英国国民保健体系(NHS)在2004年8月26日公布了一项在一级医疗体系中如何诊治消化不良的新指南。该指南提供了针对成人消化不良症状和基础病因的 循证建议,规定了一级医疗体系中的医务人员如何针对消化不良成年患者开展各项诊疗活动。该指南涉及了一级医疗体系中的医务人员,包括全科医师、护士、社区 药师和其他与病人直接接触的初级保健专业人员。但二级医疗体系的医务人员也要对该指南有所了解,确保病人得到连续治疗。该指南将在英格兰和威尔士的国民保 健体系中推广使用。
《2010NHS消化不良管理指南》内容预览
Dyspepsia is a common complaint. More is spent on drugs for dyspepsia than on any other treatment for a symptom group. Universal investigation for dyspepsia is neither clinically desirable nor affordable and rational management poses a challenge.
Dyspepsia is a group of symptoms and is not itself a disease. According to the Rome II definition, dyspepsia refers to pain or discomfort centred in the upper abdomen. Pain in the lower abdomen does not constitute dyspepsia. “Discomfort” refers to subjective negative sensation such as upper abdominal fullness, early satiety, bloating, belching, nausea, retching and/or vomiting.
Up to 40% of the adult population suffer from dyspepsia/heartburn in any one year. The main causes are GORD (15-25%), gastric and duodenal ulcers (15-25%), and stomach cancer (2%). The remaining 60% are classified as “non-ulcer dyspepsia” (NUD) or “functional dyspepsia” (the preferred term these days). Such patients have symptoms but on investigation no causal pathology or disease is identified. Medication is not necessary for all patients with functional dyspepsia. There is a substantial placebo response to therapy. When medication is given, short-term treatment, intermittent if necessary, is likely to be more appropriate than long-term continuous therapy. Functional dyspepsia is not a condition caused by gastric hypersecretion: acid secretion is usually normal.
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