xusenlin/cmeee · Datasets at Hugging Face

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然而绝大多数研究证实FD患者基础胃酸和最大胃酸分泌量没有增加，胃酸分泌与溃疡样症状无关，症状程度与最大胃酸分泌也无相关性。	[ { "id": 0, "entity": "FD", "start_offset": 10, "end_offset": 12, "label": "dis" }, { "id": 1, "entity": "胃酸", "start_offset": 31, "end_offset": 33, "label": "bod" }, { "id": 2, "entity": "溃疡", "start_offset": 36, "end_offset": 38, "label": "dis" }, { "id": 3, "entity": "最大胃酸分泌", "start_offset": 49, "end_offset": 55, "label": "ite" } ]
所以，胃酸在功能性消化不良发病中的作用仍需进一步研究。	[ { "id": 0, "entity": "功能性消化不良", "start_offset": 6, "end_offset": 13, "label": "dis" } ]
（三）慢性胃炎与十二指肠炎功能性消化不良患者中大约有30%～50%经组织学检查证实为胃窦胃炎，欧洲不少国家将慢性胃炎视为功能性消化不良，认为慢性胃炎可能通过神经及体液因素影响胃的运动功能，也有作者认为非糜烂性十二指肠炎也属于功能性消化不良。	[ { "id": 0, "entity": "慢性胃炎", "start_offset": 3, "end_offset": 7, "label": "dis" }, { "id": 1, "entity": "十二指肠炎", "start_offset": 8, "end_offset": 13, "label": "dis" }, { "id": 2, "entity": "功能性消化不良", "start_offset": 13, "end_offset": 20, "label": "dis" }, { "id": 3, "entity": "胃窦胃炎", "start_offset": 42, "end_offset": 46, "label": "dis" }, { "id": 4, "entity": "慢性胃炎", "start_offset": 54, "end_offset": 58, "label": "dis" }, { "id": 5, "entity": "功能性消化不良", "start_offset": 60, "end_offset": 67, "label": "dis" }, { "id": 6, "entity": "慢性胃炎", "start_offset": 70, "end_offset": 74, "label": "dis" }, { "id": 7, "entity": "神经", "start_offset": 78, "end_offset": 80, "label": "bod" }, { "id": 8, "entity": "体液", "start_offset": 81, "end_offset": 83, "label": "bod" }, { "id": 9, "entity": "胃", "start_offset": 87, "end_offset": 88, "label": "bod" }, { "id": 10, "entity": "非糜烂性十二指肠炎", "start_offset": 100, "end_offset": 109, "label": "dis" }, { "id": 11, "entity": "功能性消化不良", "start_offset": 112, "end_offset": 119, "label": "dis" } ]
应当指出的是，功能性消化不良症状的轻重并不与胃黏膜炎症病变相互平行。	[ { "id": 0, "entity": "功能性消化不良", "start_offset": 7, "end_offset": 14, "label": "dis" }, { "id": 1, "entity": "胃黏膜炎症", "start_offset": 22, "end_offset": 27, "label": "dis" } ]
（四）幽门螺杆菌感染幽门螺杆菌是一种革兰阴性细菌，一般定植于胃的黏液层表面。	[ { "id": 0, "entity": "幽门螺杆菌感染", "start_offset": 3, "end_offset": 10, "label": "dis" }, { "id": 1, "entity": "幽门螺杆菌", "start_offset": 10, "end_offset": 15, "label": "mic" }, { "id": 2, "entity": "革兰阴性细菌", "start_offset": 18, "end_offset": 24, "label": "mic" }, { "id": 3, "entity": "胃", "start_offset": 30, "end_offset": 31, "label": "bod" }, { "id": 4, "entity": "黏液层", "start_offset": 32, "end_offset": 35, "label": "bod" } ]
幽门螺杆菌感染与功能性消化不良关系的研究结果差异很大，有些研究认为幽门螺杆菌感染是FD的病理生理因素之一，因为在成人中，功能性消化不良患者的胃黏膜内常可发现幽门螺杆菌，检出率在40%～70%之间。	[ { "id": 0, "entity": "幽门螺杆菌感染", "start_offset": 0, "end_offset": 7, "label": "dis" }, { "id": 1, "entity": "功能性消化不良", "start_offset": 8, "end_offset": 15, "label": "dis" }, { "id": 2, "entity": "幽门螺杆菌感染", "start_offset": 33, "end_offset": 40, "label": "dis" }, { "id": 3, "entity": "FD", "start_offset": 41, "end_offset": 43, "label": "dis" }, { "id": 4, "entity": "功能性消化不良", "start_offset": 60, "end_offset": 67, "label": "dis" }, { "id": 5, "entity": "幽门螺杆菌", "start_offset": 78, "end_offset": 83, "label": "mic" } ]
但大量的研究却表明：FD患者的幽门螺杆菌感染率并不高于正常健康人，阳性幽门螺杆菌和阴性幽门螺杆菌者的胃肠运动和胃排空功能无明显差异，且幽门螺杆菌阳性的FD患者经根除幽门螺杆菌治疗后其消化不良症状并不一定随之消失，进一步研究证实幽门螺杆菌特异性抗原与FD无相关性，甚至其特异血清型CagA与任何消化不良症状或任何原发性功能性上腹不适症状均无关系。	[ { "id": 0, "entity": "FD", "start_offset": 10, "end_offset": 12, "label": "dis" }, { "id": 1, "entity": "幽门螺杆菌感染", "start_offset": 15, "end_offset": 22, "label": "dis" }, { "id": 2, "entity": "幽门螺杆菌", "start_offset": 35, "end_offset": 40, "label": "mic" }, { "id": 3, "entity": "幽门螺杆菌", "start_offset": 43, "end_offset": 48, "label": "mic" }, { "id": 4, "entity": "胃肠", "start_offset": 50, "end_offset": 52, "label": "bod" }, { "id": 5, "entity": "胃", "start_offset": 55, "end_offset": 56, "label": "bod" }, { "id": 6, "entity": "幽门螺杆菌", "start_offset": 67, "end_offset": 72, "label": "mic" }, { "id": 7, "entity": "FD", "start_offset": 75, "end_offset": 77, "label": "dis" }, { "id": 8, "entity": "消化不良", "start_offset": 91, "end_offset": 95, "label": "dis" }, { "id": 9, "entity": "幽门螺杆菌", "start_offset": 113, "end_offset": 118, "label": "mic" }, { "id": 10, "entity": "FD", "start_offset": 124, "end_offset": 126, "label": "dis" }, { "id": 11, "entity": "消化不良", "start_offset": 146, "end_offset": 150, "label": "dis" }, { "id": 12, "entity": "原发性功能性上腹不适", "start_offset": 155, "end_offset": 165, "label": "dis" } ]
目前国内学者的共识意见为幽门螺杆菌感染为慢性活动性胃炎的主要病因，有消化不良症状的幽门螺杆菌感染者可归属于FD范畴。	[ { "id": 0, "entity": "幽门螺杆菌感染", "start_offset": 12, "end_offset": 19, "label": "dis" }, { "id": 1, "entity": "慢性活动性胃炎", "start_offset": 20, "end_offset": 27, "label": "dis" }, { "id": 2, "entity": "消化不良", "start_offset": 34, "end_offset": 38, "label": "dis" }, { "id": 3, "entity": "幽门螺杆菌感染", "start_offset": 41, "end_offset": 48, "label": "dis" }, { "id": 4, "entity": "FD", "start_offset": 53, "end_offset": 55, "label": "dis" } ]
（五）胃肠运动功能障碍许多的研究都认为FD其实是胃肠道功能紊乱的一种。	[ { "id": 0, "entity": "胃肠运动功能障碍", "start_offset": 3, "end_offset": 11, "label": "dis" }, { "id": 1, "entity": "FD", "start_offset": 19, "end_offset": 21, "label": "dis" }, { "id": 2, "entity": "胃肠道功能紊乱", "start_offset": 24, "end_offset": 31, "label": "dis" } ]
它与其他胃肠功能紊乱性疾病有着相似的发病机制。	[ { "id": 0, "entity": "胃肠功能紊乱性疾病", "start_offset": 4, "end_offset": 13, "label": "dis" } ]
近年来随着对胃肠功能疾病在生理学（运动-感觉）、基础学（脑-肠作用）及精神社会学等方面的进一步了解，并基于其所表现的症状及解剖位置，罗马委员会制定了新的标准，即罗马Ⅲ标准。	[ { "id": 0, "entity": "胃肠功能疾病", "start_offset": 6, "end_offset": 12, "label": "dis" } ]
罗马Ⅲ标准不仅包括诊断标准，亦对胃肠功能紊乱的基础生理、病理、神经支配及胃肠激素、免疫系统做了详尽的叙述，同时在治疗方面也提出了指导性意见。	[ { "id": 0, "entity": "胃肠功能紊乱", "start_offset": 16, "end_offset": 22, "label": "dis" }, { "id": 1, "entity": "免疫系统", "start_offset": 41, "end_offset": 45, "label": "bod" } ]
因此罗马Ⅲ标准是目前世界各国用于功能性胃肠疾病诊断、治疗的一个共识文件。	[ { "id": 0, "entity": "功能性胃肠疾病", "start_offset": 16, "end_offset": 23, "label": "dis" } ]
该标准认为：胃肠道运动在消化期与消化间期有不同的形式和特点。	[ { "id": 0, "entity": "胃肠道", "start_offset": 6, "end_offset": 9, "label": "bod" } ]
空腹状态下由胃至末端回肠存在一种周期性运动形式，称为消化间期移行性综合运动（MMC）。	[ { "id": 0, "entity": "胃", "start_offset": 6, "end_offset": 7, "label": "bod" }, { "id": 1, "entity": "末端回肠", "start_offset": 8, "end_offset": 12, "label": "bod" } ]
大约在正常餐后4～6小时，这种周期性、特征性的运动起于近端胃，并缓慢传导到整个小肠。	[ { "id": 0, "entity": "小肠", "start_offset": 39, "end_offset": 41, "label": "bod" } ]
每个MMC由4个连续时相组成：Ⅰ相为运动不活跃期；Ⅱ相的特征是间断性蠕动收缩；Ⅲ相时胃发生连续性蠕动收缩，每个慢波上伴有快速发生的动作电位（峰电位），收缩环中心闭合而幽门基础压力却不高，处于开放状态，故能清除胃内残留食物；Ⅳ相是Ⅲ相结束回到Ⅰ相的恢复期。	[ { "id": 0, "entity": "胃", "start_offset": 42, "end_offset": 43, "label": "bod" }, { "id": 1, "entity": "幽门", "start_offset": 83, "end_offset": 85, "label": "bod" }, { "id": 2, "entity": "胃", "start_offset": 104, "end_offset": 105, "label": "bod" } ]
与之相对应，在Ⅲ期还伴有胃酸分泌、胰腺和胆汁分泌。	[ { "id": 0, "entity": "胃酸", "start_offset": 12, "end_offset": 14, "label": "bod" }, { "id": 1, "entity": "胰腺", "start_offset": 17, "end_offset": 19, "label": "bod" }, { "id": 2, "entity": "胆汁", "start_offset": 20, "end_offset": 22, "label": "bod" } ]
空腹状态下，十二指肠最大收缩频率为12次/分，从十二指肠开始MMC向远端移动速度为5～10cm/min，90分钟后达末端回肠，其作用是清除肠腔内不被消化的颗粒。	[ { "id": 0, "entity": "腹", "start_offset": 1, "end_offset": 2, "label": "bod" }, { "id": 1, "entity": "十二指肠", "start_offset": 24, "end_offset": 28, "label": "bod" }, { "id": 2, "entity": "末端回肠", "start_offset": 58, "end_offset": 62, "label": "bod" }, { "id": 3, "entity": "肠腔", "start_offset": 69, "end_offset": 71, "label": "bod" } ]
进餐打乱了消化间期的活动，出现一种特殊的运动类型：胃窦-十二指肠协调收缩。	[ { "id": 0, "entity": "胃窦-十二指肠", "start_offset": 25, "end_offset": 32, "label": "bod" } ]
胃底出现容受性舒张，远端胃出现不规则时相性收缩，持续数分钟后进入较稳定的运动模式，即3次/分的节律性蠕动性收缩，并与幽门括约肌的开放和十二指肠协调运动，推动食物进入十二指肠。	[ { "id": 0, "entity": "胃", "start_offset": 0, "end_offset": 1, "label": "bod" }, { "id": 1, "entity": "胃", "start_offset": 12, "end_offset": 13, "label": "bod" }, { "id": 2, "entity": "幽门括约肌", "start_offset": 58, "end_offset": 63, "label": "bod" }, { "id": 3, "entity": "十二指肠", "start_offset": 67, "end_offset": 71, "label": "bod" } ]
此时小肠出现不规则、随机的收缩运动，并根据食物的大小和性质，使得这种运动模式可维持2.5～8小时。	[ { "id": 0, "entity": "小肠", "start_offset": 2, "end_offset": 4, "label": "bod" } ]
此后当食物从小肠排空后，又恢复消化间期模式。	[ { "id": 0, "entity": "小肠", "start_offset": 6, "end_offset": 8, "label": "bod" } ]
在长期的对FD患者的研究中发现：约50%FD患者存在餐后胃排空延迟，可以是液体或（和）固体排空障碍。	[ { "id": 0, "entity": "FD", "start_offset": 5, "end_offset": 7, "label": "dis" }, { "id": 1, "entity": "FD", "start_offset": 20, "end_offset": 22, "label": "dis" }, { "id": 2, "entity": "液体或（和）固体排空障碍", "start_offset": 37, "end_offset": 49, "label": "dis" } ]
小儿FD中有61.53%胃排空迟缓胃运动异常的综合表现，胃近端张力减低胃窦运动减弱胃电紊乱胃排空功能。	[ { "id": 0, "entity": "胃", "start_offset": 12, "end_offset": 13, "label": "bod" }, { "id": 1, "entity": "胃排空迟缓", "start_offset": 12, "end_offset": 17, "label": "sym" }, { "id": 2, "entity": "胃运动异常", "start_offset": 17, "end_offset": 22, "label": "dis" }, { "id": 3, "entity": "胃", "start_offset": 28, "end_offset": 29, "label": "bod" }, { "id": 4, "entity": "胃近端张力减低", "start_offset": 28, "end_offset": 35, "label": "sym" }, { "id": 5, "entity": "胃窦", "start_offset": 35, "end_offset": 37, "label": "bod" }, { "id": 6, "entity": "胃窦运动减弱", "start_offset": 35, "end_offset": 41, "label": "sym" }, { "id": 7, "entity": "胃", "start_offset": 41, "end_offset": 42, "label": "bod" }, { "id": 8, "entity": "胃电紊乱", "start_offset": 41, "end_offset": 45, "label": "sym" }, { "id": 9, "entity": "胃", "start_offset": 45, "end_offset": 46, "label": "bod" } ]
胃内压力测定发现，25%功能性消化不良胃窦运动功能减弱胃窦无收缩。	[ { "id": 0, "entity": "胃内压力测定", "start_offset": 0, "end_offset": 6, "label": "pro" }, { "id": 1, "entity": "功能性消化不良", "start_offset": 12, "end_offset": 19, "label": "dis" }, { "id": 2, "entity": "胃窦", "start_offset": 19, "end_offset": 21, "label": "bod" }, { "id": 3, "entity": "胃窦运动功能减弱", "start_offset": 19, "end_offset": 27, "label": "sym" }, { "id": 4, "entity": "胃窦无收缩", "start_offset": 27, "end_offset": 32, "label": "sym" } ]
