gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2017-27-1-50-61gastro-j-123Research ArticleКЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИCLINICAL GUIDELINESКлинические рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению функциональной диспепсииDiagnosis and treatment of the functional dyspepsia: clinical guidelines of the Russian Gastroenterological AssociationИвашкинВ. Т.IvashkinV. T.noemail@neicon.ruМаевИ. В.MayevI. V.noemail@neicon.ruШептулинА. А.SheptulinA. A.arkalshep@gmail.comЛапинаТ. Л.LapinaT. L.noemail@neicon.ruТрухмановА. С.TrukhmanovA. S.noemail@neicon.ruКартавенкоИ. М.KartavenkoI. M.noemail@neicon.ruКиприанисВ. А.KiprianisV. A.noemail@neicon.ruОхлобыстинаО. З.OkhlobystinaO. Z.noemail@neicon.ruФГБОУ ВО «Первый Московский государственный медицинский университет им. И. М. Сеченова»РоссияThe State Education Institution of Higher Professional Training The First Sechenov Moscow State Medical UniversityRussian FederationФГБОУ ВО «Московский государственный медико-стоматологический университет им. А. И. Евдокимова»РоссияState educational government-financed institution of higher professional education «Yevdokimov Moscow State University of Medicine and Dentistry»Russian Federation2017120820182715061Copyright © Ивашкин В.Т., Маев И.В., Шептулин А.А., Лапина Т.Л., Трухманов А.С., Картавенко И.М., Киприанис В.А., Охлобыстина О.З., 20182018Ивашкин В.Т., Маев И.В., Шептулин А.А., Лапина Т.Л., Трухманов А.С., Картавенко И.М., Киприанис В.А., Охлобыстина О.З.Ivashkin V.T., Mayev I.V., Sheptulin A.A., Lapina T.L., Trukhmanov A.S., Kartavenko I.M., Kiprianis V.A., Okhlobystina O.Z.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/123

Цель публикации. Ознакомить практикующих врачей с современными представлениями об этиологии и патогенезе функциональной диспепсии (ФД), а также с принятыми в настоящее время подходами к диагностике и лечению данного заболевания. Основные положения. ФД относится к наиболее распространенным гастроэнтерологическим заболеваниям. В ее этиологии играют роль наследственная предрасположенность, вредные привычки, перенесенные пищевые токсикоинфекции, психосоциальные факторы. Патогенетические звенья включают гиперсекрецию соляной кислоты, нарушения моторики желудка и двенадцатиперстной кишки, висцеральную гиперчувствительность. Диагноз ФД правомерно устанавливать после исключения органических заболеваний, протекающих с симптомами диспепсии. Лечение строят по ступенчатому принципу, оно включает общие мероприятия, применение препаратов, снижающих секрецию соляной кислоты, а также нормализующих моторику и висцеральную чувствительность желудка и двенадцатиперстной кишки, в случаях резистентности - психофармакологические препараты и психотерапевтические методы. Заключение. Соблюдение алгоритма ведения больных с синдромом диспепсии позволяет повысить точность диагностики ФД и улучшить результаты ее лечения.

The aim of publication. To present the modern concept on etiology and pathogenesis of functional dyspepsia (FD) to general practitioners, as well as with the accepted approach to diagnostics and treatment of this disease. Summary. FD is the most common digestive disease. It’s etiology includes genetic predisposition, bad habits, previous intestinal infections, psychosocial factors. The basic pathogenic factors may include HCl hypersecretion, stomach and duodenal dysmotility and visceral hypersensitivity. FD diagnosis should be established after ruling out of the organic diseases that may manifest by dyspepsia. Treatment is based on the stepwise approach, that includes general procedures, application of the drugs reducing hydrochloric acid secretion and normalizing motility and visceral sensitivity of the stomach and duodenum, in difficult to treat cases - psychopharmacological drugs and psychotherapeutic methods. Conclusion. Following of the functional dyspepsia management algorithm allows to increase the accuracy of FD diagnosis and improve treatment results.

