AGA临床实践更新关于评估和管理吐,腹部膨胀和腹:专家评价
Baha Moshiree1, Douglas Drossman2, Aasma Shaukat3
1Atrium Health, Division of Gastroenterology, Hepatology and Nutrition, Wake Forest Medical University, Charlotte, North Carolina.
Gastroenterology
|July 15, 2023
概括
本临床更新提供了最佳实践建议,用于管理吐和膨胀,这些常见但令人衰弱的胃肠道症状. 它涵盖了诊断,饮食改变,行为疗法和改善患者生活质量的药物.
科学领域:
- 胃肠病学 胃肠病学
- 临床实践最新情况
- 消化系统健康 消化系统健康
背景情况:
- 排,膨胀和腹部膨胀是非常普遍的胃肠道症状,导致频繁的门诊.
- 这些症状显著影响患者的生活质量,并可能导致工作缺勤.
- 由于病理生理学和诊断的不同,对于吐和膨胀的最佳治疗方法的证据有限.
研究的目的:
- 为临床医生提供最佳实践建议,以管理吐,胀气和腹部膨胀.
- 指导是基于受控试验和观察数据.
- 涵盖临床特征,诊断和管理,包括饮食,行为和药物治疗.
主要方法:
- 由美国胃肠道学会 (AGA) 委托的专家审查.
- 从已发表的文献中获得的指导,包括临床试验和观察性研究.
- 基于专家意见的建议声明,没有正式的系统审查.
主要成果:
- 使用病史,检查和阻抗 pH 监测来区分胃和胃后吐.
- 胃上的治疗包括行为疗法 (CBT,腹膜呼吸,语音疗法) 和神经调节器.
- 罗马四号标准主要的腹部胀气/腹;排除碳水化合物问题与饮食/呼吸测试.
- 在高危患者中通过吸气/呼吸测试评估小肠细菌过度生长.
- 通过血清学检测排除腹腔疾病;如果阳性,通过活检确认;涉及营养学家.
- 订购腹部成像/内镜仅用于警报特征,症状恶化或异常检查.
- 胃空化研究不是常规的膨胀;考虑是否出现恶心/吐.
- 直肠生理学测试建议与便秘/疏散问题相关的膨胀.
- 低FODMAP饮食监测由营养学家是最好的.
- 益生菌不推用于膨胀/张.
- 如果发现骨盆底障碍,生物反对膨胀有效.
- 中枢神经调节剂可降低对膨胀/张的内脏过敏.
- 如果有便秘,便秘药可能会治疗胀气.
- 心理疗法 (催眠疗法,CBT) 可以治疗膨胀/张.
- 隔膜呼吸和神经调节器可以治疗腹部发性失能症.
结论:
- 提供了最佳实践建议,用于诊断和管理吐和膨胀.
- 对于复杂的病例,建议采用涉及营养学家和心理治疗的多学科方法.
- 对于某些疾病,如腹部乱和骨盆底疾病,建议使用中央神经调节器和生物反等特定治疗方法.
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