儿童中，FD患儿胃窦收缩幅度明显低于健康儿胃容量-压力关系曲线和电子恒压器检查发现患者胃近端容纳舒张功能受损胃顺应性降低近端胃壁张力下降FD患者有小肠运动障碍，以近端小肠为主，胃窦-十二指肠测压发现胃窦十二指肠运动不协调十二指肠运动紊乱，约有1/3的FD存在肠易激综合征。	[ { "id": 0, "entity": "FD", "start_offset": 4, "end_offset": 6, "label": "dis" }, { "id": 1, "entity": "胃窦", "start_offset": 8, "end_offset": 10, "label": "bod" }, { "id": 2, "entity": "胃窦收缩幅度明显低于健康儿", "start_offset": 8, "end_offset": 21, "label": "sym" }, { "id": 3, "entity": "胃容量-压力", "start_offset": 21, "end_offset": 27, "label": "ite" }, { "id": 4, "entity": "电子恒压器检查", "start_offset": 32, "end_offset": 39, "label": "pro" }, { "id": 5, "entity": "胃", "start_offset": 43, "end_offset": 44, "label": "bod" }, { "id": 6, "entity": "胃近端容纳舒张功能受损", "start_offset": 43, "end_offset": 54, "label": "sym" }, { "id": 7, "entity": "胃", "start_offset": 54, "end_offset": 55, "label": "bod" }, { "id": 8, "entity": "胃顺应性降低", "start_offset": 54, "end_offset": 60, "label": "sym" }, { "id": 9, "entity": "近端胃壁", "start_offset": 60, "end_offset": 64, "label": "bod" }, { "id": 10, "entity": "近端胃壁张力下降", "start_offset": 60, "end_offset": 68, "label": "sym" }, { "id": 11, "entity": "FD", "start_offset": 68, "end_offset": 70, "label": "dis" }, { "id": 12, "entity": "小肠运动障碍", "start_offset": 73, "end_offset": 79, "label": "dis" }, { "id": 13, "entity": "近端小肠", "start_offset": 81, "end_offset": 85, "label": "bod" }, { "id": 14, "entity": "胃窦", "start_offset": 99, "end_offset": 101, "label": "bod" }, { "id": 15, "entity": "十二指肠", "start_offset": 101, "end_offset": 105, "label": "bod" }, { "id": 16, "entity": "胃窦十二指肠运动不协调", "start_offset": 99, "end_offset": 110, "label": "sym" }, { "id": 17, "entity": "十二指肠运动紊乱", "start_offset": 110, "end_offset": 118, "label": "dis" }, { "id": 18, "entity": "FD", "start_offset": 125, "end_offset": 127, "label": "dis" }, { "id": 19, "entity": "肠易激综合征", "start_offset": 129, "end_offset": 135, "label": "dis" } ]
（六）内脏感觉异常许多功能性消化不良的患者对生理或轻微有害刺激的感受异常或过于敏感。	[ { "id": 0, "entity": "功能性消化不良", "start_offset": 11, "end_offset": 18, "label": "dis" } ]
一些患者对灌注酸和盐水的敏感性提高；一些患者即使在使用了H2</sub>受体拮抗剂阻断酸分泌的情况下，静脉注射五肽胃泌素仍会发生疼痛。	[ { "id": 0, "entity": "灌注酸", "start_offset": 5, "end_offset": 8, "label": "dru" }, { "id": 1, "entity": "盐水", "start_offset": 9, "end_offset": 11, "label": "dru" }, { "id": 2, "entity": "酸", "start_offset": 43, "end_offset": 44, "label": "bod" }, { "id": 3, "entity": "静脉注射", "start_offset": 51, "end_offset": 55, "label": "pro" }, { "id": 4, "entity": "五肽胃泌素", "start_offset": 55, "end_offset": 60, "label": "dru" }, { "id": 5, "entity": "疼痛", "start_offset": 64, "end_offset": 66, "label": "sym" } ]
一些研究报道，球囊在近端胃膨胀时，功能性消化不良患者的疼痛往往会加重，他们疼痛发作时球囊膨胀的水平显著低于对照组内脏感觉的异常在功能性消化不良中可能起到了一定作用。	[ { "id": 0, "entity": "球囊", "start_offset": 7, "end_offset": 9, "label": "bod" }, { "id": 1, "entity": "胃", "start_offset": 12, "end_offset": 13, "label": "bod" }, { "id": 2, "entity": "功能性消化不良", "start_offset": 17, "end_offset": 24, "label": "dis" }, { "id": 3, "entity": "疼痛往往会加重", "start_offset": 27, "end_offset": 34, "label": "sym" }, { "id": 4, "entity": "球囊", "start_offset": 42, "end_offset": 44, "label": "bod" }, { "id": 5, "entity": "疼痛发作时球囊膨胀的水平显著低于对照组", "start_offset": 37, "end_offset": 56, "label": "sym" }, { "id": 6, "entity": "内脏", "start_offset": 56, "end_offset": 58, "label": "bod" }, { "id": 7, "entity": "功能性消化不良", "start_offset": 64, "end_offset": 71, "label": "dis" } ]
但这种感觉异常的基础尚不清楚，初步研究证实功能性消化不良患者存在两种内脏传入功能障碍，一种是不被察觉的反射传入信号，另一种为感知信号。	[ { "id": 0, "entity": "感觉异常", "start_offset": 3, "end_offset": 7, "label": "sym" }, { "id": 1, "entity": "功能性消化不良", "start_offset": 21, "end_offset": 28, "label": "dis" }, { "id": 2, "entity": "内脏传入功能障碍", "start_offset": 34, "end_offset": 42, "label": "dis" } ]
当胃肠道机械感受器感受扩张刺激后，受试者会因扩张容量的逐渐增加而产生感知、不适及疼痛，从而获得不同状态的扩张容量，功能性消化不良患者感知阈明显低于正常人，表明患者感觉过敏。	[ { "id": 0, "entity": "胃肠道机械感受器", "start_offset": 1, "end_offset": 9, "label": "bod" }, { "id": 1, "entity": "功能性消化不良", "start_offset": 57, "end_offset": 64, "label": "dis" } ]
（七）心理社会因素心理学因素是否与功能性消化不良的发病有关一直存在着争议。	[ { "id": 0, "entity": "功能性消化不良", "start_offset": 17, "end_offset": 24, "label": "dis" } ]
国内有学者曾对186名FD患者的年龄、性别、生活习惯以及文化程度等进行了解，并做了焦虑及抑郁的评定，结果发现FD患者以年龄偏大的女性多见，它的发生与焦虑及抑郁有较明显的关系。	[ { "id": 0, "entity": "FD", "start_offset": 11, "end_offset": 13, "label": "dis" }, { "id": 1, "entity": "焦虑", "start_offset": 41, "end_offset": 43, "label": "dis" }, { "id": 2, "entity": "抑", "start_offset": 44, "end_offset": 45, "label": "dis" }, { "id": 3, "entity": "抑", "start_offset": 44, "end_offset": 45, "label": "pro" }, { "id": 4, "entity": "结果", "start_offset": 50, "end_offset": 52, "label": "dis" }, { "id": 5, "entity": "的发", "start_offset": 70, "end_offset": 72, "label": "dis" }, { "id": 6, "entity": "与焦", "start_offset": 73, "end_offset": 75, "label": "dis" } ]
但目前尚无确切的证据表明功能性消化不良症状与精神异常或慢性应激有关。	[ { "id": 0, "entity": "功能性消化不良", "start_offset": 12, "end_offset": 19, "label": "dis" }, { "id": 1, "entity": "精神异常", "start_offset": 22, "end_offset": 26, "label": "dis" }, { "id": 2, "entity": "慢性应激", "start_offset": 27, "end_offset": 31, "label": "dis" } ]
功能性消化不良患者重大生活应激事件的数量也不一定高于其他人群，但很可能这些患者对应激的感受程度要更高。	[ { "id": 0, "entity": "功能性消化不良", "start_offset": 0, "end_offset": 7, "label": "dis" }, { "id": 1, "entity": "重大生活应激", "start_offset": 9, "end_offset": 15, "label": "dis" }, { "id": 2, "entity": "应激", "start_offset": 40, "end_offset": 42, "label": "dis" } ]
（八）其他胃肠功能紊乱性疾病1.胃食管反流性疾病（GERD）胃灼热和反流是胃食管反流的特异性症状，但是许多GERD患者并无此明显症状，有些患者主诉既有胃灼热消化不良。	[ { "id": 0, "entity": "胃肠功能紊乱性疾病", "start_offset": 5, "end_offset": 14, "label": "dis" }, { "id": 1, "entity": "胃食管反流性疾病", "start_offset": 16, "end_offset": 24, "label": "dis" }, { "id": 2, "entity": "GERD", "start_offset": 25, "end_offset": 29, "label": "dis" }, { "id": 3, "entity": "胃灼热", "start_offset": 30, "end_offset": 33, "label": "sym" }, { "id": 4, "entity": "反流", "start_offset": 34, "end_offset": 36, "label": "sym" }, { "id": 5, "entity": "胃食管反流", "start_offset": 37, "end_offset": 42, "label": "dis" }, { "id": 6, "entity": "GERD", "start_offset": 53, "end_offset": 57, "label": "dis" }, { "id": 7, "entity": "胃", "start_offset": 75, "end_offset": 76, "label": "bod" }, { "id": 8, "entity": "胃灼热", "start_offset": 75, "end_offset": 78, "label": "sym" }, { "id": 9, "entity": "消化不良", "start_offset": 78, "end_offset": 82, "label": "dis" } ]
目前有许多学者已接受了以下看法：有少数GERD患者并无食管炎，许多GERD患者具有复杂的消化不良病史，而不仅是单纯胃灼热酸反流症状。	[ { "id": 0, "entity": "GERD", "start_offset": 19, "end_offset": 23, "label": "dis" }, { "id": 1, "entity": "食管炎", "start_offset": 27, "end_offset": 30, "label": "dis" }, { "id": 2, "entity": "GERD", "start_offset": 33, "end_offset": 37, "label": "dis" }, { "id": 3, "entity": "消化不良", "start_offset": 44, "end_offset": 48, "label": "dis" }, { "id": 4, "entity": "胃", "start_offset": 57, "end_offset": 58, "label": "bod" }, { "id": 5, "entity": "胃灼热", "start_offset": 57, "end_offset": 60, "label": "sym" }, { "id": 6, "entity": "酸反流", "start_offset": 60, "end_offset": 63, "label": "sym" } ]
用食管24小时pH监测研究发现：约有20%的功能性消化不良患者和反流性疾病有关。	[ { "id": 0, "entity": "功能性消化不良", "start_offset": 22, "end_offset": 29, "label": "dis" }, { "id": 1, "entity": "反流性疾病", "start_offset": 32, "end_offset": 37, "label": "dis" } ]
最近Sandlu等报告，20例小儿厌食中，12例（60%）有胃食管反流胃食管反流性疾病和某些功能性消化不良的病例有关。	[ { "id": 0, "entity": "小儿厌食", "start_offset": 15, "end_offset": 19, "label": "dis" }, { "id": 1, "entity": "胃食管", "start_offset": 30, "end_offset": 33, "label": "bod" }, { "id": 2, "entity": "胃食管反流", "start_offset": 30, "end_offset": 35, "label": "sym" }, { "id": 3, "entity": "胃食管反流性疾病", "start_offset": 35, "end_offset": 43, "label": "dis" }, { "id": 4, "entity": "功能性消化不良", "start_offset": 46, "end_offset": 53, "label": "dis" } ]
2.吞气症许多患者常下意识地吞入过量的空气，导致腹胀饱胀和嗳气，这种情况也常继发于应激或焦虑。	[ { "id": 0, "entity": "吞气症", "start_offset": 2, "end_offset": 5, "label": "dis" }, { "id": 1, "entity": "腹", "start_offset": 24, "end_offset": 25, "label": "bod" }, { "id": 2, "entity": "腹胀", "start_offset": 24, "end_offset": 26, "label": "sym" }, { "id": 3, "entity": "饱胀", "start_offset": 26, "end_offset": 28, "label": "sym" }, { "id": 4, "entity": "嗳气", "start_offset": 29, "end_offset": 31, "label": "sym" }, { "id": 5, "entity": "应激", "start_offset": 41, "end_offset": 43, "label": "dis" }, { "id": 6, "entity": "焦虑", "start_offset": 44, "end_offset": 46, "label": "dis" } ]
3.肠易激综合征（IBS）功能性消化不良与其他胃肠道紊乱之间常常有许多重叠。	[ { "id": 0, "entity": "肠易激综合征", "start_offset": 2, "end_offset": 8, "label": "dis" }, { "id": 1, "entity": "IBS", "start_offset": 9, "end_offset": 12, "label": "dis" }, { "id": 2, "entity": "功能性消化不良", "start_offset": 13, "end_offset": 20, "label": "dis" }, { "id": 3, "entity": "胃肠道紊乱", "start_offset": 23, "end_offset": 28, "label": "dis" } ]
约有1/3的IBS患者有消化不良症状；功能性消化不良患者中有IBS症状的比例也近似。	[ { "id": 0, "entity": "IBS", "start_offset": 6, "end_offset": 9, "label": "dis" }, { "id": 1, "entity": "消化不良症状", "start_offset": 12, "end_offset": 18, "label": "dis" }, { "id": 2, "entity": "功能性消化不良", "start_offset": 19, "end_offset": 26, "label": "dis" }, { "id": 3, "entity": "IBS", "start_offset": 30, "end_offset": 33, "label": "dis" } ]
【临床表现及分型】临床症状主要包括上腹痛腹胀早饱、嗳气、厌食、胃灼热泛酸、恶心和呕吐。	[ { "id": 0, "entity": "上腹", "start_offset": 17, "end_offset": 19, "label": "bod" }, { "id": 1, "entity": "上腹痛", "start_offset": 17, "end_offset": 20, "label": "sym" }, { "id": 2, "entity": "腹", "start_offset": 20, "end_offset": 21, "label": "bod" }, { "id": 3, "entity": "腹胀", "start_offset": 20, "end_offset": 22, "label": "sym" }, { "id": 4, "entity": "早饱", "start_offset": 22, "end_offset": 24, "label": "sym" }, { "id": 5, "entity": "嗳气", "start_offset": 25, "end_offset": 27, "label": "sym" }, { "id": 6, "entity": "厌食", "start_offset": 28, "end_offset": 30, "label": "sym" }, { "id": 7, "entity": "胃", "start_offset": 31, "end_offset": 32, "label": "bod" }, { "id": 8, "entity": "胃灼热", "start_offset": 31, "end_offset": 34, "label": "sym" }, { "id": 9, "entity": "泛酸", "start_offset": 34, "end_offset": 36, "label": "sym" }, { "id": 10, "entity": "恶心", "start_offset": 37, "end_offset": 39, "label": "sym" }, { "id": 11, "entity": "呕吐", "start_offset": 40, "end_offset": 42, "label": "sym" } ]
病程多在2年内，症状可反复发作，也可在相当一段时间内无症状。	[ { "id": 0, "entity": "病程多在2年内", "start_offset": 0, "end_offset": 7, "label": "sym" }, { "id": 1, "entity": "症状可反复发作", "start_offset": 8, "end_offset": 15, "label": "sym" }, { "id": 2, "entity": "一段时间内无症状", "start_offset": 21, "end_offset": 29, "label": "sym" } ]
可以某一症状为主，也可有多个症状的叠加。	[ { "id": 0, "entity": "某一症状为主", "start_offset": 2, "end_offset": 8, "label": "sym" }, { "id": 1, "entity": "多个症状的叠加", "start_offset": 12, "end_offset": 19, "label": "sym" } ]
