Morano Domenico, Scarlata Giuseppe Guido Maria, Spagnuolo Rocco, Suraci Evelina, Colica Carmela, Luzza Francesco, Abenavoli Ludovico
Dipartimento di Scienze della salute, Università "Magna Graecia", Catanzaro.
Consiglio Nazionale delle Ricerche, Istituto di Bioimmagini e Sistemi Biologici Complessi, Azienda ospedaliero-universitaria "Renato Dulbecco", Catanzaro.
Recenti Prog Med. 2025 Jul-Aug;116(7-8):424-436. doi: 10.1701/4530.45312.
Functional disorders of the upper digestive tract, including functional dyspepsia and irritable bowel syndrome with predominant gastric symptoms, represent conditions that are highly prevalent in the general population and are associated with a marked impairment of patients' quality of life. Functional dyspepsia, characterised by symptoms such as epigastric pain, early satiety and bloating, in the absence of detectable structural abnormalities, is commonly divided into two subtypes: postprandial distress syndrome and epigastric pain syndrome, as described in the Rome IV diagnostic criteria. Although the pathogenesis of these disorders is not completely understood, it is believed that there is a complex interaction between altered gastrointestinal motility, visceral hypersensitivity, gut dysbiosis and dysfunction in the central modulation of visceral signals. Current guidelines recommend a multimodal therapeutic approach, including both pharmacological treatments and lifestyle modifications. First-line drugs for the management of functional dyspepsia include prokinetics, such as domperidone and itopride, and proton pump inhibitors, the latter being indicated mainly in patients with symptoms associated with hyperacidity. In refractory cases, numerous studies support the use of tricyclic antidepressants and serotonin modulators, which appear to bring significant symptomatic improvement. Recently, scientific interest has also turned to the role of the intestinal microbiota in the pathogenesis of functional disorders of the upper digestive tract, opening up prospects for innovative therapies, including the use of probiotics and modulation of the intestinal flora. However, current guidelines emphasize the need for further clinical evidence to consider such approaches as standard of care. In conclusion, although significant progress has been made in the understanding and treatment of these disorders, there remains much room for development with regard to targeted and personalized therapeutic strategies.
上消化道功能障碍，包括功能性消化不良和以胃部症状为主的肠易激综合征，是普通人群中高度流行的疾病，与患者生活质量的显著受损相关。功能性消化不良的特征是上腹部疼痛、早饱感和腹胀等症状，在没有可检测到的结构异常的情况下，通常分为两种亚型：餐后不适综合征和上腹部疼痛综合征，如罗马IV诊断标准所述。尽管这些疾病的发病机制尚未完全明了，但人们认为，胃肠动力改变、内脏高敏感性、肠道菌群失调以及内脏信号中枢调节功能障碍之间存在复杂的相互作用。当前指南推荐采用多模式治疗方法，包括药物治疗和生活方式改变。治疗功能性消化不良的一线药物包括促动力药，如多潘立酮和伊托必利，以及质子泵抑制剂，后者主要用于有胃酸过多相关症状的患者。在难治性病例中，大量研究支持使用三环类抗抑郁药和5-羟色胺调节剂，它们似乎能带来显著的症状改善。最近，科学界的兴趣也转向了肠道微生物群在上消化道功能障碍发病机制中的作用，为创新疗法开辟了前景，包括使用益生菌和调节肠道菌群。然而，当前指南强调需要更多临床证据才能将此类方法视为标准治疗方案。总之，尽管在这些疾病的理解和治疗方面已经取得了重大进展，但在靶向和个性化治疗策略方面仍有很大的发展空间。
