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