1989年，美国芝加哥FD专题会议将功能性消化不良分为5个亚型：反流样消化不良（refluxlikedyspepsia）、运动障碍样消化不良（dysmotilitylikedyspepsia）、溃疡样消化不良（ulcerlikedyspepsia）、吞气症（aerophagia）及特发性消化不良（idiopathicdyspepsia）。	[ { "id": 0, "entity": "FD", "start_offset": 11, "end_offset": 13, "label": "dis" }, { "id": 1, "entity": "功能性消化不良", "start_offset": 18, "end_offset": 25, "label": "dis" }, { "id": 2, "entity": "反流样消化不良", "start_offset": 32, "end_offset": 39, "label": "dis" }, { "id": 3, "entity": "refluxlikedyspepsia", "start_offset": 40, "end_offset": 59, "label": "dis" }, { "id": 4, "entity": "运动障碍样消化不良", "start_offset": 61, "end_offset": 70, "label": "dis" }, { "id": 5, "entity": "dysmotilitylikedyspepsia", "start_offset": 71, "end_offset": 95, "label": "dis" }, { "id": 6, "entity": "溃疡样消化不良", "start_offset": 97, "end_offset": 104, "label": "dis" }, { "id": 7, "entity": "ulcerlikedyspepsia", "start_offset": 105, "end_offset": 123, "label": "dis" }, { "id": 8, "entity": "吞气症", "start_offset": 125, "end_offset": 128, "label": "dis" }, { "id": 9, "entity": "aerophagia", "start_offset": 129, "end_offset": 139, "label": "dis" }, { "id": 10, "entity": "特发性消化不良", "start_offset": 141, "end_offset": 148, "label": "dis" }, { "id": 11, "entity": "idiopathicdyspepsia", "start_offset": 149, "end_offset": 168, "label": "dis" } ]
（一）运动障碍样消化不良此型患者的表现以腹胀早饱及嗳气为主。	[ { "id": 0, "entity": "运动障碍样消化不良", "start_offset": 3, "end_offset": 12, "label": "dis" }, { "id": 1, "entity": "腹", "start_offset": 20, "end_offset": 21, "label": "bod" }, { "id": 2, "entity": "腹胀", "start_offset": 20, "end_offset": 22, "label": "sym" }, { "id": 3, "entity": "早饱", "start_offset": 22, "end_offset": 24, "label": "sym" }, { "id": 4, "entity": "嗳气", "start_offset": 25, "end_offset": 27, "label": "sym" } ]
症状多在进食后加重。	[ { "id": 0, "entity": "症状多在进食后加重", "start_offset": 0, "end_offset": 9, "label": "sym" } ]
过饱时会出现腹痛恶心甚至呕吐反流样消化不良突出的表现是胸骨后痛胃灼热反流。	[ { "id": 0, "entity": "腹", "start_offset": 6, "end_offset": 7, "label": "bod" }, { "id": 1, "entity": "过饱时会出现腹痛恶心甚至呕吐", "start_offset": 0, "end_offset": 14, "label": "sym" }, { "id": 2, "entity": "反流样消化不良", "start_offset": 14, "end_offset": 21, "label": "dis" }, { "id": 3, "entity": "胸骨", "start_offset": 27, "end_offset": 29, "label": "bod" }, { "id": 4, "entity": "胸骨后痛", "start_offset": 27, "end_offset": 31, "label": "sym" }, { "id": 5, "entity": "胃", "start_offset": 31, "end_offset": 32, "label": "bod" }, { "id": 6, "entity": "胃灼热", "start_offset": 31, "end_offset": 34, "label": "sym" }, { "id": 7, "entity": "反流", "start_offset": 34, "end_offset": 36, "label": "sym" } ]
内镜检查未发现食管炎，但24小时pH监测可发现部分患者有胃食管酸反流食管对酸敏感性增加有关。	[ { "id": 0, "entity": "内镜检查", "start_offset": 0, "end_offset": 4, "label": "pro" }, { "id": 1, "entity": "食管炎", "start_offset": 7, "end_offset": 10, "label": "dis" }, { "id": 2, "entity": "胃食管", "start_offset": 28, "end_offset": 31, "label": "bod" }, { "id": 3, "entity": "胃食管酸反流", "start_offset": 28, "end_offset": 34, "label": "sym" }, { "id": 4, "entity": "食管", "start_offset": 34, "end_offset": 36, "label": "bod" } ]
（三）溃疡样消化不良主要表现与十二指肠溃疡特点相同，夜间痛，饥饿痛，进食或服抗酸剂能缓解，可伴有反酸，少数患者伴胃灼热症状呈慢性周期性。	[ { "id": 0, "entity": "溃疡样消化不良", "start_offset": 3, "end_offset": 10, "label": "dis" }, { "id": 1, "entity": "十二指肠溃疡", "start_offset": 15, "end_offset": 21, "label": "dis" }, { "id": 2, "entity": "夜间痛", "start_offset": 26, "end_offset": 29, "label": "sym" }, { "id": 3, "entity": "饥饿痛", "start_offset": 30, "end_offset": 33, "label": "sym" }, { "id": 4, "entity": "抗酸剂", "start_offset": 38, "end_offset": 41, "label": "dru" }, { "id": 5, "entity": "反酸", "start_offset": 48, "end_offset": 50, "label": "sym" }, { "id": 6, "entity": "胃", "start_offset": 56, "end_offset": 57, "label": "bod" }, { "id": 7, "entity": "胃灼热", "start_offset": 56, "end_offset": 59, "label": "sym" }, { "id": 8, "entity": "症状呈慢性周期性", "start_offset": 59, "end_offset": 67, "label": "sym" } ]
内镜检查未发现溃疡和糜烂性炎症。	[ { "id": 0, "entity": "内镜检查", "start_offset": 0, "end_offset": 4, "label": "pro" }, { "id": 1, "entity": "溃疡", "start_offset": 7, "end_offset": 9, "label": "dis" }, { "id": 2, "entity": "糜烂性炎症", "start_offset": 10, "end_offset": 15, "label": "dis" } ]
（四）非特异型消化不良消化不良表现不能归入上述类型者。	[ { "id": 0, "entity": "非特异型消化不良", "start_offset": 3, "end_offset": 11, "label": "dis" }, { "id": 1, "entity": "消化不良", "start_offset": 11, "end_offset": 15, "label": "dis" } ]
常合并肠易激综合征。	[ { "id": 0, "entity": "肠易激综合征", "start_offset": 3, "end_offset": 9, "label": "dis" } ]
【诊断及鉴别诊断】（一）诊断对于功能性消化不良的诊断，首先应排除器质性消化不良。	[ { "id": 0, "entity": "功能性消化不良", "start_offset": 16, "end_offset": 23, "label": "dis" }, { "id": 1, "entity": "器质性消化不良", "start_offset": 32, "end_offset": 39, "label": "dis" } ]
除了仔细询问病史及全面体检外，应进行以下的器械及实验室检查：①血常规；②粪隐血试验；③上消化道内镜；④肝胆胰超声；⑤肝肾功能；⑥血糖；⑦甲状腺功能；⑧胸部X检查。	[ { "id": 0, "entity": "血常规", "start_offset": 31, "end_offset": 34, "label": "pro" }, { "id": 1, "entity": "粪隐血试验", "start_offset": 36, "end_offset": 41, "label": "pro" }, { "id": 2, "entity": "上消化道内镜", "start_offset": 43, "end_offset": 49, "label": "pro" }, { "id": 3, "entity": "肝胆胰超声", "start_offset": 51, "end_offset": 56, "label": "pro" }, { "id": 4, "entity": "肝肾功能", "start_offset": 58, "end_offset": 62, "label": "pro" }, { "id": 5, "entity": "血糖", "start_offset": 64, "end_offset": 66, "label": "pro" }, { "id": 6, "entity": "甲状腺功能", "start_offset": 68, "end_offset": 73, "label": "pro" }, { "id": 7, "entity": "胸部X检查", "start_offset": 75, "end_offset": 80, "label": "pro" } ]
其中①～④为第一线检查，⑤～⑧为可选择性检查，多数根据第一线检查即可基本确定功能性消化不良的诊断。	[ { "id": 0, "entity": "功能性消化不良", "start_offset": 38, "end_offset": 45, "label": "dis" } ]
此外，近年来开展的胃食管24小时pH监测、超声或放射性核素胃排空检查以及胃肠道压力测定等多种胃肠道动力检查手段，在FD的诊断与鉴别诊断上也起到了十分重要的作用。	[ { "id": 0, "entity": "胃食管24小时pH监测", "start_offset": 9, "end_offset": 20, "label": "pro" }, { "id": 1, "entity": "超声或放射性核素胃排空检查", "start_offset": 21, "end_offset": 34, "label": "pro" }, { "id": 2, "entity": "胃肠道压力测定", "start_offset": 36, "end_offset": 43, "label": "pro" }, { "id": 3, "entity": "胃肠道动力检查", "start_offset": 46, "end_offset": 53, "label": "pro" }, { "id": 4, "entity": "FD", "start_offset": 57, "end_offset": 59, "label": "dis" } ]
许多原因不明的腹痛恶心及呕吐患者往往经胃肠道压力检查找到了病因，这些检查也逐渐开始应用于儿科患者。	[ { "id": 0, "entity": "腹", "start_offset": 7, "end_offset": 8, "label": "bod" }, { "id": 1, "entity": "腹痛", "start_offset": 7, "end_offset": 9, "label": "sym" }, { "id": 2, "entity": "恶心", "start_offset": 9, "end_offset": 11, "label": "sym" }, { "id": 3, "entity": "呕吐", "start_offset": 12, "end_offset": 14, "label": "sym" }, { "id": 4, "entity": "胃肠道压力检查", "start_offset": 19, "end_offset": 26, "label": "pro" }, { "id": 5, "entity": "儿科", "start_offset": 44, "end_offset": 46, "label": "dep" } ]
（二）功能性消化不良通用的诊断标准2.内镜检查未发现胃及十二指肠溃疡、糜烂和肿瘤等器质性病变，未发现食管炎，也无上述疾病史。	[ { "id": 0, "entity": "功能性消化不良", "start_offset": 3, "end_offset": 10, "label": "dis" }, { "id": 1, "entity": "内镜检查", "start_offset": 19, "end_offset": 23, "label": "pro" }, { "id": 2, "entity": "胃及十二指肠溃疡", "start_offset": 26, "end_offset": 34, "label": "dis" }, { "id": 3, "entity": "糜烂", "start_offset": 35, "end_offset": 37, "label": "dis" }, { "id": 4, "entity": "肿瘤", "start_offset": 38, "end_offset": 40, "label": "dis" }, { "id": 5, "entity": "器质性病变", "start_offset": 41, "end_offset": 46, "label": "dis" }, { "id": 6, "entity": "食管炎", "start_offset": 50, "end_offset": 53, "label": "dis" } ]
3.实验室、B超及X线检查排除肝、胆、胰疾病。	[ { "id": 0, "entity": "实验室、B超及X线检查", "start_offset": 2, "end_offset": 13, "label": "pro" }, { "id": 1, "entity": "肝、胆、胰疾病", "start_offset": 15, "end_offset": 22, "label": "dis" } ]
4.无糖尿病、结缔组织病、肾脏疾病及精神病史。	[ { "id": 0, "entity": "糖尿病", "start_offset": 3, "end_offset": 6, "label": "dis" }, { "id": 1, "entity": "结缔组织病", "start_offset": 7, "end_offset": 12, "label": "dis" }, { "id": 2, "entity": "肾脏疾病", "start_offset": 13, "end_offset": 17, "label": "dis" }, { "id": 3, "entity": "精神病", "start_offset": 18, "end_offset": 21, "label": "dis" } ]
5.无腹部手术史。	[ { "id": 0, "entity": "腹部手术", "start_offset": 3, "end_offset": 7, "label": "pro" } ]
（三）儿童功能性消化不良的罗马Ⅲ诊断标准必须包括以下所有项：1.持续或反复发作的上腹部（脐上）疼痛或不适排便后不能缓解，或症状发作与排便频率或粪便性状的改变无关肠易激综合征）。	[ { "id": 0, "entity": "功能性消化不良", "start_offset": 5, "end_offset": 12, "label": "dis" }, { "id": 1, "entity": "腹", "start_offset": 41, "end_offset": 42, "label": "bod" }, { "id": 2, "entity": "脐", "start_offset": 44, "end_offset": 45, "label": "bod" }, { "id": 3, "entity": "持续或反复发作的上腹部（脐上）疼痛或不适", "start_offset": 32, "end_offset": 52, "label": "sym" }, { "id": 4, "entity": "排便后不能缓解", "start_offset": 52, "end_offset": 59, "label": "sym" }, { "id": 5, "entity": "粪便", "start_offset": 71, "end_offset": 73, "label": "bod" }, { "id": 6, "entity": "症状发作与排便频率或粪便性状的改变无关", "start_offset": 61, "end_offset": 80, "label": "sym" }, { "id": 7, "entity": "肠易激综合征", "start_offset": 80, "end_offset": 86, "label": "dis" } ]
（四）鉴别诊断1.胃食管反流胃食管反流性疾病功能性消化不良中的反流亚型与其鉴别困难。	[ { "id": 0, "entity": "胃食管反流", "start_offset": 9, "end_offset": 14, "label": "dis" }, { "id": 1, "entity": "胃食管反流性疾病", "start_offset": 14, "end_offset": 22, "label": "dis" }, { "id": 2, "entity": "功能性消化不良", "start_offset": 22, "end_offset": 29, "label": "dis" } ]
胃食管反流性疾病具有典型或不典型反流症状，内镜证实有不同程度的食管炎症改变，24小时食管pH监测有酸反应，无内镜下食管炎表现的患者属于反流样消化不良或胃食管反流性疾病不易确定，但两者在治疗上是相同的。	[ { "id": 0, "entity": "胃食管反流性疾病", "start_offset": 0, "end_offset": 8, "label": "dis" }, { "id": 1, "entity": "内镜", "start_offset": 21, "end_offset": 23, "label": "pro" }, { "id": 2, "entity": "反流样消化不良", "start_offset": 67, "end_offset": 74, "label": "dis" }, { "id": 3, "entity": "胃食管反流性疾病", "start_offset": 75, "end_offset": 83, "label": "dis" } ]
2.具有溃疡样症状的器质性消化不良包括：十二指肠溃疡、十二指肠炎、幽门管溃疡、幽门前区溃疡、糜烂性胃窦炎。	[ { "id": 0, "entity": "溃疡", "start_offset": 4, "end_offset": 6, "label": "dis" }, { "id": 1, "entity": "器质性消化不良", "start_offset": 10, "end_offset": 17, "label": "dis" }, { "id": 2, "entity": "十二指肠溃疡", "start_offset": 20, "end_offset": 26, "label": "dis" }, { "id": 3, "entity": "十二指肠炎", "start_offset": 27, "end_offset": 32, "label": "dis" }, { "id": 4, "entity": "幽门管溃疡", "start_offset": 33, "end_offset": 38, "label": "dis" }, { "id": 5, "entity": "幽门前区溃疡", "start_offset": 39, "end_offset": 45, "label": "dis" }, { "id": 6, "entity": "糜烂性胃窦炎", "start_offset": 46, "end_offset": 52, "label": "dis" } ]
