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. 30 2012
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 63 1. 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) 50 282 Jun. 30 2012 藥 學 雜 誌 第 111 冊 61
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. 30 2012
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: 1495-503. 2. Dickerson LM, King DE: Evaluation and management of nonulcer dyspepsia. Am Fam Physician 2004; 70: 107-14. 3. Drossman DA, Corazziari E. Delvaux M et al: Rome The Functional gastrointestinal disorders, 3rd edition. McLean. VA: Degnon Associates 2006; 1-1048. 4. 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: 1666-73. 5. Jones MP, Crowell MD, Olden KW, Creed F. Functional gastrointestinal disorders: an update for the psychiatrist. Psychosomatics 2007; 48: 93-102. 6. Soo S, Forman D, Delaney BC, Moayyedi P:A systematic review of psychological therapies for non-ulcer dyspepsia. Am J Gastroenterol 2004; 99: 1817-22. 7. Keohane J, Quigley EM: Functional dyspepsia and nonerosive reflux disease: clinical interactions and their implications. MedGenMed 2007; 9: 31. 8. Ables AZ, Simon I, Melton ER: Update on helicobacter pylori treatment. Am Fam Physician 2007; 75: 351-8. 9. Talley NJ: Update on the role of drug therapy in non-ulcer dyspepsia. Rev Gastroenterol Disorder 2003; 3: 25-30. 282 Jun. 30 2012 藥 學 雜 誌 第 111 冊 63
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. 30 2012