难治性功能性胃肠病中枢神经药物的治疗

尝试应用神经递质药物（主要是抗抑郁药物）是取得难治性功能性胃肠病（refractory functional gastrointestinal disease，rFGIDs）疗效提升的理论和实践突破口之一。FGIDs治疗实践中应用神经递质药物针对的靶标包括：（1）作 为病因的精神心理因素；（2）FGIDs合并的精神心理问题临床表现；（3）中枢和外周神经对胃肠道功能（运动、分泌和 感觉等）的调控紊乱机制的靶点。文章主要是以“肠脑互动”思维，从神经胃肠病学基础机制，探讨应用神经递质类药 物（主要是抗抑郁药）处置精神心理因素相关难治性FGIDs时，选择种类、剂量、疗程、依从性、疗效，以及安全性等诸 多方面具有消化专科特点的实用策略。

Central nervous medication for refractory functional gastrointestinal disorders

Trying to use the neurotransmitter drugs(mainly antidepressants)is breakthrough of theory and practice to obtain a better curative effect in the management of refractory functional gastrointestinal disease(rFGIDs)medications.Targets for neurotransmitter drug management include:(1)the psychosocial factors serving as pathogenic factors of rFGIDs,(2)clinical psychosocial complications associated with FGIDs,and,especially,(3)the mechanisms of central and peripheral nerve regulation on gastrointestinal function(movement,secretion,sensation,etc.).The comments in this article are based on up to the date of theoretical progress of"gut-brain interaction"and neuro-gastroenterology.Our comments are gastroenterol specialized,which mainly discusses the application of neurotransmitter drugs(mostly antidepressants)related refractory FGIDs therapy.The items include selecting drug varieties,dose,course of treatment,compliance,efficacy,and safety.