Tome June, Kamboj Amrit K, Loftus Conor G
Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Mayo Clin Proc. 2023 Mar;98(3):458-467. doi: 10.1016/j.mayocp.2022.11.001.
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.
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。
