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Funkcionalna dispepsija (FD) je pogosta bolezen prebavil z omejenimi možnostmi zdravljenja. FD pacienti bolehajo za mnogimi gastrointestinalnimi simptomi (GI), vključno s postprandialnim disstresnim sindromom, zgodnjo sitostjo in bolečinami v epigastru ali nelagodje, vendar brez naravnih vzrokov.
V obsežni raziskavi je bilo ugotovljeno, da je bila skupna razširjenost neraziskane dispepsije 20,8%. Na žalost je zapletenost patofizioloških mehanizmov FD povzročila nezadostno učinkovitost pri že tako omejenih razpoložljivih možnostih zdravljenja. Čeprav FD pacientom ne predstavlja resnih ali usodnih groženj, močno zmanjša kakovost življenja bolnika. Poleg tega FD doprinaša velika gospodarska bremena, ki jih je mogoče pripisati stroškom zdravstvene oskrbe in diagnostičnih postopkov. Statistični podatki iz leta 2009 so pokazali, da je FD ob ameriških bolnikih ustvarila za 18,4 milijarde ameriških dolarjev stroškov. Preberite si, kako akupunktura lahko zmanjša stroške zdravstvenega sistema. Kljub vse večjemu povpraševanju po učinkovitem zdravljenju v zahodnih družbah ni uveljavljenih načinov zdravljenja FD. Številni sedanji pristopi lahko do neke mere zmanjšajo nelagodje, vendar tudi z določenimi skrbmi. Na primer, izkoreninjenje Helicobacter pylori trenutno velja za prvo vrsto zdravljenja bolnikov s FD z okužbo s H. pylori. Vendar so povečana odpornost na antibiotike in z zdravljenjem povezani neželeni učinki glavne pomanjkljivosti tega zdravljenja. Poleg tega se v klinični praksi za zdravljenje bolnikov s FD priporočajo zdravila za zaviranje kisline, vključno z zaviralci protonske črpalke, prokinetičnimi zdravili in tricikličnimi antidepresivi. Preberite si, kako lahko TKM pomaga pri kislinskem refluksu.
Vendar je zaradi njihove omejene učinkovitosti in neželenih učinkov potreba po zdravljenju še vedno neizpolnjena. Kitajska zeliščna medicina (KZM) je del rutine pri zdravljenju FD na Kitajskem in postaja priljubljena v drugih državah. V tradicionalni kitajski medicini (TKM) se FD enakovredno imenuje "napihnjenost in polnost" (Pi Man), "bolečina v želodcu" (Wei Wan Tong) in "zadrževanje" (Ji Zhi). FD lahko razdelimo tudi na različne sindrome TKM, ki lahko vključujejo, vendar niso omejeni na:
(a) sindrom jetrno-želodčne disharmonije;
(b) vlaga - vročina vranice in sindrom želodca;
(c) mraz in vročina pri sindromu zapletenosti in
(d) sindrom šibkosti vranice in želodca.
Z namenom lajšanja simptomov FD je cilj TKM uskladiti ali izboljšati povezave med različnimi organi in sistemi v človeškem telesu. Natančna diagnoza tipa sindroma TKM je ključna smernica za ustrezno izbiro posamezne formule KZM.
Kitajska zeliščna medicina za funkcionalno dispepsijo: sistematični pregled [1] Skupina raziskovalcev Kitajske Univerze v Hongkongu in Hongkongškega inštituta za integrativno medicino je izvedla celovito iskanje literature z namenom sistematičnega pregleda (SP) z metaanalizami v osmih mednarodnih in kitajskih bazah podatkov. Po dostopu z merili za nadzor kakovosti je bilo vključenih 14 SP-ov, ki preučujejo kitajsko zeliščno medicino (KZM), samostojno ali v kombinaciji s konvencionalno farmakoterapijo za FD. Metaanalize so pokazale, da je bila KZM učinkovitejša od prokinetičnih učinkovin za lajšanje svetovnih dispeptičnih simptomov (epigastrična bolečina ali nelagodje). Zdi se, da tri specifične formule KZM kažejo vrhunske rezultate pri lajšanju svetovnih dispeptičnih simptomov, vključno s Si Ni San, spremenjeno Xiao Yao San in Xiang Sha Liu Jun Zi dekokcij. O pojavu neželenih učinkov pri uporabi KZM ali farmakoterapije niso poročali o opaznejših spremembah.
Učinki in mehanizmi akupunkture in elektroakupunkture za funkcionalno dispepsijo: sistematični pregled [2] Univerzitetna medicinska šola Johns Hopkins in Kitajske akademije medicinske znanosti sta najmočnejši instituciji Združenih državah Amerike in na Kitajskem. Raziskovalci so izvedli sistematični pregled, da bi ocenili rezultate in lastnosti obstoječih kliničnih dokazov za raziskovanje obstoječih mehanizmov akupunkture pri zdravljenju FD. V ta pregled je bilo vključenih osem študij s skupno 17 postavkami za odkrivanje tehnik za mehanistične raziskave. Pozitivni učinki akupunkture in EA so bili opaženi pri uravnavanju želodčne gibljivosti, želodčne akomodacije, duševnega stanja, prebavnih hormonov ter centralnih in avtonomnih funkcij, hkrati pa so izboljšali dispeptične simptome in kakovost življenja. Tu si lahko preberete še več o tem, kako lahko zeliščna medicina pomaga pri uravnavanju hormonov.
