功能性胃肠病罗马.ppt

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1、功能性胃肠病(FGIDs)研究进展姒健敏FGIDs:概念Thefunctionalgastrointestinaldisorders,definedasavariablecombinationofchronicorrecurrentgastrointestinalsymptomsnotexp-lainedbystructuralorbiochemicalabnormalities.DrossmanDA,RomeIIBS诊断1#FGID分类199019891994Rome1书1992-1995Rome11999RomeIIGu

2、t增刊2000RomeII书2006胃肠病学增刊+Rome书功能性胃肠病的罗马标准演变RomeIIIFunctionalGastrointestinalDisordersAFunctionalesophagealdisordersA1FunctionalheartburnA2FunctionalchestpainofpresumedesophagealoriginBFunctionalgastroduodenaldisordersB1FunctionaldyspepsiaB1apostprandialdistresssynd

3、romeB1bepigastricpainsyndromeCFunctionalboweldisordersC1IrritablebowelsyndromeC2FunctionalbloatingC3FunctionalconstipationC4FunctionaldiarrheaC5UnspecifiedFunctionalboweldisorderDFunctionalabdominalpainsyndromeEFunctionalgallbladderandSphincterofOddidisordersFFunct

4、ionalanorectaldisordersGFunctionaldisorders:neonatesandtoddlersHFunctionaldisorders:childrenandadolescentsH1VomitingandaerophagiaH2Abodminalpain-relatedfunctionalgastrointestinaldisordersH2aFDH2bIBSH2cAbdominalmigraine罗马III标准的变化时间规定变化：症状持续至少6个月近3个月病情活动（符合诊断标准）分类发生变

5、化：反刍从食道疾病（分类A）改胃肠疾病（分类B)功能型腹痛单独分类儿童细分类标准变化：FD以餐后不适综合症B1a和上腹痛综合症B1b替代动力型和溃疡型IBS亚型重分：主张简单按照排便习惯分IBS-C,IBS-D和混合型Oddi括约肌功能障碍诊断标准更加严格基于症状发作时间（30’）和排除条件。TheFunctionalGastrointestinalDisordersandtheRomeIIIProcess。DROSSMANDA,GASTROENTEROLOGY2006;130:1377–1390FGID的重叠现象多数患者有

6、多种症状群FGID是一种或多种病症？943例合格的受试者中657（69％）例做出了回复年龄和性别分层的随机抽样，OlmstedCountry，MN年龄30－64岁反流IBS便秘Locheetal,NerogastroenterolMotil2005;17:腹泻消化不良IBS患者上消化道症状的重叠症状C-IBS（n＝76）D-IBS（n＝64）症状数量6.674.62*下腹痛（％）40.824.4**上腹痛（％）36.824.4胀气（％）75.040.9消化不良（％）48.736.4恶心（％）46.147.7晨期饱胀感（％）4

7、2.725.0烧心感（％）32.940.9*P<0.001;**P=0.05Talleyetal,AmJGastroenterol2003;98:2454GERDFD32.9%32.9%85.5%IBS-CGERDFD34.1%40.9%75.0%IBS-DIBS、哮喘(BHR)和GERD重叠随机选择的社区抽样4432例成人71.7％的回复率GER,IBS和哮喘GER和IBSGER和哮喘单独的GERGERD（n＝910）Kennedyetal,Gut1998;43:77IBS(n=546)247(335.5)45(54)17

8、5(134.7)79(21.7)201(261.6)117(104.6)539(648.9)BHR(n=442)7009191359GasSpasmsEarlySatietyHeartburnRegurgitation烧心腹痛便秘腹胀IBSIBSIBSFDFDFDFDGERDGERDGER