| セッション情報 | 特別講演13 |
|---|---|
| タイトル | SL-13：Functional dyspepsia：Exciting developments in a common disorder |
| 演者 | Tack Jan（Translational Research Center for Gastrointestinal Disorders（TARGID）, University of Leuven, Belgium） |
| 共同演者 | |
| 抄録 | Functional dyspepsia（FD）is one of the most prevalent functional gastrointestinal disorders. In the most recent iteration of the Rome criteria, Rome III, FD was subdivided into epigastric pain syndrome（EPS）and postprandial distress syndrome（PDS）. A controversy is the issue whether the Rome subdivision is sufficiently evidence-based and to which extent it determines clinical management. The underlying pathophysiology of functional dyspepsia is probably multifactorial, involving disordered gastrointestinal motor function, visceral hypersensitivity, mucosal immune activation and alterations of the brain-gut axis. A source of long-standing controversy is whether symptoms arise in the perpiphery or in the brain. While there are findings indicating central mechanisms for symptom generation in FD, there is equally compelling evidence for a contribution of peripheral mechanisms, including altered motility, changes in mucosal integrity and changes in acid clearance. In FD, currently available treatment modalities include acid suppressive drugs, gastroprokinetic drugs, H. pylori eradication therapy, tricyclic antidepressants or psychological therapies. There is evidence, although not always of high quality, of efficacy of prokinetic drugs in subgroups of patients. Novel approaches include fundus-relaxing drugs such as 5-HT1A agonists, and guanylate-cyclase-c agonists. The most recent therapeutic advance is the development of acotiamide. Acotiamide acts on muscarinic receptors and inhibits cholinesterase, and these effects lead to stimulation of gastric emptying and enhancement of gastric accommodation in FD. In rat models, acotiamide also counteracts the inhibitory effect of stress on gastric emptying rate and food intake. Acotiamide is approved for treatment of FD in Japan, and studies in other parts of the world are planned or ongoing. |
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