[1] Chu MHK, Wu IXY, Ho RST, et al. Chinese herbal medicine for functional dyspepsia: systematic review of systematic reviews. Therap Adv Gastroenterol. 2018;11:1756284818785573. Published 2018 Jul 16. doi:10.1177/1756284818785573
[2] Guo Y, Wei W, Chen JD. Effects and mechanisms of acupuncture and electroacupuncture for functional dyspepsia: A systematic review. World J Gastroenterol. 2020;26(19):2440-2457. doi:10.3748/wjg.v26.i19.2440
prevod: Tajda Kolenc
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Chinese herbal medicine and acupuncture is effective for functional dyspepsia
Functional dyspepsia (FD) is a common digestive disease with limited therapeutic options. FD patients suffer from several upper gastrointestinal (GI) symptoms including postprandial fullness, early satiety and epigastric pain or discomfort but without organic causes.
A large-scale survey found that the overall pooled prevalence of uninvestigated dyspepsia was 20.8%. Unfortunately, the complexity of pathophysiological mechanisms of FD has led to insufficient efficacy of the limited available treatment options. Even though FD does not pose severe or fatal threats to patients, it greatly reduces patient quality of life. Moreover, FD incurs heavy economic burdens, attributable to medical care and diagnostic procedure costs. Statistics show that FD created an $18.4 billion medical cost on US patients in 2009. Read how can acupuncture lower the health care costs.
Despite the increasing demand for effective treatment, there are no approved treatments for FD in Western societies. Several current approaches are able to reduce discomfort to some extent but also with certain concerns. For example, Helicobacter pylori eradication is currently considered first-line therapy for FD patients with H. pylori infection. However, increased antibiotic resistance and treatment-related side effects are the main drawbacks of this treatment. Moreover, acid-suppressing drugs including proton pump inhibitors, prokinetic medications and tricyclic antidepressants are suggested in clinical practice to treat FD patients, but there is still an unmet need for treatment because of their limited efficacies and side effects. Read how can TCM help to manage acid reflux.
Chinese herbal medicine (CHM) is part of the routine in the treatment of FD in China and is gaining popularity in other countries. In traditional Chinese medicine (TCM), FD is equivalently termed as ‘distension and fullness’ (Pi Man), ‘stomach pain’ (Wei Wan Tong) and ‘retention’ (Ji Zhi). FD can also be divided into various TCM syndromes, which may include, but not limited to:
(a) liver–stomach disharmony syndrome;
(b) dampness–heat of spleen and stomach syndrome;
(c) cold and heat in complexity syndrome and
(d) spleen–stomach weakness syndrome.
TCM aims at harmonizing or improving the relationship between different organs and systems in the human body in order to relieve the symptoms of FD. Accurate diagnosis of TCM syndrome type is considered a key for guiding the appropriate choice of individualized CHM formula.
Chinese herbal medicine for functional dyspepsia: a systematic review [1]
A group of researchers from The Chinese University of Hong Kong and Hong Kong Institute of Integrative Medicine conducted a comprehensive literature search for systematic review (SR) with meta-analyses in eight international and Chinese databases. After accessing with quality control criteria, 14 SRs studying the Chinese herbal medicine (CHM), alone or in combination with conventional pharmacotherapy for FD were included.
Meta-analyses showed that CHM was more effective than prokinetic agents for the alleviation of global dyspeptic symptoms (epigastric pain or discomfort). Three specific CHM formulae appeared to show superior results in the alleviation of global dyspeptic symptoms, including Si Ni San, modified Xiao Yao San and Xiang Sha Liu Jun Zi decoction. No significant difference in the occurrence of adverse events in using CHM or pharmacotherapy was reported.
Effects and mechanisms of acupuncture and electroacupuncture for functional dyspepsia: A systematic review [2]
Johns Hopkins University School of Medicine and China Academy of Chinese Medical Sciences are the top institutions in the United States and China respectively. The researchers conducted a systematic review to evaluate the results and qualities of existing clinical evidence for researching the underlying mechanisms of acupuncture in treating FD.
Eight studies were included in this review with a total of 17 items for detecting techniques for mechanistic research. Positive effects of acupuncture and EA were observed in regulating gastric motility, gastric accommodation, mental status, gastrointestinal hormones, and central and autonomic functions while improving dyspeptic symptoms and quality of life.
Here you can read more about how can TCM help to balance hormone levels.
[1] Chu MHK, Wu IXY, Ho RST, et al. Chinese herbal medicine for functional dyspepsia: systematic review of systematic reviews. Therap Adv Gastroenterol. 2018;11:1756284818785573. Published 2018 Jul 16. doi:10.1177/1756284818785573
[2] Guo Y, Wei W, Chen JD. Effects and mechanisms of acupuncture and electroacupuncture for functional dyspepsia: A systematic review. World J Gastroenterol. 2020;26(19):2440-2457. doi:10.3748/wjg.v26.i19.2440