胃轻瘫是一种在没有任何机械阻塞的情况下表现为上腹部症状和胃排空(GE)速率延迟的疾病。由于缺乏有关胃轻瘫的诊断和管理的指导,这种情况在临床实践中具有挑战性。
来自19个欧洲国家的40名专家达成了德尔菲共识,他们对89份声明进行了文献总结和投票。使用建议评估的分级来评估证据质量,发展,和评价标准。25份声明达成共识(定义为≥80%协议)。
欧洲共识将胃轻瘫定义为在没有机械性梗阻的情况下出现与GE延迟相关的症状。恶心和呕吐被确定为主要症状,常伴有餐后窘迫综合征的消化不良症状。胃轻瘫的真正流行病学尚不清楚,但是糖尿病,胃手术,某些神经和结缔组织疾病,以及使用某些被认为是危险因素的药物。虽然小组同意这些患者存在严重的胃运动功能受损,在潜在的病理生理学方面没有达成共识.专家组一致认为,诊断需要进行上内窥镜检查和GE检查。只有饮食疗法,多巴胺-2拮抗剂和5-HT4受体激动剂被认为是合适的治疗方法,除了在严重体重减轻的情况下提供营养支持。对质子泵抑制剂的使用没有达成共识,其他类的止吐药或促动力学,神经调质,免费的,心理,或者更具侵入性的疗法。最后,大家一致认为,胃轻瘫会对生活质量和医疗费用产生不利影响,胃轻瘫的长期预后取决于病因.
一个由欧洲专家组成的跨国小组总结了关于定义的共识的现状,症状特征,病理生理学,诊断,和胃轻瘫的管理。
Gastroparesis is a condition characterized by epigastric symptoms and delayed gastric emptying (GE) rate in the absence of any mechanical obstruction. The condition is challenging in clinical practice by the lack of guidance concerning diagnosis and management of gastroparesis.
A Delphi
consensus was undertaken by 40 experts from 19 European countries who conducted a literature summary and voting process on 89 statements. Quality of evidence was evaluated using grading of recommendations assessment, development, and evaluation criteria.
Consensus (defined as ≥80% agreement) was reached for 25 statements.
The European
consensus defined gastroparesis as the presence of symptoms associated with delayed GE in the absence of mechanical obstruction. Nausea and vomiting were identified as cardinal symptoms, with often coexisting postprandial distress syndrome symptoms of dyspepsia. The true epidemiology of gastroparesis is not known in detail, but diabetes, gastric surgery, certain neurological and connective tissue diseases, and the use of certain drugs recognized as risk factors. While the panel agreed that severely impaired gastric motor function is present in these patients, there was no consensus on underlying pathophysiology. The panel agreed that an upper endoscopy and a GE test are required for diagnosis. Only dietary therapy, dopamine-2 antagonists and 5-HT4 receptor agonists were considered appropriate therapies, in addition to nutritional support in case of severe weight loss. No consensus was reached on the use of proton pump inhibitors, other classes of antiemetics or prokinetics, neuromodulators, complimentary, psychological, or more invasive therapies. Finally, there was
consensus that gastroparesis adversely impacts on quality of life and healthcare costs and that the long-term prognosis of gastroparesis depends on the cause.
A multinational group of European experts summarized the current state of
consensus on definition, symptom characteristics, pathophysiology, diagnosis, and management of gastroparesis.