диспепсияфункциональная диспепсияорганическая диспепсияхронический гастритинфекция Helicobacter pyloriэрадикацияReferencesTack J., Talley N.J., Camilleri M. et al. Functional gastroduodenal disorders. Gastroenterology 2006; 130;1466-79.Tack J., Talley N.J., Camilleri M. et al. Functional gastroduodenal disorders. Gastroenterology 2006; 130;1466-79.Stanghellini V., Chan F.C.L., Hasler W.L. et al. Gastroduodenal disorders. Gastroenterology 2016; 150:1380-92.Stanghellini V., Chan F.C.L., Hasler W.L. et al. Gastroduodenal disorders. Gastroenterology 2016; 150:1380-92.Sugano K., Tack J., Kuipers E.J. et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut 2015; 64:133-67.Sugano K., Tack J., Kuipers E.J. et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut 2015; 64:133-67.Malfertheiner P., Megraud F., O’Morain C.A. et al. Management of Helicobacter pylori infection - the Maastricht V/Florence Consensus Report. Gut 2016 Oct 5. doi: org/10.1136/gutjnl-2016-312288.Malfertheiner P., Megraud F., O’Morain C.A. et al. Management of Helicobacter pylori infection - the Maastricht V/Florence Consensus Report. Gut 2016 Oct 5. doi: org/10.1136/gutjnl-2016-312288.McQuaid K.R. Dyspepsia // Sleisenger and Fordtran’s gastrointestinal and liver disease (Ed.: M. Feldman et al.). 7th ed. Philadelphia-London-Toronto-MontrealSydney-Tokyo; 2002. P. 102-18.McQuaid K.R. Dyspepsia // Sleisenger and Fordtran’s gastrointestinal and liver disease (Ed.: M. Feldman et al.). 7th ed. Philadelphia-London-Toronto-MontrealSydney-Tokyo; 2002. P. 102-18.Talley N.J., Stanghellini V., Heading R.C. et al. Functional gastroduodenal disorders / Rome II. The Functional Gastrointestinal Disorders (Ed.: D.A. Drossman). 2th ed. Allen Press; 2000. P. 299-350.Talley N.J., Stanghellini V., Heading R.C. et al. Functional gastroduodenal disorders / Rome II. The Functional Gastrointestinal Disorders (Ed.: D.A. Drossman). 2th ed. Allen Press; 2000. P. 299-350.Holtmann G., Talley N.J. Clinician’s manual on managing dyspepsia. Life Sci Comm London; 2000. 88 p.Holtmann G., Talley N.J. Clinician’s manual on managing dyspepsia. Life Sci Comm London; 2000. 88 p.Knill-Jones R.P. Geographical differences in the prevalence of dyspepsia. Scand J Gastroenterol 1991:26 (Suppl.182):17-24.Knill-Jones R.P. Geographical differences in the prevalence of dyspepsia. Scand J Gastroenterol 1991:26 (Suppl.182):17-24.Buonavolonta R., Goccorullo P., Boccia G. et al. Familial aggregation in children affected by functional gastrointestinal disorders. Gut 2008; 57 (Suppl. II): A3.Buonavolonta R., Goccorullo P., Boccia G. et al. Familial aggregation in children affected by functional gastrointestinal disorders. Gut 2008; 57 (Suppl. II): A3.Holtmann G., Talley N.J. Hypothesis driven research and molecular mechanisms in functional dyspepsia: the beginning of a beautiful cooperation in research and practice? Am J Gastroenterol 2006; 101:593-5.Holtmann G., Talley N.J. Hypothesis driven research and molecular mechanisms in functional dyspepsia: the beginning of a beautiful cooperation in research and practice? Am J Gastroenterol 2006; 101:593-5.Führer M., Vogelsang M., Hammer J. A double blind, placebo controlled study of the oral capsaicin test in patients with functional dyspepsia. Gut 2008; 57(Suppl. II):A.38.Führer M., Vogelsang M., Hammer J. A double blind, placebo controlled study of the oral capsaicin test in patients with functional dyspepsia. Gut 2008; 57(Suppl. II):A.38.Boekema