Koch M, Capurso G
Dipartimento Malattie Digestive e Nutrizionali, Azienda Ospedaliera, Ospedale S. Filippo Neri, Roma, Italy.
Ital J Gastroenterol. 1996 Jun;28(5):261-8.
Functional dyspepsia (FD) includes a heterogeneous group of patients suffering from a variety of different conditions. The Dyspepsia Project has been implemented in 14 GI Units since 1984, in order to epidemiologically test the discriminating power of the Working Teams definitions and of standardized questionnaires. Five per cent of admitted subjects were subclassified as sphincter of Oddi dysfunction or biliary dyspepsia (BD), defined as biliary pain associated or not to bilirubin or alkaline phosphatase elevation, in the abscence of ultrasonographic evidence of gallstone disease or bile duct dilatation. The more useful symptoms in favour of the diagnosis of biliary dyspepsia were found to be pain in the right hypochondrium, radiating to the shoulder, or to the back, initiated by food, and eventually associated with constipation, or epigastric postprandial discomfort. Interestingly, symptoms suggesting biliary dyspepsia are partially shared by dysmotility-like dyspepsia. The placebo response in functional dyspepsia is variable, between 6 and 80% of patients, reflecting variations in the kind and severity of the diseases in different studies. That represents a considerable difficulty in evaluating drug efficacy, even in the case of biliary dyspepsia. A therapeutic double-blind trial in functional dyspepsia using tauro-ursodeoxycholic acid is discussed.
功能性消化不良（FD）包括一群患有各种不同病症的异质性患者。自1984年以来，在14个胃肠病治疗单元开展了消化不良项目，以便从流行病学角度检验工作团队定义和标准化问卷的鉴别能力。5%的入院患者被归类为Oddi括约肌功能障碍或胆源性消化不良（BD），其定义为伴有或不伴有胆红素或碱性磷酸酶升高的胆绞痛，且无胆结石病或胆管扩张的超声证据。支持胆源性消化不良诊断的更有用症状包括右季肋部疼痛，可放射至肩部或背部，由食物引发，并最终伴有便秘或餐后上腹部不适。有趣的是，提示胆源性消化不良的症状与动力障碍样消化不良部分重叠。功能性消化不良的安慰剂反应各不相同，在6%至80%的患者中出现，这反映了不同研究中疾病种类和严重程度的差异。即使在胆源性消化不良的情况下，这也给评估药物疗效带来了相当大的困难。本文讨论了一项使用牛磺熊去氧胆酸治疗功能性消化不良的双盲试验。
