功能性胃肠药物治疗.pptVIP

胆囊收缩素受体-A拮抗剂 作用： CCK：抑制胃-结肠反射和胃肠运动 CCK-A受体拮抗剂：加速胃排空、促进结肠转运，可能改善内脏感觉。 主要有： 氯谷胺(loxiglumide) 右氯谷胺(dexloxiglumide) 曲美布丁(trimebutine) 三甲氧苯丁氨酯，直接作用于胃肠道平滑肌Ca2+通道、K+通道，通过抑制或增加胃肠平滑肌的收缩，调节胃肠运动正常化。 胃肠动力增强：抑制Ca2+通道 胃肠动力不足：抑制K+通道的通透性 作为脑腓肽类似物：作用外周鸦片受体 功能性胃肠病治疗新靶点 抑制胃酸药物 H2受体拮抗剂 质子泵抑制剂 黏膜保护剂、助消化药物、益生菌 保护胃肠道黏膜，减少理化因素的不良刺激 消化酶制剂，可改善消化不良的症状 改善肠道的微生态环境，可降低肠腔Ph有利于改善症状 解痉药 抗胆碱药物可作为缓解腹痛的短期对症治疗 止泻药 轻症者使用吸附止泻药，蒙脱石散，药用炭 重症腹泻，可选用洛哌丁胺和地芬诺酯，但不宜长期使用 泻药 便秘患者多选用温和的轻泻剂，聚乙二醇、乳果糖等 抗焦虑抑郁药物 根据不同表现选择不同的药物 非精神科医生多选用光谱抗精神药物 如黛力新、帕罗西汀等 请精神科会诊 Tips FGIDs是消化内科门诊最多见的疾病，可以见于医院的任何科室 FGIDs症状的出现与胃肠动力异常、内脏感觉过敏相关 在详细解释病情的基础上，调节胃肠动力是主要的治疗手段 进一步研究机制、开发新药物是必须的 * * * 方法学 * 图解：Rectal volume response to colonic distension in irritable bowel syndrome (IBS) and healthy subjects (N) during 2-min distension and postdistension period. Note the attenuated response during the distension period in both predominant constipation IBS (IBS-C) and predominant diarrhea IBS (IBS-D) compared with group N, and also the delayed recovery (return towards baseline volume levels) in the IBS subgroups. 文解：Alterations in normal intestinointestinal reflexes may be important contributors to the pathophysiology of irritable bowel syndrome (IBS). Our aims were to compare the rectal tonic responses to colonic distension in female IBS patients with predominant constipation (IBS-C) and with predominant diarrhea (IBS-D) to those in healthy females, both fasting and postprandially. Using a dual barostat assembly, 2-min colonic phasic distensions were performed during fasting and postprandially.Rectal tone was recorded before, during, and after the phasic distension. Colonic compliance and colonic sensitivity in response to the distension were also evaluated fasting and postprandially. Eight IBS-C patients, 8 IBS-D patients, and 8 age- and sex-matched healthy subjects (group N) participated. The fasting increments in rectal tone in response to colonic distension in both IBS-C (rectal balloon volume change 4.6 6.1 ml) and IBS-D (7.9 4.9