P.J., van Dam E.F., Bots M.L. et al. Associations between use of alcohol, coffee and smoking and functional bowel symptoms in the general Dutch population. DDW, New Orleans; 1998: A1070.Boekema P.J., van Dam E.F., Bots M.L. et al. Associations between use of alcohol, coffee and smoking and functional bowel symptoms in the general Dutch population. DDW, New Orleans; 1998: A1070.Kadota K., Takeshima F., Yoda A. et al. Effect of smoking cessation on gastric emptying in smokers. Gut 2008; 57 (Suppl. II): A2.Kadota K., Takeshima F., Yoda A. et al. Effect of smoking cessation on gastric emptying in smokers. Gut 2008; 57 (Suppl. II): A2.Sarnelli G., De Giorgi F., Atteo E. et al. Frequency, symptom evolution and pathophysiological correlates in prospectively identified patients with postinfectious dyspepsia. DDW, New Orleans; 2010: A2010.Sarnelli G., De Giorgi F., Atteo E. et al. Frequency, symptom evolution and pathophysiological correlates in prospectively identified patients with postinfectious dyspepsia. DDW, New Orleans; 2010: A2010.Corsetti M., Tack J. Mechanisms of functional dyspepsia and its relation to IBS. Irritable bowel syndrome. Diagnosis and treatment (Ed.: Camilleri M., Spiller M.C.). London: W.B. Saunders; 2002. P. 117-26.Corsetti M., Tack J. Mechanisms of functional dyspepsia and its relation to IBS. Irritable bowel syndrome. Diagnosis and treatment (Ed.: Camilleri M., Spiller M.C.). London: W.B. Saunders; 2002. P. 117-26.Talley N.J., Helgeson S.L., Zinsmeister A.R. et al. Gastrointestinal tract symptoms and self-reported abuse: a population-based-study. Gastroenterology 1994; 107:1040-9.Talley N.J., Helgeson S.L., Zinsmeister A.R. et al. Gastrointestinal tract symptoms and self-reported abuse: a population-based-study. Gastroenterology 1994; 107:1040-9.Koloski N.A., Talleу N.J., Boyce Ph.M. Epidemiology and health care seeking in the functional GI disorders: a population-based study. Am J Gastroenterol 2002; 97:2290-9.Koloski N.A., Talleу N.J., Boyce Ph.M. Epidemiology and health care seeking in the functional GI disorders: a population-based study. Am J Gastroenterol 2002; 97:2290-9.Охлобыстина О.З. Некоторые особенности патогенеза, клиники, диагностики и лечения синдрома функциональной диспепсии: Автореф. дис. … канд. мед. наук. М.; 2007. 24 с.Охлобыстина О.З. Некоторые особенности патогенеза, клиники, диагностики и лечения синдрома функциональной диспепсии: Автореф. дис. … канд. мед. наук. М.; 2007. 24 с.Locke G.R., Weaver A.L., Melton L.J., Talley N.J. Phsychological factors are linked to functional gastrointestinal disorders: a population based nasted casecontrol study. Am J Gastroenterol 2004; 99:350-7.Locke G.R., Weaver A.L., Melton L.J., Talley N.J. Phsychological factors are linked to functional gastrointestinal disorders: a population based nasted casecontrol study. Am J Gastroenterol 2004; 99:350-7.El-Omar E., Penman I., Ardill J.E. et al. A substantial proportion of non-ulcer dyspepsia patients have the same abnormality of acid secretion as duodenal ulcer patients. Gut 1995; 36:534-8.El-Omar E., Penman I., Ardill J.E. et al. A substantial proportion of non-ulcer dyspepsia patients have the same abnormality of acid secretion as duodenal ulcer patients. Gut 1995; 36:534-8.Samson M., Verhagen M.A., van Berge-Henegouwen G.P. et al. Abnormal clearance of exogenous acid and increased acid sensitivity of the proximal duodenum in dyspeptic patients. Gastroenterology 1999; 116:515-20.Samson M., Verhagen M.A., van Berge-Henegouwen G.P. et al. Abnormal clearance of exogenous acid and increased acid sensitivity of the proximal duodenum in dyspeptic patients. Gastroenterology 1999; 116:515-20.