在诊断功能性消化不良溃疡亚型前，必须进行内镜检查以排除以上器质性病变。	[ { "id": 0, "entity": "功能性消化不良溃疡亚型", "start_offset": 3, "end_offset": 14, "label": "dis" }, { "id": 1, "entity": "内镜检查", "start_offset": 20, "end_offset": 24, "label": "pro" }, { "id": 2, "entity": "器质性病变", "start_offset": 29, "end_offset": 34, "label": "dis" } ]
3.胃轻瘫许多全身性的或消化道疾病均可引起胃排空功能的障碍，造成胃轻瘫。	[ { "id": 0, "entity": "胃轻瘫", "start_offset": 2, "end_offset": 5, "label": "dis" }, { "id": 1, "entity": "全身性的或消化道疾病", "start_offset": 7, "end_offset": 17, "label": "dis" }, { "id": 2, "entity": "胃", "start_offset": 21, "end_offset": 22, "label": "bod" }, { "id": 3, "entity": "胃轻瘫", "start_offset": 32, "end_offset": 35, "label": "dis" } ]
较常见的原因有糖尿病、尿毒症及结缔组织病。	[ { "id": 0, "entity": "糖尿病", "start_offset": 7, "end_offset": 10, "label": "dis" }, { "id": 1, "entity": "尿毒症", "start_offset": 11, "end_offset": 14, "label": "dis" }, { "id": 2, "entity": "结缔组织病", "start_offset": 15, "end_offset": 20, "label": "dis" } ]
在诊功能性消化不良运动障碍亚型时，应仔细排除其他原因所致的胃轻瘫。	[ { "id": 0, "entity": "功能性消化不良运动障碍亚型", "start_offset": 2, "end_offset": 15, "label": "dis" }, { "id": 1, "entity": "胃轻瘫", "start_offset": 29, "end_offset": 32, "label": "dis" } ]
4.慢性难治性腹痛（CIPA）CIPA患者70%为女性，多有身体或心理创伤史。	[ { "id": 0, "entity": "慢性难治性腹痛", "start_offset": 2, "end_offset": 9, "label": "dis" }, { "id": 1, "entity": "CIPA", "start_offset": 10, "end_offset": 14, "label": "dis" }, { "id": 2, "entity": "CIPA", "start_offset": 15, "end_offset": 19, "label": "dis" }, { "id": 3, "entity": "心理创伤", "start_offset": 33, "end_offset": 37, "label": "dis" } ]
患者常常主诉有长期腹痛（超过6个月），且腹痛弥漫，多伴有腹部以外的症状。	[ { "id": 0, "entity": "腹痛弥漫", "start_offset": 20, "end_offset": 24, "label": "sym" }, { "id": 1, "entity": "腹部以外的症状", "start_offset": 28, "end_offset": 35, "label": "sym" } ]
这类患者多数有严重的潜在的心理疾患，包括抑郁、焦虑和躯体形态的紊乱。	[ { "id": 0, "entity": "心理疾患", "start_offset": 13, "end_offset": 17, "label": "dis" }, { "id": 1, "entity": "焦虑", "start_offset": 23, "end_offset": 25, "label": "dis" }, { "id": 2, "entity": "躯体形态的紊乱", "start_offset": 26, "end_offset": 33, "label": "dis" } ]
对这类患者应提供多种方式的心理、行为和药物联合治疗。	[ { "id": 0, "entity": "心理、行为和药物联合治疗", "start_offset": 13, "end_offset": 25, "label": "pro" } ]
【预防】并非所有的功能性消化不良的患儿均需接受药物治疗。	[ { "id": 0, "entity": "功能性消化不良", "start_offset": 9, "end_offset": 16, "label": "dis" } ]
如建立良好的生活习惯，避免心理紧张因素和刺激性食物，避免服用非甾体类消炎药。	[ { "id": 0, "entity": "建立良好的生活习惯", "start_offset": 1, "end_offset": 10, "label": "pro" }, { "id": 1, "entity": "避免心理紧张因素和刺激性食物", "start_offset": 11, "end_offset": 25, "label": "pro" }, { "id": 2, "entity": "非甾体类消炎药", "start_offset": 30, "end_offset": 37, "label": "dru" } ]
对于无法停药者应同时应用胃黏膜保护剂或H2</sub>受体拮抗剂。	[ { "id": 0, "entity": "胃黏膜保护剂", "start_offset": 12, "end_offset": 18, "label": "dru" } ]
【治疗】（一）一般治疗一般说来，治疗中最重要的是在医生和患者之间建立一种牢固的治疗关系。	[ { "id": 0, "entity": "一般治疗", "start_offset": 7, "end_offset": 11, "label": "pro" } ]
经过诊断性检查之后，应告诉患者功能性消化不良的诊断，同时向他们进行宣教、消除疑虑，抑制“过分检查”的趋势，将重点从寻找症状的原因转移到帮助患者克服这些症状。	[ { "id": 0, "entity": "诊断性检查", "start_offset": 2, "end_offset": 7, "label": "pro" }, { "id": 1, "entity": "功能性消化不良", "start_offset": 15, "end_offset": 22, "label": "dis" } ]
改变他们的生活环境是不太可能的，应指导患者减轻应激反应的措施，如体育锻炼和良好的饮食睡眠习惯。	[ { "id": 0, "entity": "体育锻炼", "start_offset": 32, "end_offset": 36, "label": "pro" }, { "id": 1, "entity": "良好的饮食睡眠习惯", "start_offset": 37, "end_offset": 46, "label": "pro" } ]
（二）药物治疗对于功能性消化不良，药物治疗的效果不太令人满意。	[ { "id": 0, "entity": "药物治疗", "start_offset": 3, "end_offset": 7, "label": "pro" }, { "id": 1, "entity": "功能性消化不良", "start_offset": 9, "end_offset": 16, "label": "dis" } ]
而且，症状的改善也可能与自然病程中症状的时轻时重有关，或者是安慰剂的作用。	[ { "id": 0, "entity": "安慰剂", "start_offset": 30, "end_offset": 33, "label": "dru" } ]
在症状加重时，药物治疗可能会有帮助，但应尽量减少用量，只有在有明确益处时才可长期使用。	[ { "id": 0, "entity": "药物治疗", "start_offset": 7, "end_offset": 11, "label": "pro" } ]
下面介绍一下治疗功能性消化不良的常用药物：1.抗酸剂和制酸剂（1）抗酸剂：抗酸剂（碳酸氢钠、氢氧化铝、氧化镁、三硅酸镁）：在我国常用的有碳酸钙口服液、复方氢氧化铝片及胃达。	[ { "id": 0, "entity": "功能性消化不良", "start_offset": 8, "end_offset": 15, "label": "dis" }, { "id": 1, "entity": "抗酸剂", "start_offset": 23, "end_offset": 26, "label": "dru" }, { "id": 2, "entity": "制酸剂", "start_offset": 27, "end_offset": 30, "label": "dru" }, { "id": 3, "entity": "抗酸剂", "start_offset": 33, "end_offset": 36, "label": "dru" }, { "id": 4, "entity": "抗酸剂", "start_offset": 37, "end_offset": 40, "label": "dru" }, { "id": 5, "entity": "碳酸氢钠", "start_offset": 41, "end_offset": 45, "label": "dru" }, { "id": 6, "entity": "氢氧化铝", "start_offset": 46, "end_offset": 50, "label": "dru" }, { "id": 7, "entity": "氧化镁", "start_offset": 51, "end_offset": 54, "label": "dru" }, { "id": 8, "entity": "碳酸钙口服液", "start_offset": 68, "end_offset": 74, "label": "dru" }, { "id": 9, "entity": "复方氢氧化铝片", "start_offset": 75, "end_offset": 82, "label": "dru" }, { "id": 10, "entity": "胃达", "start_offset": 83, "end_offset": 85, "label": "dru" } ]
这类药物对于缓解饥饿痛、反酸及胃灼热不良反应。	[ { "id": 0, "entity": "饥饿痛", "start_offset": 8, "end_offset": 11, "label": "sym" }, { "id": 1, "entity": "反酸", "start_offset": 12, "end_offset": 14, "label": "sym" }, { "id": 2, "entity": "胃", "start_offset": 15, "end_offset": 16, "label": "bod" }, { "id": 3, "entity": "胃灼热", "start_offset": 15, "end_offset": 18, "label": "sym" }, { "id": 4, "entity": "不良反应", "start_offset": 18, "end_offset": 22, "label": "sym" } ]
（2）抑酸剂：抑酸剂主要指H2</sub>受体拮抗剂和质子泵抑制剂。	[ { "id": 0, "entity": "抑酸剂", "start_offset": 3, "end_offset": 6, "label": "dru" }, { "id": 1, "entity": "抑酸剂", "start_offset": 7, "end_offset": 10, "label": "dru" }, { "id": 2, "entity": "质子泵抑制剂", "start_offset": 27, "end_offset": 33, "label": "dru" } ]
H2</sub>受体拮抗剂治疗功能性消化不良的报道很多，药物的疗效在统计学上显著优于安慰剂。	[ { "id": 0, "entity": "功能性消化不良", "start_offset": 15, "end_offset": 22, "label": "dis" }, { "id": 1, "entity": "安慰剂", "start_offset": 42, "end_offset": 45, "label": "dru" } ]
它们抑制胃酸的分泌，无论对溃疡亚型和反流亚型都有明显的效果。	[ { "id": 0, "entity": "胃酸", "start_offset": 4, "end_offset": 6, "label": "bod" }, { "id": 1, "entity": "溃疡亚型", "start_offset": 13, "end_offset": 17, "label": "dis" }, { "id": 2, "entity": "反流亚型", "start_offset": 18, "end_offset": 22, "label": "dis" } ]
质子泵抑制剂奥美拉唑，可抑制壁细胞H+-K+-ATP酶，抑制酸分泌作用强，持续时间长，适用于H2</sub>受体拮抗剂治疗无效的患者。	[ { "id": 0, "entity": "质子泵抑制剂", "start_offset": 0, "end_offset": 6, "label": "dru" }, { "id": 1, "entity": "奥美拉唑", "start_offset": 6, "end_offset": 10, "label": "dru" }, { "id": 2, "entity": "壁细胞H+-K+-ATP酶", "start_offset": 14, "end_offset": 27, "label": "bod" } ]
2.促动力药物根据有对照组的临床验证，现已肯定甲氧氯普胺（胃复安）、多潘立酮（吗丁啉）及西沙比利对消除功能性消化不良诸症状确有疗效。	[ { "id": 0, "entity": "促动力药物", "start_offset": 2, "end_offset": 7, "label": "dru" }, { "id": 1, "entity": "甲氧氯普胺", "start_offset": 23, "end_offset": 28, "label": "dru" }, { "id": 2, "entity": "胃复安", "start_offset": 29, "end_offset": 32, "label": "dru" }, { "id": 3, "entity": "多潘立酮", "start_offset": 34, "end_offset": 38, "label": "dru" }, { "id": 4, "entity": "吗丁啉", "start_offset": 39, "end_offset": 42, "label": "dru" }, { "id": 5, "entity": "西沙比利", "start_offset": 44, "end_offset": 48, "label": "dru" }, { "id": 6, "entity": "功能性消化不良", "start_offset": 51, "end_offset": 58, "label": "dis" } ]
儿科多潘立酮应用较多。	[ { "id": 0, "entity": "儿科", "start_offset": 0, "end_offset": 2, "label": "dep" }, { "id": 1, "entity": "多潘立酮", "start_offset": 2, "end_offset": 6, "label": "dru" } ]
（1）甲氧氯普胺：有抗中枢和外周多巴胺作用，同时兴奋5-HT4受体，促进内源性乙酰胆碱释放，增加胃窦-十二指肠协调运动，促进胃排空。	[ { "id": 0, "entity": "甲氧氯普胺", "start_offset": 3, "end_offset": 8, "label": "dru" }, { "id": 1, "entity": "中枢", "start_offset": 11, "end_offset": 13, "label": "bod" }, { "id": 2, "entity": "外周多巴胺", "start_offset": 14, "end_offset": 19, "label": "bod" }, { "id": 3, "entity": "5-HT4受体", "start_offset": 26, "end_offset": 33, "label": "bod" }, { "id": 4, "entity": "内源性乙酰胆碱", "start_offset": 36, "end_offset": 43, "label": "bod" }, { "id": 5, "entity": "胃窦-十二指肠", "start_offset": 48, "end_offset": 55, "label": "bod" }, { "id": 6, "entity": "胃", "start_offset": 62, "end_offset": 63, "label": "bod" } ]
因不良反应较多，故临床应用逐渐减少。	[ { "id": 0, "entity": "不良反应", "start_offset": 1, "end_offset": 5, "label": "sym" } ]
（2）多潘立酮：为外周多巴胺受体阻抗剂，可促进固体和液体胃排空，抑制胃容纳舒张，协调胃窦-十二指肠运动，松弛幽门，从而缓解消化不良症状。	[ { "id": 0, "entity": "多潘立酮", "start_offset": 3, "end_offset": 7, "label": "dru" }, { "id": 1, "entity": "外周多巴胺受体阻抗剂", "start_offset": 9, "end_offset": 19, "label": "dru" }, { "id": 2, "entity": "胃", "start_offset": 28, "end_offset": 29, "label": "bod" }, { "id": 3, "entity": "胃", "start_offset": 34, "end_offset": 35, "label": "bod" }, { "id": 4, "entity": "胃窦-十二指肠", "start_offset": 42, "end_offset": 49, "label": "bod" }, { "id": 5, "entity": "幽门", "start_offset": 54, "end_offset": 56, "label": "bod" }, { "id": 6, "entity": "消化不良", "start_offset": 61, "end_offset": 65, "label": "dis" } ]
1岁以下儿童由于血脑屏障功能发育尚未完全，故不宜服用。	[ { "id": 0, "entity": "血脑屏障", "start_offset": 8, "end_offset": 12, "label": "bod" } ]
（3）西沙比利：通过促进胃肠道肌层神经丛副交感神经节后纤维末梢乙酰胆碱的释放，增强食管下端括约肌张力，加强食管、胃、小肠和结肠的推进性运动。	[ { "id": 0, "entity": "西沙比利", "start_offset": 3, "end_offset": 7, "label": "dru" }, { "id": 1, "entity": "胃肠道肌层神经丛副交感神经节后纤维末梢乙酰胆碱", "start_offset": 12, "end_offset": 35, "label": "bod" }, { "id": 2, "entity": "食管", "start_offset": 41, "end_offset": 43, "label": "bod" }, { "id": 3, "entity": "括约肌", "start_offset": 45, "end_offset": 48, "label": "bod" }, { "id": 4, "entity": "食管", "start_offset": 53, "end_offset": 55, "label": "bod" }, { "id": 5, "entity": "胃", "start_offset": 56, "end_offset": 57, "label": "bod" }, { "id": 6, "entity": "小肠", "start_offset": 58, "end_offset": 60, "label": "bod" }, { "id": 7, "entity": "结肠", "start_offset": 61, "end_offset": 63, "label": "bod" } ]
对胃的作用主要有增加胃窦收缩，改善胃窦-十二指肠协调运动。	[ { "id": 0, "entity": "胃", "start_offset": 1, "end_offset": 2, "label": "bod" }, { "id": 1, "entity": "胃窦", "start_offset": 10, "end_offset": 12, "label": "bod" }, { "id": 2, "entity": "胃窦-十二指肠", "start_offset": 17, "end_offset": 24, "label": "bod" } ]
降低幽门时相性收缩频率，使胃电活动趋于正常，从而加速胃排空。	[ { "id": 0, "entity": "幽门", "start_offset": 2, "end_offset": 4, "label": "bod" }, { "id": 1, "entity": "胃", "start_offset": 13, "end_offset": 14, "label": "bod" }, { "id": 2, "entity": "胃", "start_offset": 26, "end_offset": 27, "label": "bod" } ]

