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논문KCI 등재

위식도역류 질환에서 양성자 펌프 억제제의 장기처방

Proton Pump Inhibitor for Gastroesophageal Reflux Disease: Intelligent Prescription

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참고문헌

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초록

위식도역류 질환의 빈도가 점점 증가함에 따라 불응성 역류도 흔히 접할 수 있다. 장기간 PPI를 사용하다가 증상이 재발하는 경우는 적절한 감별 접근이 필요하다. 불응성 위식도역류 질환은 여러 감별 진단을 요하는데, 초기 진단이 정확했는지 재확인이 필요하다. 특히, 비미란성 역류 질환과 기능성 가슴쓰림의 감별이 중요하며, 임피던스-pH 검사가 역류액의 산도, 성분 혹은 양적 평가가 가능하여 항역류 수술 전 후 평가에 중요한 정보를 준다. 치료적 접근에서는 환자 순응도 평가와 PPI의 약리 작용을 잘 이해하고 사용해야 할 것이다. 장기간 PPI 사용 시, 골절 위험성 증가나, 비타민 미네랄 흡수 감소 등의 영양학적 측면, 세균성 장염 등의 감염성 질환의 증가, 위 증식성병변, 위축성 변화 등의 부작용을 알고 있어하며, 아직 대부분은 임상적 유의성이 낮지만 향후의 추이를 지켜봐야 할 것이다.

Abstract

Gastroesophageal reflux disease (GERD) has a chronicity and its symptoms wax and wane by proton pump inhibitor (PPI) therapy. Chronic consumption of PPI in the patients with GERD is common, and we can cope with a PPI failure or refractory GERD. Therefore, we review various alternative modalities for chronic PPI treatment and an approach for refractory GERD. PPI has a potential for side effects. Many studies have been published the side effects of long-term PPI using. Mostly clinical level of evidence is weak and the absolute risk is low, however we may discuss the patients who need long-term PPI therapy about the controversial side effects, and manage those appropriately.

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