Картавенко И.М. Морфофункциональная оценка двенадцатиперстной кишки у лиц с функциональной диспепсией: Автореф. дис. … канд. мед. наук. М.; 2008. 23 с.Картавенко И.М. Морфофункциональная оценка двенадцатиперстной кишки у лиц с функциональной диспепсией: Автореф. дис. … канд. мед. наук. М.; 2008. 23 с.Tack J., Piessevaux H., Coulie B. et al. Role of impaired gastric accommodation to a meal in functional dyspepsia. Gastroenterology 1998; 115:1346-52.Tack J., Piessevaux H., Coulie B. et al. Role of impaired gastric accommodation to a meal in functional dyspepsia. Gastroenterology 1998; 115:1346-52.Camilleri M., Hasler W.I., Parkman H.P. et al. Measurement of gastrointestinal motility in the GI laboratory. Gastroenterology 1998; 115:747-62.Camilleri M., Hasler W.I., Parkman H.P. et al. Measurement of gastrointestinal motility in the GI laboratory. Gastroenterology 1998; 115:747-62.Lin Z., Eaker E.Y., Sarosiek I., McCallum R. Gastric myoelectrical activity and gastric emptying in patients with functional dyspepsia. Am J Gastoenterol 1999; 94:2384-9.Lin Z., Eaker E.Y., Sarosiek I., McCallum R. Gastric myoelectrical activity and gastric emptying in patients with functional dyspepsia. Am J Gastoenterol 1999; 94:2384-9.Sarnelli G., Caenepeel Ph., Geypens B. et al. Symptoms associated with impared gastric emptying of solids and liquids in functional dyspepsia. Am J Gastroenterol 2003; 98:783-8.Sarnelli G., Caenepeel Ph., Geypens B. et al. Symptoms associated with impared gastric emptying of solids and liquids in functional dyspepsia. Am J Gastroenterol 2003; 98:783-8.Stanghellini V., Tosetti C., Paternico A. et al. Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia. Gastroenterology 1996; 110:1036-42.Stanghellini V., Tosetti C., Paternico A. et al. Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia. Gastroenterology 1996; 110:1036-42.Caldarella M.P., Azpiroz F., Malagelada J.-R. Antro-fundic dysfunction in functional dyspepsia. Gastroenterology 2003; 124:1202-29.Caldarella M.P., Azpiroz F., Malagelada J.-R. Antro-fundic dysfunction in functional dyspepsia. Gastroenterology 2003; 124:1202-29.Jones M.P., Ebert Ch.C. Bloating and somatosensory amplification in functional dyspepsia (FD). Am J Gastroenterol 2003; 98:63-4.Jones M.P., Ebert Ch.C. Bloating and somatosensory amplification in functional dyspepsia (FD). Am J Gastroenterol 2003; 98:63-4.Keohane J., Quigley E.M.M. Functional dyspepsia: The role of visceral hypersensitivity in its pathogenesis. World J Gastroenterol 2006; 12:2672-6.Keohane J., Quigley E.M.M. Functional dyspepsia: The role of visceral hypersensitivity in its pathogenesis. World J Gastroenterol 2006; 12:2672-6.Tack J., Caenepeel P., Fischler B. et al. Symptoms associated with hypersensitivity to gastric distension in functional dyspepsia. Gastroenterology 2001; 121:526-35.Tack J., Caenepeel P., Fischler B. et al. Symptoms associated with hypersensitivity to gastric distension in functional dyspepsia. Gastroenterology 2001; 121:526-35.Soo Sh., Forman D., Delaney C. et al. A systemic review of psychological therapies for nonulcer dyspepsia. Am J Gastroenterol 2004; 99:1817-22.Soo Sh., Forman D., Delaney C. et al. A systemic review of psychological therapies for nonulcer dyspepsia. Am J Gastroenterol 2004; 