4545

.

Clinical Case in Community Pharmacy:

(dyspepsia,indigestion)

(clinicalguidelines)

1

24

46

?

(dyspepsia,indigestion)

(retrosternalpain)

2

ROMEIII..2006

(gastroduodenum)4

2,3

(epigastricpain)sternum

midclavicularline

(epigastricburning)(burningpain)

(post-prandialfullness)

(earlysatiety)

ROMEIII

?

4

functionaldyspepsia,pepticulcerdisease

(PUD),gastroesophagealrefluxdisease(GERD),gastroparesis5,esophagealcancer,gastriccancer

carbohydratemalabsorption,

biliarytractdisorders,pancreatitis,ischemicboweldisease,intestinalparasitemanifestation

(irritablebowelsyndrome:IBS)

metabolicdisturbance,thyroiddisorders

psychiatricdisorders

alpha-glucosidaseinhibitors,

alcohol,NSAIDs,corticosteroids,erythromycin,bisphosphonates,opioidsmineralsupplements

Clinical Case in Community Pharmacy:

4747

Clinical Case in Community Pharmacy:

uninvestigateddyspepsiameta-analysis

85functionaldyspepsia

(pepticulcerdisease)10

6

?

55

functionaldyspepsia55

alarmfeature1 1.

2.

(melena)

3.

55

4.

5.

alarm features 1

H.pylori

(GERD)

7,8

GERDIBS

(heartburn)

/(acidregurgitation)

(sharp/stabbing

substernalpain)

48

Clinical Case in Community Pharmacy:

biliarycolic

biliarycolic

/

(stabbingpain)

Tylenol8-hours

Ponstan

?

functional

dyspepsia

?

..2553

alarmfeatures

55

1 ( .. 2553)

4949

Clinical Case in Community Pharmacy:

alarmfeatures

H.pyloriH.pylori

antrumgastricemptyingtime

H.pylori9,10

H.pylori(40)

(4.3100,0002.9

100,000)H.pylori

H.pylori

hemorrhagic/erosivegastritisgastricMALTlymphoma/carcinoma

?

1

3 gastric

emptyingtimegas

1

psychologicalintervention

cognitivebehavioraltherapy(CBT)

CBT

50

Clinical Case in Community Pharmacy:

?

55alarmfeature

3,11

GERD

protonpumpinhibitors(PPIs)histamine-2receptorantagonists

(H2RAs)

gastroparesisprokinetics5,12

2-4

step-up

antacidH2RAsPPIsstep-down

PPIs6

13

?

prokinetics3

step-up

step-down

1

Antacidalummilk,milk

ofmagnesia

Aluminumsalt

Magnesiumsalt

1

5151

Clinical Case in Community Pharmacy:

H2RAscimetidine,

ranitidine

PPIsomeprazole,

lansoprazole,rabeprazole,

pantoprazole,esomeprazole

postprandial

hyperacidity

Cimetidinepotent

CYP450inhibitor

CYP

substrate

gynecomastia

(omeprazole

)

enteric-coated

preparation

moderateCYP450

inhibitor

CYPsubstrate

Metoclopramide Domperidone

prolactin

blood-brainbarrier

14

prolactin

prokineticsdomperi-

donemetoclopramide2

52

Clinical Case in Community Pharmacy:

Metroclopramide Domperidone

Extrapyramidalsymp-

toms

Ventriculararrhythmia

potassiumchannel

4015

Step-downomeprazole

domperidone2011

omeprazole10315domperidone

domperidoneomeprazole

(prokinetics)

/prokinetics

5353

Clinical Case in Community Pharmacy:

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2.ParkJK,HuhKC,ShinCM,etal.[Currentissuesinfunctionaldyspepsia].TheKoreanjournal

ofgastroenterology=TaehanSohwagiHakhoechi2014;64:133-41.

3.AnsariS,FordAC.Initialmanagementofdyspepsiainprimarycare:anevidence-based

approach2013.

4.FujiwaraY,ArakawaT.OverlapinPatientsWithDyspepsia/FunctionalDyspepsia.Journal

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endoscopicfindingsinsubjectswithdyspepsia?Systematicreviewandmeta-analysis.Clinical

gastroenterologyandhepatology:theofficialclinicalpracticejournaloftheAmerican

GastroenterologicalAssociation2010;8:830-7,7.e1-2.

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syndrome-arebothdiseasesmutuallyexclusive?Journalofneurogastroenterologyand

motility2011;17:360-5.

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irritablebowelsyndromebasedonRomeIIIcriteria.BMCgastroenterology2008;8:43.

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10.ZulloA,HassanC,DeFrancescoV,etal.Helicobacterpyloriandfunctionaldyspepsia:

anunsolvedissue?Worldjournalofgastroenterology:WJG2014;20:8957-63.

11.SteinB,EverhartKK,LacyBE.TreatmentofFunctionalDyspepsiaandGastroparesis.

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12.HiyamaT,YoshiharaM,MatsuoK,etal.Meta-analysisoftheeffectsofprokineticagents

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2007;22:304-10.

13.vanMarrewijkCJ,MujakovicS,FransenGA,etal.Effectandcost-effectivenessofstep-up

versusstep-downtreatmentwithantacids,H2-receptorantagonists,andprotonpump

inhibitorsinpatientswithnewonsetdyspepsia(DIAMONDstudy):aprimary-care-based

randomisedcontrolledtrial.Lancet2009;373:215-25.

14.PattersonD,AbellT,RothsteinR,KochK,BarnettJ.Adouble-blindmulticentercomparison

ofdomperidoneandmetoclopramideinthetreatmentofdiabeticpatientswithsymptoms

ofgastroparesisFig.1.TheAmericanjournalofgastroenterology1999;94:1230-4.

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onHERGChannels.Pharmacology2005;74:31-6.