Functional Gastrointestinal Disorders 3 Functional dyspepsia

被引:319
作者
Ford, Alexander C. [1 ,2 ]
Mahadeva, Sanjiv [3 ]
Carbone, M. Florencia [4 ]
Lacy, Brian E. [5 ]
Talley, Nicholas J. [6 ]
机构
[1] Univ Leeds, Leeds Inst Med Res St Jamess, Leeds, W Yorkshire, England
[2] St James Univ Hosp, Leeds Gastroenterol Inst, Leeds LS9 7TF, W Yorkshire, England
[3] Univ Malaya, Fac Med, Dept Med, Kuala Lumpur, Malaysia
[4] Univ Leuven, Dept Chron Dis Metab & Ageing, Leuven, Belgium
[5] Mayo Clin, Jacksonville, FL 32224 USA
[6] Univ Newcastle, Australian Gastrointestinal Res Alliance, Newcastle, NSW, Australia
关键词
QUALITY-OF-LIFE; HELICOBACTER-PYLORI ERADICATION; PROTON PUMP INHIBITORS; ROME III CRITERIA; DUODENAL EOSINOPHILIA; NONULCER DYSPEPSIA; DOUBLE-BLIND; PATHOPHYSIOLOGICAL MECHANISMS; CLINICAL CHARACTERISTICS; GASTRIC ACCOMMODATION;
D O I
10.1016/S0140-6736(20)30469-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Dyspepsia is a complex of symptoms referable to the gastroduodenal region of the gastrointestinal tract and includes epigastric pain or burning, postprandial fullness, or early satiety. Approximately 80% of individuals with dyspepsia have no structural explanation for their symptoms and have functional dyspepsia. Functional dyspepsia affects up to 16% of otherwise healthy individuals in the general population. Risk factors include psychological comorbidity, acute gastroenteritis, female sex, smoking, use of non-steroidal anti-inflammatory drugs, and Helicobacter pylori infection. The pathophysiology remains incompletely understood, but it is probably related to disordered communication between the gut and the brain, leading to motility disturbances, visceral hypersensitivity, and alterations in gastrointestinal microbiota, mucosal and immune function, and CNS processing. Although technically a normal endoscopy is required to diagnose functional dyspepsia, the utility of endoscopy in all patients with typical symptoms is minimal; its use should be restricted to people aged 55 years and older, or to those with concerning features, such as weight loss or vomiting. As a result of our incomplete understanding of its pathophysiology, functional dyspepsia is difficult to treat and, in most patients, the condition is chronic and the natural history is one of fluctuating symptoms. Eradication therapy should be offered to patients with functional dyspepsia who test positive for Helicobacter pylori. Other therapies with evidence of effectiveness include proton pump inhibitors, histamine-2 receptor antagonists, prokinetics, and central neuromodulators. The role of psychological therapies is uncertain. As our understanding of the pathophysiology of functional dyspepsia increases, it is probable that the next decade will see the emergence of truly disease-modifying therapies for the first time.
引用
收藏
页码:1689 / 1702
页数:14
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