99:1817-22.Warrwewijk C.J., Van Oijen M.G.H., Paloheimo L.I. et al. Influence of gastric mucosal status on successs of stepwise acid suppressive therapy for dyspepsia. Aliment Pharmacol Ther 2009; 30:82-9.Warrwewijk C.J., Van Oijen M.G.H., Paloheimo L.I. et al. Influence of gastric mucosal status on successs of stepwise acid suppressive therapy for dyspepsia. Aliment Pharmacol Ther 2009; 30:82-9.Mönkemüller K., Malfertheiner P. Drug treatment of functional dyspepsia. World J Gastroenterol 2006:12; 2694-700.Mönkemüller K., Malfertheiner P. Drug treatment of functional dyspepsia. World J Gastroenterol 2006:12; 2694-700.Moayyedi P., Delaney B.C., Vakil N. The efficacy of proton pump inhibitors in non-ulcer dyspepsia: a systematic review and economic analysis. Gastroenterology 2004; 127:1329-37.Moayyedi P., Delaney B.C., Vakil N. The efficacy of proton pump inhibitors in non-ulcer dyspepsia: a systematic review and economic analysis. Gastroenterology 2004; 127:1329-37.Tominaga K., Suzuki H., Umegaki E. et al. Rabeprazole imprоves the symptoms of functional dyspepsia - a double-blind randomized placebo-controlled multi-center trial in Japan: The CAESAR study. DDW, New Orleans 2010: A383.Tominaga K., Suzuki H., Umegaki E. et al. Rabeprazole imprоves the symptoms of functional dyspepsia - a double-blind randomized placebo-controlled multi-center trial in Japan: The CAESAR study. DDW, New Orleans 2010: A383.Рекомендации Российской Гастроэнтерологической Ассоциации по диагностике и лечению инфекции Helicobacter pylori у взрослых. Рос журн гастроэнтерол гепатол колопроктол 2012; 1:87-9.Рекомендации Российской Гастроэнтерологической Ассоциации по диагностике и лечению инфекции Helicobacter pylori у взрослых. Рос журн гастроэнтерол гепатол колопроктол 2012; 1:87-9.Allescher H.-D., Böckenhoff A., Knapp G. et al. Treatment of non-ulcer dyspepsia: a meta-analysis of placebo-controlled prospective studies. Scand J Gastroenterol 2001; 36:934-41.Allescher H.-D., Böckenhoff A., Knapp G. et al. Treatment of non-ulcer dyspepsia: a meta-analysis of placebo-controlled prospective studies. Scand J Gastroenterol 2001; 36:934-41.Moayyedi P., Soo S., Deeks J. et al. Systemic review: Antacids, H2-receptor antagonists, prokinetics, bismuth and sucralfate therapy for non-ulcer dyspepsia. Aliment Pharmacol Ther 2003; 17:1215-27.Moayyedi P., Soo S., Deeks J. et al. Systemic review: Antacids, H2-receptor antagonists, prokinetics, bismuth and sucralfate therapy for non-ulcer dyspepsia. Aliment Pharmacol Ther 2003; 17:1215-27.Veldhuyzen van Zanten S.J., Jones M.J., Verlinden M., Talley N.J. Efficacy of cisapride and domperidone in functional dyspepsia: a meta-analysis. Am J Gastoenterol 2001; 96:689-96.Veldhuyzen van Zanten S.J., Jones M.J., Verlinden M., Talley N.J. Efficacy of cisapride and domperidone in functional dyspepsia: a meta-analysis. Am J Gastoenterol 2001; 96:689-96.Письмо директора Департамента государственного регулирования лекарственных средств Министерства здравоохранения Российской Федерации А.Г. Цындымеева № 20-3/162 от 05.03.2015.Письмо директора Департамента государственного регулирования лекарственных средств Министерства здравоохранения Российской Федерации А.Г. Цындымеева № 20-3/162 от 05.03.2015.Holtmann G., Talley N.J., Liebregts T. et al. A placebocontrolled trial of itopride in functional dyspepsia. N Engl J Med 2006; 354:832-40.Holtmann G., Talley N.J., Liebregts T. et al. A placebocontrolled trial of itopride in functional dyspepsia. N Engl J Med 2006; 354:832-40.