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肠道-脑相互作用障碍的处理方法

Approach to Disorders of Gut-Brain Interaction.

作者信息

Tome June, Kamboj Amrit K, Loftus Conor G

机构信息

Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.

出版信息

Mayo Clin Proc. 2023 Mar;98(3):458-467. doi: 10.1016/j.mayocp.2022.11.001.


DOI:10.1016/j.mayocp.2022.11.001
PMID:36868754
Abstract

Disorders of gut-brain interaction, previously known as functional gastrointestinal disorders (eg, functional dyspepsia and irritable bowel syndrome), are commonly encountered in both the primary care and gastroenterology clinics. These disorders are often associated with high morbidity and poor patient quality of life and often lead to increased health care use. The management of these disorders can be challenging, as patients often present after having undergone an extensive workup without a definite etiology. In this review, we provide a practical five-step approach to the clinical assessment and management of disorders of gut-brain interaction. The five-step approach includes (1) excluding organic etiologies of the patient's symptoms and using Rome IV criteria for diagnosis, (2) empathizing with the patient to develop trust and a therapeutic relationship, (3) educating the patient about the pathophysiology of these gastrointestinal disorders, (4) expectation setting with a focus on improving function and quality of life, and (5) establishing a treatment plan with central and peripherally acting medications and nonpharmacological modalities. We discuss the pathophysiology of disorders of gut-brain interaction (eg, visceral hypersensitivity), initial assessment and risk stratification, as well as treatment for a variety of diseases with a focus on irritable bowel syndrome and functional dyspepsia.

摘要

肠-脑互动障碍,以前称为功能性胃肠疾病(如功能性消化不良和肠易激综合征),在初级保健和胃肠病诊所中都很常见。这些疾病通常与高发病率和患者生活质量差相关,并且常常导致医疗保健使用增加。这些疾病的管理可能具有挑战性,因为患者在经过广泛检查后往往没有明确的病因。在本综述中,我们提供了一种实用的五步方法来对肠-脑互动障碍进行临床评估和管理。这五步方法包括:(1)排除患者症状的器质性病因并使用罗马IV标准进行诊断;(2)同情患者以建立信任和治疗关系;(3)向患者介绍这些胃肠疾病的病理生理学;(4)设定以改善功能和生活质量为重点的期望;(5)制定包括中枢和外周作用药物以及非药物治疗方式的治疗计划。我们讨论了肠-脑互动障碍的病理生理学(如内脏高敏感性)、初始评估和风险分层,以及以肠易激综合征和功能性消化不良为重点的各种疾病的治疗方法。

相似文献

[1]
Approach to Disorders of Gut-Brain Interaction.

Mayo Clin Proc. 2023-3

[2]
Current Treatment Options and Therapeutic Insights for Gastrointestinal Dysmotility and Functional Gastrointestinal Disorders.

Front Pharmacol. 2022-1-25

[3]
Management of functional gastrointestinal disorders.

Clin Med (Lond). 2021-1

[4]
Overlaps with bladder pain syndrome and irritable bowel syndrome are associated with higher symptom burden and reduced quality of life in functional dyspepsia.

Neurogastroenterol Motil. 2022-11

[5]
Understanding neuroimmune interactions in disorders of gut-brain interaction: from functional to immune-mediated disorders.

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[6]
Functional gastrointestinal disorders: advances in understanding and management.

Lancet. 2020-11-21

[7]
Impact of functional gastrointestinal disorders on health-related quality of life: a population-based case-control study.

Aliment Pharmacol Ther. 2004-1-15

[8]
Functional Dyspepsia and Irritable Bowel Syndrome: Beyond Rome IV.

Dig Dis. 2017

[9]
Mechanisms Underlying Food-Triggered Symptoms in Disorders of Gut-Brain Interactions.

Am J Gastroenterol. 2022-6-1

[10]
Disorders of gut-brain interaction: Highly prevalent and burdensome yet under-taught within medical education.

United European Gastroenterol J. 2022-9

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[2]
Psychometric properties of the Hungarian Visceral Sensitivity Index (VSI-H): insights from two cross-sectional studies on self-reported IBS and gluten-related conditions.

BMC Psychol. 2025-7-1

[3]
Evaluating burnout syndrome among medical students at the Aristotle University of Thessaloniki in Greece: a cross-sectional study.

Front Psychiatry. 2025-5-28

[4]
Raising Expectations in IBS-C Management.

Gastroenterol Hepatol (N Y). 2025-4

[5]
Review Article: Individualised Management of Reflux-Like Symptoms-Strategies Beyond Acid Suppression.

Aliment Pharmacol Ther. 2025-5

[6]
Bilingual Perspectives of Functional Dyspepsia Management in People From Underserved Areas.

Clin Transl Gastroenterol. 2025-3-1

[7]
Unveiling the efficacy of paroxetine and gabapentin in ulcerative colitis patients in remission with co-existing IBS-like symptoms: a single-blinded randomized clinical trial.

Front Med (Lausanne). 2024-11-20

[8]
Clostridioides difficile infection promotes gastrointestinal dysfunction in human and mice post-acute phase of the disease.

Anaerobe. 2024-6

[9]
Effects of Extracts and Their Main Flavonoids on Colon Motility-An Ex Vivo Study.

Int J Mol Sci. 2023-12-9

[10]
Parieto-occipital ERP indicators of gut mechanosensation in humans.

Nat Commun. 2023-6-13

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