然而绝大多数研究证实FD患者基础胃酸和最大胃酸分泌量没有增加，胃酸分泌与溃疡样症状无关，症状程度与最大胃酸分泌也无相关性。

[ { "id": 0, "entity": "FD", "start_offset": 10, "end_offset": 12, "label": "dis" }, { "id": 1, "entity": "胃酸", "start_offset": 31, "end_offset": 33, "label": "bod" }, { "id": 2, "entity": "溃疡", "start_offset": 36, "end_offset": 38, "label": "dis" }, { "id": 3, "entity": "最大胃酸分泌", "start_offset": 49, "end_offset": 55, "label": "ite" } ]

所以，胃酸在功能性消化不良发病中的作用仍需进一步研究。

[ { "id": 0, "entity": "功能性消化不良", "start_offset": 6, "end_offset": 13, "label": "dis" } ]

（三）慢性胃炎与十二指肠炎功能性消化不良患者中大约有30%～50%经组织学检查证实为胃窦胃炎，欧洲不少国家将慢性胃炎视为功能性消化不良，认为慢性胃炎可能通过神经及体液因素影响胃的运动功能，也有作者认为非糜烂性十二指肠炎也属于功能性消化不良。

[ { "id": 0, "entity": "慢性胃炎", "start_offset": 3, "end_offset": 7, "label": "dis" }, { "id": 1, "entity": "十二指肠炎", "start_offset": 8, "end_offset": 13, "label": "dis" }, { "id": 2, "entity": "功能性消化不良", "start_offset": 13, "end_offset": 20, "label": "dis" }, { "id": 3, "entity": "胃窦胃炎", "start_offset": 42, "end_offset": 46, "label": "dis" }, { "id": 4, "entity": "慢性胃炎", "start_offset": 54, "end_offset": 58, "label": "dis" }, { "id": 5, "entity": "功能性消化不良", "start_offset": 60, "end_offset": 67, "label": "dis" }, { "id": 6, "entity": "慢性胃炎", "start_offset": 70, "end_offset": 74, "label": "dis" }, { "id": 7, "entity": "神经", "start_offset": 78, "end_offset": 80, "label": "bod" }, { "id": 8, "entity": "体液", "start_offset": 81, "end_offset": 83, "label": "bod" }, { "id": 9, "entity": "胃", "start_offset": 87, "end_offset": 88, "label": "bod" }, { "id": 10, "entity": "非糜烂性十二指肠炎", "start_offset": 100, "end_offset": 109, "label": "dis" }, { "id": 11, "entity": "功能性消化不良", "start_offset": 112, "end_offset": 119, "label": "dis" } ]

应当指出的是，功能性消化不良症状的轻重并不与胃黏膜炎症病变相互平行。

[ { "id": 0, "entity": "功能性消化不良", "start_offset": 7, "end_offset": 14, "label": "dis" }, { "id": 1, "entity": "胃黏膜炎症", "start_offset": 22, "end_offset": 27, "label": "dis" } ]

（四）幽门螺杆菌感染幽门螺杆菌是一种革兰阴性细菌，一般定植于胃的黏液层表面。

[ { "id": 0, "entity": "幽门螺杆菌感染", "start_offset": 3, "end_offset": 10, "label": "dis" }, { "id": 1, "entity": "幽门螺杆菌", "start_offset": 10, "end_offset": 15, "label": "mic" }, { "id": 2, "entity": "革兰阴性细菌", "start_offset": 18, "end_offset": 24, "label": "mic" }, { "id": 3, "entity": "胃", "start_offset": 30, "end_offset": 31, "label": "bod" }, { "id": 4, "entity": "黏液层", "start_offset": 32, "end_offset": 35, "label": "bod" } ]

幽门螺杆菌感染与功能性消化不良关系的研究结果差异很大，有些研究认为幽门螺杆菌感染是FD的病理生理因素之一，因为在成人中，功能性消化不良患者的胃黏膜内常可发现幽门螺杆菌，检出率在40%～70%之间。

[ { "id": 0, "entity": "幽门螺杆菌感染", "start_offset": 0, "end_offset": 7, "label": "dis" }, { "id": 1, "entity": "功能性消化不良", "start_offset": 8, "end_offset": 15, "label": "dis" }, { "id": 2, "entity": "幽门螺杆菌感染", "start_offset": 33, "end_offset": 40, "label": "dis" }, { "id": 3, "entity": "FD", "start_offset": 41, "end_offset": 43, "label": "dis" }, { "id": 4, "entity": "功能性消化不良", "start_offset": 60, "end_offset": 67, "label": "dis" }, { "id": 5, "entity": "幽门螺杆菌", "start_offset": 78, "end_offset": 83, "label": "mic" } ]

但大量的研究却表明：FD患者的幽门螺杆菌感染率并不高于正常健康人，阳性幽门螺杆菌和阴性幽门螺杆菌者的胃肠运动和胃排空功能无明显差异，且幽门螺杆菌阳性的FD患者经根除幽门螺杆菌治疗后其消化不良症状并不一定随之消失，进一步研究证实幽门螺杆菌特异性抗原与FD无相关性，甚至其特异血清型CagA与任何消化不良症状或任何原发性功能性上腹不适症状均无关系。

[ { "id": 0, "entity": "FD", "start_offset": 10, "end_offset": 12, "label": "dis" }, { "id": 1, "entity": "幽门螺杆菌感染", "start_offset": 15, "end_offset": 22, "label": "dis" }, { "id": 2, "entity": "幽门螺杆菌", "start_offset": 35, "end_offset": 40, "label": "mic" }, { "id": 3, "entity": "幽门螺杆菌", "start_offset": 43, "end_offset": 48, "label": "mic" }, { "id": 4, "entity": "胃肠", "start_offset": 50, "end_offset": 52, "label": "bod" }, { "id": 5, "entity": "胃", "start_offset": 55, "end_offset": 56, "label": "bod" }, { "id": 6, "entity": "幽门螺杆菌", "start_offset": 67, "end_offset": 72, "label": "mic" }, { "id": 7, "entity": "FD", "start_offset": 75, "end_offset": 77, "label": "dis" }, { "id": 8, "entity": "消化不良", "start_offset": 91, "end_offset": 95, "label": "dis" }, { "id": 9, "entity": "幽门螺杆菌", "start_offset": 113, "end_offset": 118, "label": "mic" }, { "id": 10, "entity": "FD", "start_offset": 124, "end_offset": 126, "label": "dis" }, { "id": 11, "entity": "消化不良", "start_offset": 146, "end_offset": 150, "label": "dis" }, { "id": 12, "entity": "原发性功能性上腹不适", "start_offset": 155, "end_offset": 165, "label": "dis" } ]

目前国内学者的共识意见为幽门螺杆菌感染为慢性活动性胃炎的主要病因，有消化不良症状的幽门螺杆菌感染者可归属于FD范畴。

[ { "id": 0, "entity": "幽门螺杆菌感染", "start_offset": 12, "end_offset": 19, "label": "dis" }, { "id": 1, "entity": "慢性活动性胃炎", "start_offset": 20, "end_offset": 27, "label": "dis" }, { "id": 2, "entity": "消化不良", "start_offset": 34, "end_offset": 38, "label": "dis" }, { "id": 3, "entity": "幽门螺杆菌感染", "start_offset": 41, "end_offset": 48, "label": "dis" }, { "id": 4, "entity": "FD", "start_offset": 53, "end_offset": 55, "label": "dis" } ]

（五）胃肠运动功能障碍许多的研究都认为FD其实是胃肠道功能紊乱的一种。

[ { "id": 0, "entity": "胃肠运动功能障碍", "start_offset": 3, "end_offset": 11, "label": "dis" }, { "id": 1, "entity": "FD", "start_offset": 19, "end_offset": 21, "label": "dis" }, { "id": 2, "entity": "胃肠道功能紊乱", "start_offset": 24, "end_offset": 31, "label": "dis" } ]

它与其他胃肠功能紊乱性疾病有着相似的发病机制。

[ { "id": 0, "entity": "胃肠功能紊乱性疾病", "start_offset": 4, "end_offset": 13, "label": "dis" } ]

近年来随着对胃肠功能疾病在生理学（运动-感觉）、基础学（脑-肠作用）及精神社会学等方面的进一步了解，并基于其所表现的症状及解剖位置，罗马委员会制定了新的标准，即罗马Ⅲ标准。

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罗马Ⅲ标准不仅包括诊断标准，亦对胃肠功能紊乱的基础生理、病理、神经支配及胃肠激素、免疫系统做了详尽的叙述，同时在治疗方面也提出了指导性意见。

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因此罗马Ⅲ标准是目前世界各国用于功能性胃肠疾病诊断、治疗的一个共识文件。

[ { "id": 0, "entity": "功能性胃肠疾病", "start_offset": 16, "end_offset": 23, "label": "dis" } ]

该标准认为：胃肠道运动在消化期与消化间期有不同的形式和特点。

[ { "id": 0, "entity": "胃肠道", "start_offset": 6, "end_offset": 9, "label": "bod" } ]

空腹状态下由胃至末端回肠存在一种周期性运动形式，称为消化间期移行性综合运动（MMC）。

[ { "id": 0, "entity": "胃", "start_offset": 6, "end_offset": 7, "label": "bod" }, { "id": 1, "entity": "末端回肠", "start_offset": 8, "end_offset": 12, "label": "bod" } ]

大约在正常餐后4～6小时，这种周期性、特征性的运动起于近端胃，并缓慢传导到整个小肠。

[ { "id": 0, "entity": "小肠", "start_offset": 39, "end_offset": 41, "label": "bod" } ]

每个MMC由4个连续时相组成：Ⅰ相为运动不活跃期；Ⅱ相的特征是间断性蠕动收缩；Ⅲ相时胃发生连续性蠕动收缩，每个慢波上伴有快速发生的动作电位（峰电位），收缩环中心闭合而幽门基础压力却不高，处于开放状态，故能清除胃内残留食物；Ⅳ相是Ⅲ相结束回到Ⅰ相的恢复期。

[ { "id": 0, "entity": "胃", "start_offset": 42, "end_offset": 43, "label": "bod" }, { "id": 1, "entity": "幽门", "start_offset": 83, "end_offset": 85, "label": "bod" }, { "id": 2, "entity": "胃", "start_offset": 104, "end_offset": 105, "label": "bod" } ]

与之相对应，在Ⅲ期还伴有胃酸分泌、胰腺和胆汁分泌。

[ { "id": 0, "entity": "胃酸", "start_offset": 12, "end_offset": 14, "label": "bod" }, { "id": 1, "entity": "胰腺", "start_offset": 17, "end_offset": 19, "label": "bod" }, { "id": 2, "entity": "胆汁", "start_offset": 20, "end_offset": 22, "label": "bod" } ]

空腹状态下，十二指肠最大收缩频率为12次/分，从十二指肠开始MMC向远端移动速度为5～10cm/min，90分钟后达末端回肠，其作用是清除肠腔内不被消化的颗粒。

[ { "id": 0, "entity": "腹", "start_offset": 1, "end_offset": 2, "label": "bod" }, { "id": 1, "entity": "十二指肠", "start_offset": 24, "end_offset": 28, "label": "bod" }, { "id": 2, "entity": "末端回肠", "start_offset": 58, "end_offset": 62, "label": "bod" }, { "id": 3, "entity": "肠腔", "start_offset": 69, "end_offset": 71, "label": "bod" } ]

进餐打乱了消化间期的活动，出现一种特殊的运动类型：胃窦-十二指肠协调收缩。

[ { "id": 0, "entity": "胃窦-十二指肠", "start_offset": 25, "end_offset": 32, "label": "bod" } ]

胃底出现容受性舒张，远端胃出现不规则时相性收缩，持续数分钟后进入较稳定的运动模式，即3次/分的节律性蠕动性收缩，并与幽门括约肌的开放和十二指肠协调运动，推动食物进入十二指肠。

[ { "id": 0, "entity": "胃", "start_offset": 0, "end_offset": 1, "label": "bod" }, { "id": 1, "entity": "胃", "start_offset": 12, "end_offset": 13, "label": "bod" }, { "id": 2, "entity": "幽门括约肌", "start_offset": 58, "end_offset": 63, "label": "bod" }, { "id": 3, "entity": "十二指肠", "start_offset": 67, "end_offset": 71, "label": "bod" } ]

此时小肠出现不规则、随机的收缩运动，并根据食物的大小和性质，使得这种运动模式可维持2.5～8小时。

[ { "id": 0, "entity": "小肠", "start_offset": 2, "end_offset": 4, "label": "bod" } ]

此后当食物从小肠排空后，又恢复消化间期模式。

[ { "id": 0, "entity": "小肠", "start_offset": 6, "end_offset": 8, "label": "bod" } ]

在长期的对FD患者的研究中发现：约50%FD患者存在餐后胃排空延迟，可以是液体或（和）固体排空障碍。

[ { "id": 0, "entity": "FD", "start_offset": 5, "end_offset": 7, "label": "dis" }, { "id": 1, "entity": "FD", "start_offset": 20, "end_offset": 22, "label": "dis" }, { "id": 2, "entity": "液体或（和）固体排空障碍", "start_offset": 37, "end_offset": 49, "label": "dis" } ]

小儿FD中有61.53%胃排空迟缓胃运动异常的综合表现，胃近端张力减低胃窦运动减弱胃电紊乱胃排空功能。

[ { "id": 0, "entity": "胃", "start_offset": 12, "end_offset": 13, "label": "bod" }, { "id": 1, "entity": "胃排空迟缓", "start_offset": 12, "end_offset": 17, "label": "sym" }, { "id": 2, "entity": "胃运动异常", "start_offset": 17, "end_offset": 22, "label": "dis" }, { "id": 3, "entity": "胃", "start_offset": 28, "end_offset": 29, "label": "bod" }, { "id": 4, "entity": "胃近端张力减低", "start_offset": 28, "end_offset": 35, "label": "sym" }, { "id": 5, "entity": "胃窦", "start_offset": 35, "end_offset": 37, "label": "bod" }, { "id": 6, "entity": "胃窦运动减弱", "start_offset": 35, "end_offset": 41, "label": "sym" }, { "id": 7, "entity": "胃", "start_offset": 41, "end_offset": 42, "label": "bod" }, { "id": 8, "entity": "胃电紊乱", "start_offset": 41, "end_offset": 45, "label": "sym" }, { "id": 9, "entity": "胃", "start_offset": 45, "end_offset": 46, "label": "bod" } ]

胃内压力测定发现，25%功能性消化不良胃窦运动功能减弱胃窦无收缩。

[ { "id": 0, "entity": "胃内压力测定", "start_offset": 0, "end_offset": 6, "label": "pro" }, { "id": 1, "entity": "功能性消化不良", "start_offset": 12, "end_offset": 19, "label": "dis" }, { "id": 2, "entity": "胃窦", "start_offset": 19, "end_offset": 21, "label": "bod" }, { "id": 3, "entity": "胃窦运动功能减弱", "start_offset": 19, "end_offset": 27, "label": "sym" }, { "id": 4, "entity": "胃窦无收缩", "start_offset": 27, "end_offset": 32, "label": "sym" } ]

