2 表一消化不良的鑑別診斷類別盛行率 80% 10-15% 5-10% <2% (gastroparesis) (lactose, fructose) (Crohn's disease, sarcoidosis) ( ) ( ) 3 表二 Rome III 功能性

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1 臨床藥物治療學功能性消化不良之介紹與治療國軍桃園總醫院藥劑科藥師李威黃建衡施嘉慶王茂富摘要 4 1 Rome III criteria dyspepsia Helicobacter pylori 壹前言 20% ( ) 80% (nonulcer dyspepsia) (idiopathic) (functional) ( ) Rome III criteria (nonulcer dyspepsia) () ( ) 1 貳病態生理機轉機轉 (visceral hypersensitivity) 4 (neurotransmitter) (serotonin, 5-hydroxytryptamine) (5-HT3 & 5-HT4) 5 60 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.2 Jun

2 2 表一消化不良的鑑別診斷類別盛行率 80% 10-15% 5-10% <2% (gastroparesis) (lactose, fructose) (Crohn's disease, sarcoidosis) ( ) ( ) 3 表二 Rome III 功能性消化不良的診斷標準 a. 6 b. 6 c. 6 d. 6 () ( 15%~30%) 6 7 參診斷一詢問病史 () (celiac sprue or gluten sensitive enteropathy) 二上消化道內視鏡 ( 胃鏡 ) 檢查 55 (Maastricht European consensus report) 45 (American Digestive Health Foundation) Jun 藥學雜誌第 111 冊 61

3 臨床藥物治療學表三常見會造成腸胃不適的藥物 (erythromycin) (garlic, ginkgo, chaste tree berry) Metformin Orlistat (Xenical) 8,9 肆治療一制酸劑 25% Sucralfate Misoprostol 二腸胃蠕動促進劑 metoclopramide domperidone cisapride cisapride metacloparmide (EPS, extrapyramidal syndrome) domperidone mosapride cisapride 5-HT4 5-HT3 mosapride cisapride mosapride mosapride metoclopramide 三幽門螺旋桿菌根除性治療 (systemic reviews) (meta- 62 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.2 Jun

4 analysis) 四精神治療藥物 (tricyclic antidepressants,tcas) (selective serotonin reuptake inhibitors, SSRIs) 737 TCAs 3 TCAs SSRIs buspirone (serotoninergic effect) 五心理介入治療 (12 ) 六降低痛覺刺激的藥物 Amitriptyline (TCA) 伍結論 () 參考資料 : 1. Bischops R, Karamanolis G, Arts J, et al: Relationship between symptoms and ingestion of a meal in functional dyspepsia. Gut 2008; 57: Dickerson LM, King DE: Evaluation and management of nonulcer dyspepsia. Am Fam Physician 2004; 70: Drossman DA, Corazziari E. Delvaux M et al: Rome The Functional gastrointestinal disorders, 3rd edition. McLean. VA: Degnon Associates 2006; Van Oudenhove L, Vandenberghe J, Geeraerts B, et al: Determinants of symptoms in functional dyspepsia: gastric sensorimotor function, psychosocial factors or somatisation? Gut 2008; 57: Jones MP, Crowell MD, Olden KW, Creed F. Functional gastrointestinal disorders: an update for the psychiatrist. Psychosomatics 2007; 48: Soo S, Forman D, Delaney BC, Moayyedi P:A systematic review of psychological therapies for non-ulcer dyspepsia. Am J Gastroenterol 2004; 99: Keohane J, Quigley EM: Functional dyspepsia and nonerosive reflux disease: clinical interactions and their implications. MedGenMed 2007; 9: Ables AZ, Simon I, Melton ER: Update on helicobacter pylori treatment. Am Fam Physician 2007; 75: Talley NJ: Update on the role of drug therapy in non-ulcer dyspepsia. Rev Gastroenterol Disorder 2003; 3: Jun 藥學雜誌第 111 冊 63

5 臨床藥物治療學 Introduction and Treatment of Functional Dyspepsia Wei Lee, Chien-Heng Huang, Chia-Ching Shin, Mau-Fu Wang Department of Pharmacy, Taoyuan Armed Forces General Hospital Abstract Functional dyspepsia is a chronic and repeated occurrence of upper gastrointestinal dysfunction. It is difficult to diagnose. There is still no firm evidence to support its specific mechanism. The most efficient method to treat functional dyspepsia is to combine the psychological and physiological treatment, giving the appropriate medication or psychotherapy. This article expected to provide pharmaceutical professionals evidence-based data to clarify concepts and further understanding of the disease. 64 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.2 Jun

( ) 4+2 4+1 一藥師考試人數統計 ( 表一 ) 表一最近十年 (90 年至 99 年 ) 藥師國考報名到考及格人數統計表 ( 表一 ) 2 2001 2002 2003-1 2003-2 2004-1 2004-2 2005-1

( ) 4+2 4+1 一藥師考試人數統計 ( 表一 ) 表一最近十年 (90 年至 99 年 ) 藥師國考報名到考及格人數統計表 ( 表一 ) 2 2001 2002 2003-1 2003-2 2004-1 2004-2 2005-1 綜合評論 Commentary 臺灣藥學教育與藥師考試之改造林藥師藥局藥師林振順 ( 整理 ) 考試委員胡幼圃 ( 口述 ) 壹前言 2003 pharm.d. 2006 2008 2003 2005 2011 8 ( ) PGY 貳藥師考試 640 ( 15 ) 4+1+1 ( ) ( ) 8 THE JOURNAL

2 表 一 消 化 不 良 的 鑑 別 診 斷 類 別 盛 行 率 80% 10-15% 5-10% <2% (gastroparesis) (lactose, fructose) (Crohn's disease, sarcoidosis) ( ) ( ) 3 表 二 Rome III 功 能 性

2 表一消化不良的鑑別診斷類別盛行率 80% 10-15% 5-10% <2% (gastroparesis) (lactose, fructose) (Crohn's disease, sarcoidosis) ( ) ( ) 3 表二 Rome III 功能性