臨牀消化器内科 Vol.30 No.2(1)


特集名 機能性消化管疾患―病態の解明と新たな治療
題名 総論:機能性消化管疾患の位置づけ
発刊年月 2015年 02月
著者 屋嘉比 康治 埼玉医科大学総合医療センター消化器・肝臓内科
【 要旨 】 本稿においては消化器疾患における機能性消化管疾患(FGID)の位置づけについて述べてみた. 消化器疾患におけるその位置づけとして (1) FGIDは国民に広く認められる(FDやIBSは国民の10~20%)もっとも一般的な疾患であること,(2) FGIDそのものは良性疾患でも常に悪性疾患の可能性が潜んでいることを銘記して診療に当たること,すなわち警告症状のある症例などは内視鏡検 査や超音波検査,必要であれば CT検査もためらわずに行う,(3) FGIDの病態には典型的な心身症的発症機序が関与しており消化器内科医も心理社 会的因子に配慮することが必要であること,さらに (4) FGIDの病態を理解するためには脳腸相関を介する生理学的調節機序の理解が重要であることを述べた.
Theme Unraveling of the Pathophysiology of Functional Gastrointestinal Disorders and Updated Treatments
Title Relation of Functional Gastrointestinal Disorders (FGIDs) to Gastroenterology
Author Koji Yakabi Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University
[ Summary ] FGIDs were evaluated in relation to their prevalence, diagnosis, pathogenesis and pathophysiology in order to determine the place of functional gastrointestinal disorders in the field of gastroenterology. 1. FGIDs are among the most common diseases in the entire range of gastrointestinal diseases. The prevalence of irritable bowel syndrome or functional dyspepsia is 10‒20 % in the Japanese population. 2. FGIDs are benign diseases that are diagnosed by eliminating other gastrointestinal diseases, as well as systemic diseases such as metabolic or endocrinological conditions. Types of examinations such as endoscopies, blood chemistry panels and ultrasonography should be performed for patients suspected of baving FGID, especially patients exhibiting alarm sign. CT examinations also should be performed when appropriate. 3. FGIDs are psychosomatically related diseases, because they may occur due to psychological stress, depression or anxiety. Patients with FD have a higher percentage of complications such as depression and anxiety. Gastroenterologists must also understand and care for psychosomatic problems in patients with FGID. 4. To understand the pathogenesis of FGIDs, it is important to consider the physiological regulation exercised by brain gut interactions.
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