儿童中，FD患儿胃窦收缩幅度明显低于健康儿胃容量-压力关系曲线和电子恒压器检查发现患者胃近端容纳舒张功能受损胃顺应性降低近端胃壁张力下降FD患者有小肠运动障碍，以近端小肠为主，胃窦-十二指肠测压发现胃窦十二指肠运动不协调十二指肠运动紊乱，约有1/3的FD存在肠易激综合征。

[ { "id": 0, "entity": "FD", "start_offset": 4, "end_offset": 6, "label": "dis" }, { "id": 1, "entity": "胃窦", "start_offset": 8, "end_offset": 10, "label": "bod" }, { "id": 2, "entity": "胃窦收缩幅度明显低于健康儿", "start_offset": 8, "end_offset": 21, "label": "sym" }, { "id": 3, "entity": "胃容量-压力", "start_offset": 21, "end_offset": 27, "label": "ite" }, { "id": 4, "entity": "电子恒压器检查", "start_offset": 32, "end_offset": 39, "label": "pro" }, { "id": 5, "entity": "胃", "start_offset": 43, "end_offset": 44, "label": "bod" }, { "id": 6, "entity": "胃近端容纳舒张功能受损", "start_offset": 43, "end_offset": 54, "label": "sym" }, { "id": 7, "entity": "胃", "start_offset": 54, "end_offset": 55, "label": "bod" }, { "id": 8, "entity": "胃顺应性降低", "start_offset": 54, "end_offset": 60, "label": "sym" }, { "id": 9, "entity": "近端胃壁", "start_offset": 60, "end_offset": 64, "label": "bod" }, { "id": 10, "entity": "近端胃壁张力下降", "start_offset": 60, "end_offset": 68, "label": "sym" }, { "id": 11, "entity": "FD", "start_offset": 68, "end_offset": 70, "label": "dis" }, { "id": 12, "entity": "小肠运动障碍", "start_offset": 73, "end_offset": 79, "label": "dis" }, { "id": 13, "entity": "近端小肠", "start_offset": 81, "end_offset": 85, "label": "bod" }, { "id": 14, "entity": "胃窦", "start_offset": 99, "end_offset": 101, "label": "bod" }, { "id": 15, "entity": "十二指肠", "start_offset": 101, "end_offset": 105, "label": "bod" }, { "id": 16, "entity": "胃窦十二指肠运动不协调", "start_offset": 99, "end_offset": 110, "label": "sym" }, { "id": 17, "entity": "十二指肠运动紊乱", "start_offset": 110, "end_offset": 118, "label": "dis" }, { "id": 18, "entity": "FD", "start_offset": 125, "end_offset": 127, "label": "dis" }, { "id": 19, "entity": "肠易激综合征", "start_offset": 129, "end_offset": 135, "label": "dis" } ]

（六）内脏感觉异常许多功能性消化不良的患者对生理或轻微有害刺激的感受异常或过于敏感。

[ { "id": 0, "entity": "功能性消化不良", "start_offset": 11, "end_offset": 18, "label": "dis" } ]

一些患者对灌注酸和盐水的敏感性提高；一些患者即使在使用了H2受体拮抗剂阻断酸分泌的情况下，静脉注射五肽胃泌素仍会发生疼痛。

[ { "id": 0, "entity": "灌注酸", "start_offset": 5, "end_offset": 8, "label": "dru" }, { "id": 1, "entity": "盐水", "start_offset": 9, "end_offset": 11, "label": "dru" }, { "id": 2, "entity": "酸", "start_offset": 43, "end_offset": 44, "label": "bod" }, { "id": 3, "entity": "静脉注射", "start_offset": 51, "end_offset": 55, "label": "pro" }, { "id": 4, "entity": "五肽胃泌素", "start_offset": 55, "end_offset": 60, "label": "dru" }, { "id": 5, "entity": "疼痛", "start_offset": 64, "end_offset": 66, "label": "sym" } ]

一些研究报道，球囊在近端胃膨胀时，功能性消化不良患者的疼痛往往会加重，他们疼痛发作时球囊膨胀的水平显著低于对照组内脏感觉的异常在功能性消化不良中可能起到了一定作用。

[ { "id": 0, "entity": "球囊", "start_offset": 7, "end_offset": 9, "label": "bod" }, { "id": 1, "entity": "胃", "start_offset": 12, "end_offset": 13, "label": "bod" }, { "id": 2, "entity": "功能性消化不良", "start_offset": 17, "end_offset": 24, "label": "dis" }, { "id": 3, "entity": "疼痛往往会加重", "start_offset": 27, "end_offset": 34, "label": "sym" }, { "id": 4, "entity": "球囊", "start_offset": 42, "end_offset": 44, "label": "bod" }, { "id": 5, "entity": "疼痛发作时球囊膨胀的水平显著低于对照组", "start_offset": 37, "end_offset": 56, "label": "sym" }, { "id": 6, "entity": "内脏", "start_offset": 56, "end_offset": 58, "label": "bod" }, { "id": 7, "entity": "功能性消化不良", "start_offset": 64, "end_offset": 71, "label": "dis" } ]

但这种感觉异常的基础尚不清楚，初步研究证实功能性消化不良患者存在两种内脏传入功能障碍，一种是不被察觉的反射传入信号，另一种为感知信号。

[ { "id": 0, "entity": "感觉异常", "start_offset": 3, "end_offset": 7, "label": "sym" }, { "id": 1, "entity": "功能性消化不良", "start_offset": 21, "end_offset": 28, "label": "dis" }, { "id": 2, "entity": "内脏传入功能障碍", "start_offset": 34, "end_offset": 42, "label": "dis" } ]

当胃肠道机械感受器感受扩张刺激后，受试者会因扩张容量的逐渐增加而产生感知、不适及疼痛，从而获得不同状态的扩张容量，功能性消化不良患者感知阈明显低于正常人，表明患者感觉过敏。

[ { "id": 0, "entity": "胃肠道机械感受器", "start_offset": 1, "end_offset": 9, "label": "bod" }, { "id": 1, "entity": "功能性消化不良", "start_offset": 57, "end_offset": 64, "label": "dis" } ]

（七）心理社会因素心理学因素是否与功能性消化不良的发病有关一直存在着争议。

[ { "id": 0, "entity": "功能性消化不良", "start_offset": 17, "end_offset": 24, "label": "dis" } ]

国内有学者曾对186名FD患者的年龄、性别、生活习惯以及文化程度等进行了解，并做了焦虑及抑郁的评定，结果发现FD患者以年龄偏大的女性多见，它的发生与焦虑及抑郁有较明显的关系。

[ { "id": 0, "entity": "FD", "start_offset": 11, "end_offset": 13, "label": "dis" }, { "id": 1, "entity": "焦虑", "start_offset": 41, "end_offset": 43, "label": "dis" }, { "id": 2, "entity": "抑", "start_offset": 44, "end_offset": 45, "label": "dis" }, { "id": 3, "entity": "抑", "start_offset": 44, "end_offset": 45, "label": "pro" }, { "id": 4, "entity": "结果", "start_offset": 50, "end_offset": 52, "label": "dis" }, { "id": 5, "entity": "的发", "start_offset": 70, "end_offset": 72, "label": "dis" }, { "id": 6, "entity": "与焦", "start_offset": 73, "end_offset": 75, "label": "dis" } ]

但目前尚无确切的证据表明功能性消化不良症状与精神异常或慢性应激有关。

[ { "id": 0, "entity": "功能性消化不良", "start_offset": 12, "end_offset": 19, "label": "dis" }, { "id": 1, "entity": "精神异常", "start_offset": 22, "end_offset": 26, "label": "dis" }, { "id": 2, "entity": "慢性应激", "start_offset": 27, "end_offset": 31, "label": "dis" } ]

功能性消化不良患者重大生活应激事件的数量也不一定高于其他人群，但很可能这些患者对应激的感受程度要更高。

[ { "id": 0, "entity": "功能性消化不良", "start_offset": 0, "end_offset": 7, "label": "dis" }, { "id": 1, "entity": "重大生活应激", "start_offset": 9, "end_offset": 15, "label": "dis" }, { "id": 2, "entity": "应激", "start_offset": 40, "end_offset": 42, "label": "dis" } ]

（八）其他胃肠功能紊乱性疾病1.胃食管反流性疾病（GERD）胃灼热和反流是胃食管反流的特异性症状，但是许多GERD患者并无此明显症状，有些患者主诉既有胃灼热消化不良。

[ { "id": 0, "entity": "胃肠功能紊乱性疾病", "start_offset": 5, "end_offset": 14, "label": "dis" }, { "id": 1, "entity": "胃食管反流性疾病", "start_offset": 16, "end_offset": 24, "label": "dis" }, { "id": 2, "entity": "GERD", "start_offset": 25, "end_offset": 29, "label": "dis" }, { "id": 3, "entity": "胃灼热", "start_offset": 30, "end_offset": 33, "label": "sym" }, { "id": 4, "entity": "反流", "start_offset": 34, "end_offset": 36, "label": "sym" }, { "id": 5, "entity": "胃食管反流", "start_offset": 37, "end_offset": 42, "label": "dis" }, { "id": 6, "entity": "GERD", "start_offset": 53, "end_offset": 57, "label": "dis" }, { "id": 7, "entity": "胃", "start_offset": 75, "end_offset": 76, "label": "bod" }, { "id": 8, "entity": "胃灼热", "start_offset": 75, "end_offset": 78, "label": "sym" }, { "id": 9, "entity": "消化不良", "start_offset": 78, "end_offset": 82, "label": "dis" } ]

目前有许多学者已接受了以下看法：有少数GERD患者并无食管炎，许多GERD患者具有复杂的消化不良病史，而不仅是单纯胃灼热酸反流症状。

[ { "id": 0, "entity": "GERD", "start_offset": 19, "end_offset": 23, "label": "dis" }, { "id": 1, "entity": "食管炎", "start_offset": 27, "end_offset": 30, "label": "dis" }, { "id": 2, "entity": "GERD", "start_offset": 33, "end_offset": 37, "label": "dis" }, { "id": 3, "entity": "消化不良", "start_offset": 44, "end_offset": 48, "label": "dis" }, { "id": 4, "entity": "胃", "start_offset": 57, "end_offset": 58, "label": "bod" }, { "id": 5, "entity": "胃灼热", "start_offset": 57, "end_offset": 60, "label": "sym" }, { "id": 6, "entity": "酸反流", "start_offset": 60, "end_offset": 63, "label": "sym" } ]

用食管24小时pH监测研究发现：约有20%的功能性消化不良患者和反流性疾病有关。

[ { "id": 0, "entity": "功能性消化不良", "start_offset": 22, "end_offset": 29, "label": "dis" }, { "id": 1, "entity": "反流性疾病", "start_offset": 32, "end_offset": 37, "label": "dis" } ]

最近Sandlu等报告，20例小儿厌食中，12例（60%）有胃食管反流胃食管反流性疾病和某些功能性消化不良的病例有关。

[ { "id": 0, "entity": "小儿厌食", "start_offset": 15, "end_offset": 19, "label": "dis" }, { "id": 1, "entity": "胃食管", "start_offset": 30, "end_offset": 33, "label": "bod" }, { "id": 2, "entity": "胃食管反流", "start_offset": 30, "end_offset": 35, "label": "sym" }, { "id": 3, "entity": "胃食管反流性疾病", "start_offset": 35, "end_offset": 43, "label": "dis" }, { "id": 4, "entity": "功能性消化不良", "start_offset": 46, "end_offset": 53, "label": "dis" } ]

2.吞气症许多患者常下意识地吞入过量的空气，导致腹胀饱胀和嗳气，这种情况也常继发于应激或焦虑。

[ { "id": 0, "entity": "吞气症", "start_offset": 2, "end_offset": 5, "label": "dis" }, { "id": 1, "entity": "腹", "start_offset": 24, "end_offset": 25, "label": "bod" }, { "id": 2, "entity": "腹胀", "start_offset": 24, "end_offset": 26, "label": "sym" }, { "id": 3, "entity": "饱胀", "start_offset": 26, "end_offset": 28, "label": "sym" }, { "id": 4, "entity": "嗳气", "start_offset": 29, "end_offset": 31, "label": "sym" }, { "id": 5, "entity": "应激", "start_offset": 41, "end_offset": 43, "label": "dis" }, { "id": 6, "entity": "焦虑", "start_offset": 44, "end_offset": 46, "label": "dis" } ]

3.肠易激综合征（IBS）功能性消化不良与其他胃肠道紊乱之间常常有许多重叠。

[ { "id": 0, "entity": "肠易激综合征", "start_offset": 2, "end_offset": 8, "label": "dis" }, { "id": 1, "entity": "IBS", "start_offset": 9, "end_offset": 12, "label": "dis" }, { "id": 2, "entity": "功能性消化不良", "start_offset": 13, "end_offset": 20, "label": "dis" }, { "id": 3, "entity": "胃肠道紊乱", "start_offset": 23, "end_offset": 28, "label": "dis" } ]

约有1/3的IBS患者有消化不良症状；功能性消化不良患者中有IBS症状的比例也近似。

[ { "id": 0, "entity": "IBS", "start_offset": 6, "end_offset": 9, "label": "dis" }, { "id": 1, "entity": "消化不良症状", "start_offset": 12, "end_offset": 18, "label": "dis" }, { "id": 2, "entity": "功能性消化不良", "start_offset": 19, "end_offset": 26, "label": "dis" }, { "id": 3, "entity": "IBS", "start_offset": 30, "end_offset": 33, "label": "dis" } ]

【临床表现及分型】临床症状主要包括上腹痛腹胀早饱、嗳气、厌食、胃灼热泛酸、恶心和呕吐。

[ { "id": 0, "entity": "上腹", "start_offset": 17, "end_offset": 19, "label": "bod" }, { "id": 1, "entity": "上腹痛", "start_offset": 17, "end_offset": 20, "label": "sym" }, { "id": 2, "entity": "腹", "start_offset": 20, "end_offset": 21, "label": "bod" }, { "id": 3, "entity": "腹胀", "start_offset": 20, "end_offset": 22, "label": "sym" }, { "id": 4, "entity": "早饱", "start_offset": 22, "end_offset": 24, "label": "sym" }, { "id": 5, "entity": "嗳气", "start_offset": 25, "end_offset": 27, "label": "sym" }, { "id": 6, "entity": "厌食", "start_offset": 28, "end_offset": 30, "label": "sym" }, { "id": 7, "entity": "胃", "start_offset": 31, "end_offset": 32, "label": "bod" }, { "id": 8, "entity": "胃灼热", "start_offset": 31, "end_offset": 34, "label": "sym" }, { "id": 9, "entity": "泛酸", "start_offset": 34, "end_offset": 36, "label": "sym" }, { "id": 10, "entity": "恶心", "start_offset": 37, "end_offset": 39, "label": "sym" }, { "id": 11, "entity": "呕吐", "start_offset": 40, "end_offset": 42, "label": "sym" } ]

病程多在2年内，症状可反复发作，也可在相当一段时间内无症状。

[ { "id": 0, "entity": "病程多在2年内", "start_offset": 0, "end_offset": 7, "label": "sym" }, { "id": 1, "entity": "症状可反复发作", "start_offset": 8, "end_offset": 15, "label": "sym" }, { "id": 2, "entity": "一段时间内无症状", "start_offset": 21, "end_offset": 29, "label": "sym" } ]

可以某一症状为主，也可有多个症状的叠加。

[ { "id": 0, "entity": "某一症状为主", "start_offset": 2, "end_offset": 8, "label": "sym" }, { "id": 1, "entity": "多个症状的叠加", "start_offset": 12, "end_offset": 19, "label": "sym" } ]