Ивашкин В.Т., Шептулин А.А., Трухманов А.С. Эффективность применения ганатона (итоприда гидрохлорида) в лечении больных функциональной диспепсией. Фарматека 2009; 13:50-4.Ивашкин В.Т., Шептулин А.А., Трухманов А.С. Эффективность применения ганатона (итоприда гидрохлорида) в лечении больных функциональной диспепсией. Фарматека 2009; 13:50-4.Sawant P., Das H.S., Desai N. et al. Comparative evaluation of the efficacy and tolerability of itopride hydrochloride and domperidone in patients with non-ulcer dyspepsia. JAPI 2004; 52:626-8.Sawant P., Das H.S., Desai N. et al. Comparative evaluation of the efficacy and tolerability of itopride hydrochloride and domperidone in patients with non-ulcer dyspepsia. JAPI 2004; 52:626-8.Huang X., Lv B., Zhang S. et al. Itopride therapy for functional dyspepsia: a meta-analysis. World J Gastroenterol 2012; 18:7371-7.Huang X., Lv B., Zhang S. et al. Itopride therapy for functional dyspepsia: a meta-analysis. World J Gastroenterol 2012; 18:7371-7.Holtmann G., Nandurkar S., Talley N.J. et al. Herbal medicine for the treatment of functional dyspepsia: a systematic review of the literature and meta-analysis. Gastroenterology 2007; Suppl.2: A1204.Holtmann G., Nandurkar S., Talley N.J. et al. Herbal medicine for the treatment of functional dyspepsia: a systematic review of the literature and meta-analysis. Gastroenterology 2007; Suppl.2: A1204.Ottilinger B., Storr M., Malfertheiner P., Allescher H.-D STW 5 (Iberogast®) - a safe and effective standart in the treatment of functional gastrointestinal disorders. Wien Med Wschr 2013; 163:65-72.Ottilinger B., Storr M., Malfertheiner P., Allescher H.-D STW 5 (Iberogast®) - a safe and effective standart in the treatment of functional gastrointestinal disorders. Wien Med Wschr 2013; 163:65-72.Aktas A., Caner B., Ozturk F. et al. The effect of trimebutine maleate on gastric emptying in patients with non-ulcer dyspepsia. Ann Nucl Med 1999; 13:231-4.Aktas A., Caner B., Ozturk F. et al. The effect of trimebutine maleate on gastric emptying in patients with non-ulcer dyspepsia. Ann Nucl Med 1999; 13:231-4.Jackson J.L., O’Malley P.G., Tomkins G. et al. Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis. Am J Med 2000; 108:65-72.Jackson J.L., O’Malley P.G., Tomkins G. et al. Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis. Am J Med 2000; 108:65-72.Talley N.J., Locke G.R., Saito Y.A. et al. Effect of amitriptyline and escitalopram on functional dyspepsia: a multicenter, randomized controlled study. Gastroenterology 2015; 149:340-9.Talley N.J., Locke G.R., Saito Y.A. et al. Effect of amitriptyline and escitalopram on functional dyspepsia: a multicenter, randomized controlled study. Gastroenterology 2015; 149:340-9.Soo Sh., Forman D., Delaney C., Moayyedi P. A systemic review of psychological therapies for nonulcer duspepsia. Am J Gastroenterol 2004; 99:1817-22.Soo Sh., Forman D., Delaney C., Moayyedi P. A systemic review of psychological therapies for nonulcer duspepsia. Am J Gastroenterol 2004; 99:1817-22.Lapidus L., Andersson S., Bengtsson G., Kilander A. Prognosis of dyspepsia in women - a 24-year follow-up of a population sample. Gut 2002; 34 (Suppl. II):A106.Lapidus L., Andersson S., Bengtsson G., Kilander A. Prognosis of dyspepsia in women - a 24-year follow-up of a population sample. Gut 2002; 34 (Suppl. II):A106.

The authors declare that there are no conflicts of interest present.