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위축성 위염 혹은 위암에 미치는 프로톤펌프억제제의 영향: Safe 측면

Effects of Proton Pump Inhibitors on Atrophic Gastritis and Gastric Cancer: Safe Perspective

박홍준|김현수
대한내과학회 (The Korean Association Of Internal Medicine)|2011.07|대한내과학회지 (The Korean Journal of Medicine)|제81권 제1호|pp. 1-5

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참고문헌

키워드

프로톤펌프억제제; 고가스트린혈증; 위저선 폴립; 유암종; 위축성위염; 위암Long-term PPI; Hypergastrinemia; Fundic gland polyp; Carcinoid tumor; Atrophic gastritis
주제분류내과학

초록

PPIs 약물은 지난 20년간 위산 관련 질환에서 위장관 점막 치유와 증상 완화를 통하여 삶의 질까지 향상시키는 매우 효과적이고 안전한 약물로 입증되어 왔다. 하지만 최근 PPIs의 복용 환자가 증가하면서 PPIs의 장기복용에 따른 고가스트린혈증과 관련된 위 종양의 가능성이 이슈화되고 있다. 하지만 이러한 PPIs 연관 고가스트린혈증과 연관된 위암은 인체에서 보고된 바 없으며 직접적인 인과관계가 증명되지 않았다. 따라서 향후 전향적 무작위비교 연구를 통한 근거가 제시되기까지는 위산 관련 질환에서 산분비 억제의 이점이 뚜렷한 만큼 안전하게 처방될 수 있는 약제라 판단된다. 단, PPIs 약물을 처방하는 의사는 장기복용에 따른 다양한 위 종양의 가능성을 고려하여 고위험의 장기 복용 환자에서 주기적인 내시경 검사와 더불어 최소한의 유효 용량 처방과 적절한 시기에 적절한 용법으로 tapering하려는 노력이 필요하다.

Abstract

Proton pump inhibitors (PPIs) are widely used over 20 years for management of symptoms due to acid related diseases such as peptic ulcer and reflux esophagitis. Serious adverse events are extremely rare for short-term PPIs use. Recently, as long-term PPIs use increase, diverse reports have been reported on adverse event related with long-term PPIs use. Long-term PPIs use is generally referred as use of PPIs more than 1 year. Secondary hypergastrinemia after long-term PPIs use is associated with development of fundic gland polyps (FGP) and hyperplasia of enterochromaffin-like cell (ECL) that might be concerned with gastric carcinoid tumor. Furthermore, several studies have posed the relationship between the risk of gastric cancer and long-term PPIs use with co-existing H. pylori infection. The present review summarize the recent accumulated evidence on neoplasm associated with secondary hypergastrinemia after long-term PPIs use. (Korean J Med 2011;81:1-5)

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