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機能性消化不全
Alexander C Ford1, Sanjiv Mahadeva2, M Florencia Carbone3
1Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.
Lancet (London, England)
|October 13, 2020
まとめ
機能性消化不良は,健康な人の16%に影響し,明確な構造的な原因のない腹部上部の症状を伴う. 治療は不完全な理解のために困難ですが,ヘリコバクター・パイロリ根絶と他の治療法は有望です.
科学分野:
- 胃腸内科
- 機能的胃腸疾患
背景:
- 消化不良は 腹部上部の痛みや灼熱,満腹感,早めの飽き飽きといった症状を含みます.
- 機能性消化不全 (FD) は一般人口の16%まで発生し,80%の症例では構造的な説明がない.
- FDの危険因子には,心理的な問題,H. pylori感染,NSAIDの使用,喫煙,女性の性別が含まれます.
研究 の 目的:
- 機能性消化不全の現在の理解,その病理生理学,診断,管理をレビューする.
- FDの複雑で不完全なメカニズムによる治療における課題を強調する.
主な方法:
- 機能性消化不全の病理学,危険因子,診断方法,治療選択肢に関する文献レビュー.
- 根絶療法,酸抑制剤,プロキネティック,神経調節剤を含む様々な治療方法に関する現在の証拠の分析.
主要な成果:
- FDの病理生理学は多因性であり,腸-脳軸機能不全があり,運動能力の問題,内臓過敏症,および微生物群の変化につながる.
- エンドスコピーの効用はFDでは限られており,主に高齢の患者 (> 55) または警報機能を有する患者に対して推奨されます.
- いくつかの治療法は,H. pyloriの根絶,PPI,H2RA,プロキネティクス,中央神経調節剤を含む有効性を示しているが,心理学的治療法の役割は不明である.
結論:
- 機能性消化不良は,症状が変動する慢性疾患であり,病理学的理解が不完全であるため,しばしば治療が困難である.
- 陽性な患者にはH. pyloriの根絶が推奨されます. 将来の研究で 病気を修正する治療法が得られるかもしれません
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