1989年，美国芝加哥FD专题会议将功能性消化不良分为5个亚型：反流样消化不良（refluxlikedyspepsia）、运动障碍样消化不良（dysmotilitylikedyspepsia）、溃疡样消化不良（ulcerlikedyspepsia）、吞气症（aerophagia）及特发性消化不良（idiopathicdyspepsia）。

[ { "id": 0, "entity": "FD", "start_offset": 11, "end_offset": 13, "label": "dis" }, { "id": 1, "entity": "功能性消化不良", "start_offset": 18, "end_offset": 25, "label": "dis" }, { "id": 2, "entity": "反流样消化不良", "start_offset": 32, "end_offset": 39, "label": "dis" }, { "id": 3, "entity": "refluxlikedyspepsia", "start_offset": 40, "end_offset": 59, "label": "dis" }, { "id": 4, "entity": "运动障碍样消化不良", "start_offset": 61, "end_offset": 70, "label": "dis" }, { "id": 5, "entity": "dysmotilitylikedyspepsia", "start_offset": 71, "end_offset": 95, "label": "dis" }, { "id": 6, "entity": "溃疡样消化不良", "start_offset": 97, "end_offset": 104, "label": "dis" }, { "id": 7, "entity": "ulcerlikedyspepsia", "start_offset": 105, "end_offset": 123, "label": "dis" }, { "id": 8, "entity": "吞气症", "start_offset": 125, "end_offset": 128, "label": "dis" }, { "id": 9, "entity": "aerophagia", "start_offset": 129, "end_offset": 139, "label": "dis" }, { "id": 10, "entity": "特发性消化不良", "start_offset": 141, "end_offset": 148, "label": "dis" }, { "id": 11, "entity": "idiopathicdyspepsia", "start_offset": 149, "end_offset": 168, "label": "dis" } ]

（一）运动障碍样消化不良此型患者的表现以腹胀早饱及嗳气为主。

[ { "id": 0, "entity": "运动障碍样消化不良", "start_offset": 3, "end_offset": 12, "label": "dis" }, { "id": 1, "entity": "腹", "start_offset": 20, "end_offset": 21, "label": "bod" }, { "id": 2, "entity": "腹胀", "start_offset": 20, "end_offset": 22, "label": "sym" }, { "id": 3, "entity": "早饱", "start_offset": 22, "end_offset": 24, "label": "sym" }, { "id": 4, "entity": "嗳气", "start_offset": 25, "end_offset": 27, "label": "sym" } ]

症状多在进食后加重。

[ { "id": 0, "entity": "症状多在进食后加重", "start_offset": 0, "end_offset": 9, "label": "sym" } ]

过饱时会出现腹痛恶心甚至呕吐反流样消化不良突出的表现是胸骨后痛胃灼热反流。

[ { "id": 0, "entity": "腹", "start_offset": 6, "end_offset": 7, "label": "bod" }, { "id": 1, "entity": "过饱时会出现腹痛恶心甚至呕吐", "start_offset": 0, "end_offset": 14, "label": "sym" }, { "id": 2, "entity": "反流样消化不良", "start_offset": 14, "end_offset": 21, "label": "dis" }, { "id": 3, "entity": "胸骨", "start_offset": 27, "end_offset": 29, "label": "bod" }, { "id": 4, "entity": "胸骨后痛", "start_offset": 27, "end_offset": 31, "label": "sym" }, { "id": 5, "entity": "胃", "start_offset": 31, "end_offset": 32, "label": "bod" }, { "id": 6, "entity": "胃灼热", "start_offset": 31, "end_offset": 34, "label": "sym" }, { "id": 7, "entity": "反流", "start_offset": 34, "end_offset": 36, "label": "sym" } ]

内镜检查未发现食管炎，但24小时pH监测可发现部分患者有胃食管酸反流食管对酸敏感性增加有关。

[ { "id": 0, "entity": "内镜检查", "start_offset": 0, "end_offset": 4, "label": "pro" }, { "id": 1, "entity": "食管炎", "start_offset": 7, "end_offset": 10, "label": "dis" }, { "id": 2, "entity": "胃食管", "start_offset": 28, "end_offset": 31, "label": "bod" }, { "id": 3, "entity": "胃食管酸反流", "start_offset": 28, "end_offset": 34, "label": "sym" }, { "id": 4, "entity": "食管", "start_offset": 34, "end_offset": 36, "label": "bod" } ]

（三）溃疡样消化不良主要表现与十二指肠溃疡特点相同，夜间痛，饥饿痛，进食或服抗酸剂能缓解，可伴有反酸，少数患者伴胃灼热症状呈慢性周期性。

[ { "id": 0, "entity": "溃疡样消化不良", "start_offset": 3, "end_offset": 10, "label": "dis" }, { "id": 1, "entity": "十二指肠溃疡", "start_offset": 15, "end_offset": 21, "label": "dis" }, { "id": 2, "entity": "夜间痛", "start_offset": 26, "end_offset": 29, "label": "sym" }, { "id": 3, "entity": "饥饿痛", "start_offset": 30, "end_offset": 33, "label": "sym" }, { "id": 4, "entity": "抗酸剂", "start_offset": 38, "end_offset": 41, "label": "dru" }, { "id": 5, "entity": "反酸", "start_offset": 48, "end_offset": 50, "label": "sym" }, { "id": 6, "entity": "胃", "start_offset": 56, "end_offset": 57, "label": "bod" }, { "id": 7, "entity": "胃灼热", "start_offset": 56, "end_offset": 59, "label": "sym" }, { "id": 8, "entity": "症状呈慢性周期性", "start_offset": 59, "end_offset": 67, "label": "sym" } ]

内镜检查未发现溃疡和糜烂性炎症。

[ { "id": 0, "entity": "内镜检查", "start_offset": 0, "end_offset": 4, "label": "pro" }, { "id": 1, "entity": "溃疡", "start_offset": 7, "end_offset": 9, "label": "dis" }, { "id": 2, "entity": "糜烂性炎症", "start_offset": 10, "end_offset": 15, "label": "dis" } ]

（四）非特异型消化不良消化不良表现不能归入上述类型者。

[ { "id": 0, "entity": "非特异型消化不良", "start_offset": 3, "end_offset": 11, "label": "dis" }, { "id": 1, "entity": "消化不良", "start_offset": 11, "end_offset": 15, "label": "dis" } ]

常合并肠易激综合征。

[ { "id": 0, "entity": "肠易激综合征", "start_offset": 3, "end_offset": 9, "label": "dis" } ]

【诊断及鉴别诊断】（一）诊断对于功能性消化不良的诊断，首先应排除器质性消化不良。

[ { "id": 0, "entity": "功能性消化不良", "start_offset": 16, "end_offset": 23, "label": "dis" }, { "id": 1, "entity": "器质性消化不良", "start_offset": 32, "end_offset": 39, "label": "dis" } ]

除了仔细询问病史及全面体检外，应进行以下的器械及实验室检查：①血常规；②粪隐血试验；③上消化道内镜；④肝胆胰超声；⑤肝肾功能；⑥血糖；⑦甲状腺功能；⑧胸部X检查。

[ { "id": 0, "entity": "血常规", "start_offset": 31, "end_offset": 34, "label": "pro" }, { "id": 1, "entity": "粪隐血试验", "start_offset": 36, "end_offset": 41, "label": "pro" }, { "id": 2, "entity": "上消化道内镜", "start_offset": 43, "end_offset": 49, "label": "pro" }, { "id": 3, "entity": "肝胆胰超声", "start_offset": 51, "end_offset": 56, "label": "pro" }, { "id": 4, "entity": "肝肾功能", "start_offset": 58, "end_offset": 62, "label": "pro" }, { "id": 5, "entity": "血糖", "start_offset": 64, "end_offset": 66, "label": "pro" }, { "id": 6, "entity": "甲状腺功能", "start_offset": 68, "end_offset": 73, "label": "pro" }, { "id": 7, "entity": "胸部X检查", "start_offset": 75, "end_offset": 80, "label": "pro" } ]

其中①～④为第一线检查，⑤～⑧为可选择性检查，多数根据第一线检查即可基本确定功能性消化不良的诊断。

[ { "id": 0, "entity": "功能性消化不良", "start_offset": 38, "end_offset": 45, "label": "dis" } ]

此外，近年来开展的胃食管24小时pH监测、超声或放射性核素胃排空检查以及胃肠道压力测定等多种胃肠道动力检查手段，在FD的诊断与鉴别诊断上也起到了十分重要的作用。

[ { "id": 0, "entity": "胃食管24小时pH监测", "start_offset": 9, "end_offset": 20, "label": "pro" }, { "id": 1, "entity": "超声或放射性核素胃排空检查", "start_offset": 21, "end_offset": 34, "label": "pro" }, { "id": 2, "entity": "胃肠道压力测定", "start_offset": 36, "end_offset": 43, "label": "pro" }, { "id": 3, "entity": "胃肠道动力检查", "start_offset": 46, "end_offset": 53, "label": "pro" }, { "id": 4, "entity": "FD", "start_offset": 57, "end_offset": 59, "label": "dis" } ]

许多原因不明的腹痛恶心及呕吐患者往往经胃肠道压力检查找到了病因，这些检查也逐渐开始应用于儿科患者。

[ { "id": 0, "entity": "腹", "start_offset": 7, "end_offset": 8, "label": "bod" }, { "id": 1, "entity": "腹痛", "start_offset": 7, "end_offset": 9, "label": "sym" }, { "id": 2, "entity": "恶心", "start_offset": 9, "end_offset": 11, "label": "sym" }, { "id": 3, "entity": "呕吐", "start_offset": 12, "end_offset": 14, "label": "sym" }, { "id": 4, "entity": "胃肠道压力检查", "start_offset": 19, "end_offset": 26, "label": "pro" }, { "id": 5, "entity": "儿科", "start_offset": 44, "end_offset": 46, "label": "dep" } ]

（二）功能性消化不良通用的诊断标准2.内镜检查未发现胃及十二指肠溃疡、糜烂和肿瘤等器质性病变，未发现食管炎，也无上述疾病史。

[ { "id": 0, "entity": "功能性消化不良", "start_offset": 3, "end_offset": 10, "label": "dis" }, { "id": 1, "entity": "内镜检查", "start_offset": 19, "end_offset": 23, "label": "pro" }, { "id": 2, "entity": "胃及十二指肠溃疡", "start_offset": 26, "end_offset": 34, "label": "dis" }, { "id": 3, "entity": "糜烂", "start_offset": 35, "end_offset": 37, "label": "dis" }, { "id": 4, "entity": "肿瘤", "start_offset": 38, "end_offset": 40, "label": "dis" }, { "id": 5, "entity": "器质性病变", "start_offset": 41, "end_offset": 46, "label": "dis" }, { "id": 6, "entity": "食管炎", "start_offset": 50, "end_offset": 53, "label": "dis" } ]

3.实验室、B超及X线检查排除肝、胆、胰疾病。

[ { "id": 0, "entity": "实验室、B超及X线检查", "start_offset": 2, "end_offset": 13, "label": "pro" }, { "id": 1, "entity": "肝、胆、胰疾病", "start_offset": 15, "end_offset": 22, "label": "dis" } ]

4.无糖尿病、结缔组织病、肾脏疾病及精神病史。

[ { "id": 0, "entity": "糖尿病", "start_offset": 3, "end_offset": 6, "label": "dis" }, { "id": 1, "entity": "结缔组织病", "start_offset": 7, "end_offset": 12, "label": "dis" }, { "id": 2, "entity": "肾脏疾病", "start_offset": 13, "end_offset": 17, "label": "dis" }, { "id": 3, "entity": "精神病", "start_offset": 18, "end_offset": 21, "label": "dis" } ]

5.无腹部手术史。

[ { "id": 0, "entity": "腹部手术", "start_offset": 3, "end_offset": 7, "label": "pro" } ]

（三）儿童功能性消化不良的罗马Ⅲ诊断标准必须包括以下所有项：1.持续或反复发作的上腹部（脐上）疼痛或不适排便后不能缓解，或症状发作与排便频率或粪便性状的改变无关肠易激综合征）。

[ { "id": 0, "entity": "功能性消化不良", "start_offset": 5, "end_offset": 12, "label": "dis" }, { "id": 1, "entity": "腹", "start_offset": 41, "end_offset": 42, "label": "bod" }, { "id": 2, "entity": "脐", "start_offset": 44, "end_offset": 45, "label": "bod" }, { "id": 3, "entity": "持续或反复发作的上腹部（脐上）疼痛或不适", "start_offset": 32, "end_offset": 52, "label": "sym" }, { "id": 4, "entity": "排便后不能缓解", "start_offset": 52, "end_offset": 59, "label": "sym" }, { "id": 5, "entity": "粪便", "start_offset": 71, "end_offset": 73, "label": "bod" }, { "id": 6, "entity": "症状发作与排便频率或粪便性状的改变无关", "start_offset": 61, "end_offset": 80, "label": "sym" }, { "id": 7, "entity": "肠易激综合征", "start_offset": 80, "end_offset": 86, "label": "dis" } ]

（四）鉴别诊断1.胃食管反流胃食管反流性疾病功能性消化不良中的反流亚型与其鉴别困难。

[ { "id": 0, "entity": "胃食管反流", "start_offset": 9, "end_offset": 14, "label": "dis" }, { "id": 1, "entity": "胃食管反流性疾病", "start_offset": 14, "end_offset": 22, "label": "dis" }, { "id": 2, "entity": "功能性消化不良", "start_offset": 22, "end_offset": 29, "label": "dis" } ]

胃食管反流性疾病具有典型或不典型反流症状，内镜证实有不同程度的食管炎症改变，24小时食管pH监测有酸反应，无内镜下食管炎表现的患者属于反流样消化不良或胃食管反流性疾病不易确定，但两者在治疗上是相同的。

[ { "id": 0, "entity": "胃食管反流性疾病", "start_offset": 0, "end_offset": 8, "label": "dis" }, { "id": 1, "entity": "内镜", "start_offset": 21, "end_offset": 23, "label": "pro" }, { "id": 2, "entity": "反流样消化不良", "start_offset": 67, "end_offset": 74, "label": "dis" }, { "id": 3, "entity": "胃食管反流性疾病", "start_offset": 75, "end_offset": 83, "label": "dis" } ]

2.具有溃疡样症状的器质性消化不良包括：十二指肠溃疡、十二指肠炎、幽门管溃疡、幽门前区溃疡、糜烂性胃窦炎。

[ { "id": 0, "entity": "溃疡", "start_offset": 4, "end_offset": 6, "label": "dis" }, { "id": 1, "entity": "器质性消化不良", "start_offset": 10, "end_offset": 17, "label": "dis" }, { "id": 2, "entity": "十二指肠溃疡", "start_offset": 20, "end_offset": 26, "label": "dis" }, { "id": 3, "entity": "十二指肠炎", "start_offset": 27, "end_offset": 32, "label": "dis" }, { "id": 4, "entity": "幽门管溃疡", "start_offset": 33, "end_offset": 38, "label": "dis" }, { "id": 5, "entity": "幽门前区溃疡", "start_offset": 39, "end_offset": 45, "label": "dis" }, { "id": 6, "entity": "糜烂性胃窦炎", "start_offset": 46, "end_offset": 52, "label": "dis" } ]

在诊断功能性消化不良溃疡亚型前，必须进行内镜检查以排除以上器质性病变。

[ { "id": 0, "entity": "功能性消化不良溃疡亚型", "start_offset": 3, "end_offset": 14, "label": "dis" }, { "id": 1, "entity": "内镜检查", "start_offset": 20, "end_offset": 24, "label": "pro" }, { "id": 2, "entity": "器质性病变", "start_offset": 29, "end_offset": 34, "label": "dis" } ]

