Θεραπευτικές επιλογές στη λειτουργική δυσπεψία

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  • EGD: esophagogastroduodenoscopy; HP: Helicobacter pylori; PPI: proton pump inhibitor; Tx: therapy; FD: functional dyspepsia; Sx: symptoms; TG: therapeutic gain; TCA: tricyclic antidepressants; RR: response rate.

  • placebo 25%

    Hp

    (PPI, H2-) ( ) -

  • H. pylori

  • Hp Hp , UBT :

    - 17 RCT 3.566

    Hp 14 1 (RRR 10%, 95%CI 6-14)

    RCT 404 : Hp (49% vs. 35%)

    Moayyedi P, et al. Cochrane Database Syst Rev 2005:CD002096Mazzoleni LE, et al. Arch Intern Med 2011;171:1929

  • - PPIsPPI x1: Hp Hp

    PPIs: : - 7 RCT 3.725 : PPIs (placebo) (RRR 10%, 95%CI 2,7-17,3) PPIs:

    , , , Wang WH, et al. Clin Gastroenterol Hepatol 2007;5:178Moayyedi P, et al. Gastroenterology 2004;127:1329Moayyedi P, et al. Cochrane Database Syst Rev 2006:CD001960

  • H2RAs

    H2RAs: (placebo), - 12 RCT 2.183 : H2RAs vs. placebo: RRR 23%, 95%CI 8-35, NNT: 7:

    12 RCT Moayyedi P, et al. Cochrane Database Syst Rev 2006:CD001960Abraham NS, et al. Aliment Pharmacol Ther 2004; 19:631

  • TCAs PPIs 8

    :

    ( 10-25 mg 25-50 mg ( , ) 8-12 6 : Talley NJ, et al. Gastroenterology 2015;149:340

  • TCAsRCT: 107 PPI (50 mg/day) placebo 12

    : 22% vs. 46%

    TCAs

    SSRIs

    Wu JC, et al. Gastroenterology 2011;140:S50Jackson JL, et al. Am J Med 2000;108:65Mertz H, et al. Am J Gastroenterol 1998;93:160van Kerkhoven LA, et al. Clin Gastroenterol Hepatol 2008;6:746

  • (5-10 mg t.i.d. 4 )

    :

    publication bias

    (: QT )

    Veldhuyzen van Zanten SJ, et al. Am J Gastroenterol 2001;96:689

  • - 17 RCT: (OR 2,9, 95% CI 1,5-5,8) (OR 7,0, 95%CI 3,6-16) placebo- 19 RCT 3.178 : 33% (RRR 33%, 95%CI 18-45) :

    Tegaserod, 5-HT4 Itopride, D2 , Mosapride, 5-4 Acotiamide, Vakil N, et al. Am J Gastroenterol 2008;103:1906Iwanaga Y, et al. Jpn J Pharmacol 1996;71:129

  • RCT: (10 mg t.i.d. 4 ) ,

    Tack J, et al. Clin Gastroenterol Hepatol 2012;10:1239

  • , , : RCT Post hoc 6 RCT :

    Stein DJ, et al. Int Clin Psychopharmacol 2009;24:126

  • Hamilton J, et al. Gastroenterology 2000;119:661Mine K, et al. Dig Dis Sci 1998;43:1241Jones MP, et al. J Clin Gastroenterol 2004;38:866Calvert EL, et al. Gastroenterology 2002;123:1778

  • (Pistacia lentiscus L. var. chia)

    .

  • , , ( )

    ,

  • T, :

    148 Rome II :O : 350mg tid 3 O : 350mg tid 3

    Dabos et al. J Ethnopharmacol 2010;127:205-209

  • (77% 40%, p
  • 3/3

  • Hp in vitro, in vivo Hp, (poly--myrcene) Hp

    Dabos et al. J Ethnopharmacol 2010;127:205-209

  • 2015 " " :

  • 12 ,

    Barbera R, et al. Dig Dis Sci 1995;40:1636Feinle C, et al. Gut 2001;48:347Saito YA, et al. Am J Gastroenterol 2005;100:2743

  • Take-home messages (1)

    N Hp Hp

    Hp, PPIx1 4-8

    X TCA, ( 10 mg, 25 mg, 25 mg x2 x3)

  • Take-home messages (2) Hp , PPI TCA

    2-4

    , ,

  • *Geen tekst: alleen laten zien

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