratory, imaging, and invasive testing to a minimum, as extensive or repetitive investigations are of rather low diagnostic yield in the absence of localizing symptoms or alarm features. Factors with etiopathologic relationships to functional dyspepsia include micro-inflammation, GI infections, abnormalities of gastroduodenal motility, visceral hypersensitivity, disturbances along the brain-gut axis, and psychological factors; all of these causative mechanisms have potential to partially explain symptoms in some functional dyspepsia patients, thus providing a rationale for the efficacy of a diversity of therapeutic approaches to functional dyspepsia. Management of dyspepsia symptoms relies upon both pharmacologic treatments and non-pharmacologic approaches, including psychological and complementary interventions. The evidence in support of established functional dyspepsia therapies is reviewed, and forms the basis for an effective functional dyspepsia treatment strategy emphasizing the patient's current symptom severity, pattern, and impact on the function and quality of life of the individual.

摘要

功能性消化不良是一种常见的源于胃十二指肠的功能性胃肠道疾病,临床上在存在上腹痛和与进餐相关的症状的情况下诊断,且没有结构解释。最新的诊断标准根据主要症状模式提供了两种功能性消化不良亚型,即上腹痛综合征(EPS)和餐后不适综合征(PDS)。消化不良的评估应尽量减少实验室、影像学和侵入性检查,因为在没有定位症状或报警特征的情况下,广泛或重复的检查诊断效果相当低。与功能性消化不良有病因学关系的因素包括微炎症、胃肠道感染、胃十二指肠运动异常、内脏高敏性、脑-肠轴紊乱和心理因素;所有这些致病机制都有可能部分解释一些功能性消化不良患者的症状,从而为功能性消化不良的多种治疗方法的疗效提供了依据。消化不良症状的治疗依赖于药物治疗和非药物治疗,包括心理和补充干预。本文回顾了已确立的功能性消化不良治疗方法的证据,并以此为基础,制定了一种有效的功能性消化不良治疗策略,强调了患者当前的症状严重程度、模式以及对个人功能和生活质量的影响。

相似文献

[1]
Functional Dyspepsia: Diagnostic and Therapeutic Approaches.

Drugs. 2020-9

[2]
Rome III functional dyspepsia subdivision in PDS and EPS: recognizing postprandial symptoms reduces overlap.

Neurogastroenterol Motil. 2015-8

[3]
Fasting and postprandial gastric sensorimotor activity in functional dyspepsia: postprandial distress vs. epigastric pain syndrome.

Am J Gastroenterol. 2014-10

[4]
Symptom overlap between postprandial distress and epigastric pain syndromes of the Rome III dyspepsia classification.

Am J Gastroenterol. 2013-4-9

[5]
Postprandial distress syndrome: stratification and management.

Expert Rev Gastroenterol Hepatol. 2018-11-8

[6]
Acupuncture effectiveness as a complementary therapy in functional dyspepsia patients.

Arq Gastroenterol. 2013

[7]
[Current issues in functional dyspepsia].

Korean J Gastroenterol. 2014-9-25

[8]
Association Between Functional Dyspepsia and Severity of Depression.

J Coll Physicians Surg Pak. 2016-6

[9]
Pathophysiological Abnormalities in Functional Dyspepsia Subgroups According to the Rome III Criteria.

Am J Gastroenterol. 2017-1

[10]
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Am Fam Physician. 2020-1-15

引用本文的文献

[1]
Effects of acupuncture versus moxibustion on functional dyspepsia: a randomized clinical trial.

Chin Med. 2025-8-22

[2]
Electroacupuncture Improves Gastrointestinal Motility in Rats with Functional Dyspepsia via the GDNF/GFRα1/PI3K/Akt Signaling Pathway.

Curr Med Sci. 2025-8-8

[3]
Clinical efficacy of probiotics in improving intestinal mucosal permeability for functional dyspepsia patients with anxiety.

Front Microbiol. 2025-6-18

[4]
Comprehensive Treatment of Functional Dyspepsia Using Traditional Chinese Medicine: A Review Based on Pathophysiological Perspectives.

Drug Des Devel Ther. 2025-6-24

[5]
Clinical study status of diabetic gastrointestinal diseases.

Front Endocrinol (Lausanne). 2025-4-9

[6]
Evidence-Based Bibliometric Analysis of Acupuncture in Functional Dyspepsia: Clinical Efficacy and Research Trends.

J Multidiscip Healthc. 2025-4-16

[7]
Auricular acupoint therapy for functional gastrointestinal disorders: a systematic review and meta-analysis of randomized clinical trials.

Front Med (Lausanne). 2025-3-19

[8]
Network analysis and experimental validation to investigate against functional dyspepsia through TLR4/MyD88 by regulating the gut microbial structure.

Front Pharmacol. 2025-2-13

[9]
Efficacy and safety of acupuncture for postoperative gastroparesis syndrome: a systematic review and meta-analysis.

Front Med (Lausanne). 2025-1-6

[10]
Jianwei Xiaoshi oral liquid attenuates high-calorie diet-induced dyspepsia in immature rats via regulating the pancreatic secretion pathway and maintaining the homeostasis of intestinal microbiota.

Chin Med. 2025-1-4

本文引用的文献

[1]
A Combination of Peppermint Oil and Caraway Oil for the Treatment of Functional Dyspepsia: A Systematic Review and Meta-Analysis.

Evid Based Complement Alternat Med. 2019-11-14

[2]
Novel concepts in the pathophysiology and treatment of functional dyspepsia.

Gut. 2019-11-29

[3]
The Efficacy of Hypnotherapy in the Treatment of Functional Dyspepsia.

Am J Ther. 2019

[4]
Prokinetics for Functional Dyspepsia: A Systematic Review and Meta-Analysis of Randomized Control Trials.

Am J Gastroenterol. 2019-2

[5]
New developments in the treatment of gastroparesis and functional dyspepsia.

Curr Opin Pharmacol. 2018-9-21

[6]
Understanding Neurogastroenterology From Neuroimaging Perspective: A Comprehensive Review of Functional and Structural Brain Imaging in Functional Gastrointestinal Disorders.

J Neurogastroenterol Motil. 2018-10-1

[7]
Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration.

Aliment Pharmacol Ther. 2018-1-12

[8]
Development of a Symptom-Focused Patient-Reported Outcome Measure for Functional Dyspepsia: The Functional Dyspepsia Symptom Diary (FDSD).

Am J Gastroenterol. 2017-9-19

[9]
Food and functional dyspepsia: a systematic review.

J Hum Nutr Diet. 2017-9-15

[10]
Gastric Motor Dysfunction in Patients With Functional Gastroduodenal Symptoms.

Am J Gastroenterol. 2017-11

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