3.胃轻瘫许多全身性的或消化道疾病均可引起胃排空功能的障碍，造成胃轻瘫。

[ { "id": 0, "entity": "胃轻瘫", "start_offset": 2, "end_offset": 5, "label": "dis" }, { "id": 1, "entity": "全身性的或消化道疾病", "start_offset": 7, "end_offset": 17, "label": "dis" }, { "id": 2, "entity": "胃", "start_offset": 21, "end_offset": 22, "label": "bod" }, { "id": 3, "entity": "胃轻瘫", "start_offset": 32, "end_offset": 35, "label": "dis" } ]

较常见的原因有糖尿病、尿毒症及结缔组织病。

[ { "id": 0, "entity": "糖尿病", "start_offset": 7, "end_offset": 10, "label": "dis" }, { "id": 1, "entity": "尿毒症", "start_offset": 11, "end_offset": 14, "label": "dis" }, { "id": 2, "entity": "结缔组织病", "start_offset": 15, "end_offset": 20, "label": "dis" } ]

在诊功能性消化不良运动障碍亚型时，应仔细排除其他原因所致的胃轻瘫。

[ { "id": 0, "entity": "功能性消化不良运动障碍亚型", "start_offset": 2, "end_offset": 15, "label": "dis" }, { "id": 1, "entity": "胃轻瘫", "start_offset": 29, "end_offset": 32, "label": "dis" } ]

4.慢性难治性腹痛（CIPA）CIPA患者70%为女性，多有身体或心理创伤史。

[ { "id": 0, "entity": "慢性难治性腹痛", "start_offset": 2, "end_offset": 9, "label": "dis" }, { "id": 1, "entity": "CIPA", "start_offset": 10, "end_offset": 14, "label": "dis" }, { "id": 2, "entity": "CIPA", "start_offset": 15, "end_offset": 19, "label": "dis" }, { "id": 3, "entity": "心理创伤", "start_offset": 33, "end_offset": 37, "label": "dis" } ]

患者常常主诉有长期腹痛（超过6个月），且腹痛弥漫，多伴有腹部以外的症状。

[ { "id": 0, "entity": "腹痛弥漫", "start_offset": 20, "end_offset": 24, "label": "sym" }, { "id": 1, "entity": "腹部以外的症状", "start_offset": 28, "end_offset": 35, "label": "sym" } ]

这类患者多数有严重的潜在的心理疾患，包括抑郁、焦虑和躯体形态的紊乱。

[ { "id": 0, "entity": "心理疾患", "start_offset": 13, "end_offset": 17, "label": "dis" }, { "id": 1, "entity": "焦虑", "start_offset": 23, "end_offset": 25, "label": "dis" }, { "id": 2, "entity": "躯体形态的紊乱", "start_offset": 26, "end_offset": 33, "label": "dis" } ]

对这类患者应提供多种方式的心理、行为和药物联合治疗。

[ { "id": 0, "entity": "心理、行为和药物联合治疗", "start_offset": 13, "end_offset": 25, "label": "pro" } ]

【预防】并非所有的功能性消化不良的患儿均需接受药物治疗。

[ { "id": 0, "entity": "功能性消化不良", "start_offset": 9, "end_offset": 16, "label": "dis" } ]

如建立良好的生活习惯，避免心理紧张因素和刺激性食物，避免服用非甾体类消炎药。

[ { "id": 0, "entity": "建立良好的生活习惯", "start_offset": 1, "end_offset": 10, "label": "pro" }, { "id": 1, "entity": "避免心理紧张因素和刺激性食物", "start_offset": 11, "end_offset": 25, "label": "pro" }, { "id": 2, "entity": "非甾体类消炎药", "start_offset": 30, "end_offset": 37, "label": "dru" } ]

对于无法停药者应同时应用胃黏膜保护剂或H2受体拮抗剂。

[ { "id": 0, "entity": "胃黏膜保护剂", "start_offset": 12, "end_offset": 18, "label": "dru" } ]

【治疗】（一）一般治疗一般说来，治疗中最重要的是在医生和患者之间建立一种牢固的治疗关系。

[ { "id": 0, "entity": "一般治疗", "start_offset": 7, "end_offset": 11, "label": "pro" } ]

经过诊断性检查之后，应告诉患者功能性消化不良的诊断，同时向他们进行宣教、消除疑虑，抑制“过分检查”的趋势，将重点从寻找症状的原因转移到帮助患者克服这些症状。

[ { "id": 0, "entity": "诊断性检查", "start_offset": 2, "end_offset": 7, "label": "pro" }, { "id": 1, "entity": "功能性消化不良", "start_offset": 15, "end_offset": 22, "label": "dis" } ]

改变他们的生活环境是不太可能的，应指导患者减轻应激反应的措施，如体育锻炼和良好的饮食睡眠习惯。

[ { "id": 0, "entity": "体育锻炼", "start_offset": 32, "end_offset": 36, "label": "pro" }, { "id": 1, "entity": "良好的饮食睡眠习惯", "start_offset": 37, "end_offset": 46, "label": "pro" } ]

（二）药物治疗对于功能性消化不良，药物治疗的效果不太令人满意。

[ { "id": 0, "entity": "药物治疗", "start_offset": 3, "end_offset": 7, "label": "pro" }, { "id": 1, "entity": "功能性消化不良", "start_offset": 9, "end_offset": 16, "label": "dis" } ]

而且，症状的改善也可能与自然病程中症状的时轻时重有关，或者是安慰剂的作用。

[ { "id": 0, "entity": "安慰剂", "start_offset": 30, "end_offset": 33, "label": "dru" } ]

在症状加重时，药物治疗可能会有帮助，但应尽量减少用量，只有在有明确益处时才可长期使用。

[ { "id": 0, "entity": "药物治疗", "start_offset": 7, "end_offset": 11, "label": "pro" } ]

下面介绍一下治疗功能性消化不良的常用药物：1.抗酸剂和制酸剂（1）抗酸剂：抗酸剂（碳酸氢钠、氢氧化铝、氧化镁、三硅酸镁）：在我国常用的有碳酸钙口服液、复方氢氧化铝片及胃达。

[ { "id": 0, "entity": "功能性消化不良", "start_offset": 8, "end_offset": 15, "label": "dis" }, { "id": 1, "entity": "抗酸剂", "start_offset": 23, "end_offset": 26, "label": "dru" }, { "id": 2, "entity": "制酸剂", "start_offset": 27, "end_offset": 30, "label": "dru" }, { "id": 3, "entity": "抗酸剂", "start_offset": 33, "end_offset": 36, "label": "dru" }, { "id": 4, "entity": "抗酸剂", "start_offset": 37, "end_offset": 40, "label": "dru" }, { "id": 5, "entity": "碳酸氢钠", "start_offset": 41, "end_offset": 45, "label": "dru" }, { "id": 6, "entity": "氢氧化铝", "start_offset": 46, "end_offset": 50, "label": "dru" }, { "id": 7, "entity": "氧化镁", "start_offset": 51, "end_offset": 54, "label": "dru" }, { "id": 8, "entity": "碳酸钙口服液", "start_offset": 68, "end_offset": 74, "label": "dru" }, { "id": 9, "entity": "复方氢氧化铝片", "start_offset": 75, "end_offset": 82, "label": "dru" }, { "id": 10, "entity": "胃达", "start_offset": 83, "end_offset": 85, "label": "dru" } ]

这类药物对于缓解饥饿痛、反酸及胃灼热不良反应。

[ { "id": 0, "entity": "饥饿痛", "start_offset": 8, "end_offset": 11, "label": "sym" }, { "id": 1, "entity": "反酸", "start_offset": 12, "end_offset": 14, "label": "sym" }, { "id": 2, "entity": "胃", "start_offset": 15, "end_offset": 16, "label": "bod" }, { "id": 3, "entity": "胃灼热", "start_offset": 15, "end_offset": 18, "label": "sym" }, { "id": 4, "entity": "不良反应", "start_offset": 18, "end_offset": 22, "label": "sym" } ]

（2）抑酸剂：抑酸剂主要指H2受体拮抗剂和质子泵抑制剂。

[ { "id": 0, "entity": "抑酸剂", "start_offset": 3, "end_offset": 6, "label": "dru" }, { "id": 1, "entity": "抑酸剂", "start_offset": 7, "end_offset": 10, "label": "dru" }, { "id": 2, "entity": "质子泵抑制剂", "start_offset": 27, "end_offset": 33, "label": "dru" } ]

H2受体拮抗剂治疗功能性消化不良的报道很多，药物的疗效在统计学上显著优于安慰剂。

[ { "id": 0, "entity": "功能性消化不良", "start_offset": 15, "end_offset": 22, "label": "dis" }, { "id": 1, "entity": "安慰剂", "start_offset": 42, "end_offset": 45, "label": "dru" } ]

它们抑制胃酸的分泌，无论对溃疡亚型和反流亚型都有明显的效果。

[ { "id": 0, "entity": "胃酸", "start_offset": 4, "end_offset": 6, "label": "bod" }, { "id": 1, "entity": "溃疡亚型", "start_offset": 13, "end_offset": 17, "label": "dis" }, { "id": 2, "entity": "反流亚型", "start_offset": 18, "end_offset": 22, "label": "dis" } ]

质子泵抑制剂奥美拉唑，可抑制壁细胞H+-K+-ATP酶，抑制酸分泌作用强，持续时间长，适用于H2受体拮抗剂治疗无效的患者。

[ { "id": 0, "entity": "质子泵抑制剂", "start_offset": 0, "end_offset": 6, "label": "dru" }, { "id": 1, "entity": "奥美拉唑", "start_offset": 6, "end_offset": 10, "label": "dru" }, { "id": 2, "entity": "壁细胞H+-K+-ATP酶", "start_offset": 14, "end_offset": 27, "label": "bod" } ]

2.促动力药物根据有对照组的临床验证，现已肯定甲氧氯普胺（胃复安）、多潘立酮（吗丁啉）及西沙比利对消除功能性消化不良诸症状确有疗效。

[ { "id": 0, "entity": "促动力药物", "start_offset": 2, "end_offset": 7, "label": "dru" }, { "id": 1, "entity": "甲氧氯普胺", "start_offset": 23, "end_offset": 28, "label": "dru" }, { "id": 2, "entity": "胃复安", "start_offset": 29, "end_offset": 32, "label": "dru" }, { "id": 3, "entity": "多潘立酮", "start_offset": 34, "end_offset": 38, "label": "dru" }, { "id": 4, "entity": "吗丁啉", "start_offset": 39, "end_offset": 42, "label": "dru" }, { "id": 5, "entity": "西沙比利", "start_offset": 44, "end_offset": 48, "label": "dru" }, { "id": 6, "entity": "功能性消化不良", "start_offset": 51, "end_offset": 58, "label": "dis" } ]

儿科多潘立酮应用较多。

[ { "id": 0, "entity": "儿科", "start_offset": 0, "end_offset": 2, "label": "dep" }, { "id": 1, "entity": "多潘立酮", "start_offset": 2, "end_offset": 6, "label": "dru" } ]

（1）甲氧氯普胺：有抗中枢和外周多巴胺作用，同时兴奋5-HT4受体，促进内源性乙酰胆碱释放，增加胃窦-十二指肠协调运动，促进胃排空。

[ { "id": 0, "entity": "甲氧氯普胺", "start_offset": 3, "end_offset": 8, "label": "dru" }, { "id": 1, "entity": "中枢", "start_offset": 11, "end_offset": 13, "label": "bod" }, { "id": 2, "entity": "外周多巴胺", "start_offset": 14, "end_offset": 19, "label": "bod" }, { "id": 3, "entity": "5-HT4受体", "start_offset": 26, "end_offset": 33, "label": "bod" }, { "id": 4, "entity": "内源性乙酰胆碱", "start_offset": 36, "end_offset": 43, "label": "bod" }, { "id": 5, "entity": "胃窦-十二指肠", "start_offset": 48, "end_offset": 55, "label": "bod" }, { "id": 6, "entity": "胃", "start_offset": 62, "end_offset": 63, "label": "bod" } ]

因不良反应较多，故临床应用逐渐减少。

[ { "id": 0, "entity": "不良反应", "start_offset": 1, "end_offset": 5, "label": "sym" } ]

（2）多潘立酮：为外周多巴胺受体阻抗剂，可促进固体和液体胃排空，抑制胃容纳舒张，协调胃窦-十二指肠运动，松弛幽门，从而缓解消化不良症状。

[ { "id": 0, "entity": "多潘立酮", "start_offset": 3, "end_offset": 7, "label": "dru" }, { "id": 1, "entity": "外周多巴胺受体阻抗剂", "start_offset": 9, "end_offset": 19, "label": "dru" }, { "id": 2, "entity": "胃", "start_offset": 28, "end_offset": 29, "label": "bod" }, { "id": 3, "entity": "胃", "start_offset": 34, "end_offset": 35, "label": "bod" }, { "id": 4, "entity": "胃窦-十二指肠", "start_offset": 42, "end_offset": 49, "label": "bod" }, { "id": 5, "entity": "幽门", "start_offset": 54, "end_offset": 56, "label": "bod" }, { "id": 6, "entity": "消化不良", "start_offset": 61, "end_offset": 65, "label": "dis" } ]

1岁以下儿童由于血脑屏障功能发育尚未完全，故不宜服用。

[ { "id": 0, "entity": "血脑屏障", "start_offset": 8, "end_offset": 12, "label": "bod" } ]

（3）西沙比利：通过促进胃肠道肌层神经丛副交感神经节后纤维末梢乙酰胆碱的释放，增强食管下端括约肌张力，加强食管、胃、小肠和结肠的推进性运动。

[ { "id": 0, "entity": "西沙比利", "start_offset": 3, "end_offset": 7, "label": "dru" }, { "id": 1, "entity": "胃肠道肌层神经丛副交感神经节后纤维末梢乙酰胆碱", "start_offset": 12, "end_offset": 35, "label": "bod" }, { "id": 2, "entity": "食管", "start_offset": 41, "end_offset": 43, "label": "bod" }, { "id": 3, "entity": "括约肌", "start_offset": 45, "end_offset": 48, "label": "bod" }, { "id": 4, "entity": "食管", "start_offset": 53, "end_offset": 55, "label": "bod" }, { "id": 5, "entity": "胃", "start_offset": 56, "end_offset": 57, "label": "bod" }, { "id": 6, "entity": "小肠", "start_offset": 58, "end_offset": 60, "label": "bod" }, { "id": 7, "entity": "结肠", "start_offset": 61, "end_offset": 63, "label": "bod" } ]

对胃的作用主要有增加胃窦收缩，改善胃窦-十二指肠协调运动。

[ { "id": 0, "entity": "胃", "start_offset": 1, "end_offset": 2, "label": "bod" }, { "id": 1, "entity": "胃窦", "start_offset": 10, "end_offset": 12, "label": "bod" }, { "id": 2, "entity": "胃窦-十二指肠", "start_offset": 17, "end_offset": 24, "label": "bod" } ]

降低幽门时相性收缩频率，使胃电活动趋于正常，从而加速胃排空。

[ { "id": 0, "entity": "幽门", "start_offset": 2, "end_offset": 4, "label": "bod" }, { "id": 1, "entity": "胃", "start_offset": 13, "end_offset": 14, "label": "bod" }, { "id": 2, "entity": "胃", "start_offset": 26, "end_offset": 27, "label": "bod" } ]