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위축성 위염 혹은 위암에 미치는 프로톤펌프억제제의 영향: Unsafe 측면

Concerns on Atrophic Gastritis and Neoplasia: Unsafe Perspective

박동일|송창석
대한내과학회 (The Korean Association Of Internal Medicine)|2011.07|대한내과학회지 (The Korean Journal of Medicine)|제81권 제1호|pp. 6-10

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키워드

프로톤펌프억제제; 위축성 위염; 위암Proton-pump inhibitor; Atrophic gastritis; Neoplasia
주제분류내과학

초록

H. pylori 감염 환자에서 장기적인 PPI 복용은 여러 부작용을 유발할 수 있다. 그중 위 내의 산도변화와 관련하여 체부 위축성 위염이 발생할 수 있고 그에 따라 위암의 발생률도 증가할 수 있다. 따라서 PPI 사용 시 H. pylori 감염 여부를 먼저 파악하여 감염된 환자에서는 동시에 제균요법을 시행해야 할 것이다. 또한 PPI 장기복용은 ECL 세포 과증식을 유발할 수 있고, 기전과 병인은 밝혀지지 않았지만 위 카르시노이드 종양의 발생률을 증가시킬 수 있다. 따라서 환자의 증상에 맞추어 적정 용량을 정해진 기간 동안 사용하는 것이 이러한 부작용을 최소화 할 수 있는 방법이 될 것이다.

Abstract

Proton-pump inhibitors (PPI) have important roles in the management of acid-related disorders, especially gastro-esophageal reflux disease and peptic ulcer disease. They are considered safe, but some side effects, such as oxyntic cell hyperplasia, glandular cysts, hypergastrinemia and fundic gland polyps, are also reported. Long-term PPI administration in Helicobacter pylori (H. pylori) positive subjects promotes a shift from antral to corpus-predominant gastritis. The shift leads to corpus atrophy eventually that is known predisposing factor of gastric adenocarcinoma. It is recommended that patients being considered for long-term PPI therapy should be tested for H. pylori infection. And if present, H. pylori eradication should be preceded to PPI administration. Also, long-term PPI administration can cause enterochromaffin-like cell hyperplasia. Although the underlying mechanism and pathogenesis are not yet fully understood, it is possible that long-term PPI administration can promote the development of gastric carcinoid tumor. Therefore, to minimize the side effects, it should be used in adequate dose for a precise duration. (Korean J Med 2011;81:6-10)

참고문헌 (40)

  1. Targownik LE, "The relative efficacies of gastroprotective strategies in chronic users of nonsteroidal anti-inflammatory drugs", Gastroenterology, 134, pp.937~944 (2008)
  2. Hawkey CJ, "Omeprazole compared with misoprostol for ulcers associated with nonsteroidal antiinflammatory drugs. Omeprazole versus Misoprostol for NSAID-induced Ulcer Management (OMNIUM) Study Group", N Engl J Med, 338, pp.727~734 (1998)
  3. Jalving M, "Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy", Aliment Pharmacol Ther, 24, pp.1341~1348 (2006)
  4. Raghunath AS, "Review article: the long-term use of proton-pump inhibitors", Aliment Pharmacol Ther, 22(Suppl 1), pp.55~63 (2005)
  5. Stolte M, "Fundic gland polyps: a rare, innocuous, and reversible disturbance", Gastroenterology, 105, pp.1590~1591 (1993)
  6. Kuipers EJ, "Atrophic gastritis and Helicobacter pylori infection in patients with reflux esophagitis treated with omeprazole or fundoplication", N Engl J Med, 334, pp.1018~1022 (1996)
  7. Kuipers EJ, "Increase of Helicobacter pylori-associated corpus gastritis during acid suppressive therapy: implications for long-term safety", Am J Gastroenterol, 90, pp.1401~1406 (1995)
  8. Garcia Rodriguez LA, "Gastric acid suppression and risk of oesophageal and gastric adenocarcinoma: a nested case control study in the UK", Gut, 55, pp.1538~1544 (2006)
  9. Havu N, "Enterochromaffin-like cell carcinoids of gastric mucosa in rats after life-long inhibition of gastric secretion", Digestion, 35(Suppl 1), pp.42~55 (1986)
  10. Dawson R, "Omeprazole in oesophageal reflux disease", Lancet, 356, pp.1770~1771 (2000)
  11. Ekman L, "Toxicological studies on omeprazole", Scand J Gastroenterol Suppl, 108, pp.53~69 (1985)
  12. Vaananen H, "Non-endoscopic diagnosis of atrophic gastritis with a blood test. Correlation between gastric histology and serum levels of gastrin-17 and pepsinogen I: a multicentre study", Eur J Gastroenterol Hepatol, 15, pp.885~891 (2003)
  13. El-Zimaity HMT, "Geographic differences in the distribution of intestinal metaplasia in duodenal ulcer patients", Am J Gastroenterol, 96, pp.666~672 (2001)
  14. Correa P, "Human gastric carcinogenesis: a multistep and multifactorial process-First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention", Cancer Res, 52, pp.6735~6740 (1992)
  15. el-Omar EM, "Helicobacter pylori infection and abnormalities of acid secretion in patients with duodenal ulcer disease", Gastroenterology, 109, pp.681~691 (1995)
  16. Kuipers EJ, "Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial", Gut, 53, pp.12~20 (2004)
  17. Yang HB, "H. pylori eradication prevents the progression of gastric intestinal metaplasia in reflux esophagitis patients using long-term esomeprazole", Am J Gastroenterol, 104, pp.1642~1649 (2009)
  18. Lundell L, "Lack of effect of acid suppression therapy on gastric atrophy. Nordic Gerd Study Group", Gastroenterology, 117, pp.319~326 (1999)
  19. Pounder RE, "Omeprazole and accelerated onset of atrophic gastritis", Gastroenterology, 118, pp.238~239 (2000)
  20. McColl KE, "Omeprazole and accelerated onset of atrophic gastritis", Gastroenterology, 118, pp.239~ (2000)
  21. Chey WD, "American College of Gastroenterology guideline on the management of Helicobacter pylori infection", Am J Gastroenterol, 102, pp.1808~1825 (2007)
  22. Malfertheiner P, "Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report", Gut, 56, pp.772~781 (2007)
  23. Poynter D, "Changes in the gastric mucosa of the mouse associated with long lasting unsurmountable histamine H2 blockade", Gut, 27, pp.1338~1346 (1986)
  24. Safholm C, "Effect of 7 years' daily oral administration of omeprazole to beagle dogs", Digestion, 55, pp.139~147 (1994)
  25. Maton PN, "Omeprazole", N Engl J Med, 324, pp.965~975 (1991)
  26. Bateson MC, "Hypergastrinaemia with long-term omeprazole treatment", Aliment Pharmacol Ther, 13, pp.440~441 (1999)
  27. Orlando LA, "Chronic hypergastrinemia: causes and consequences", Dig Dis Sci, 52, pp.2482~2489 (2007)
  28. Robinson M, "Review article. current perspectives on hypergastrinaemia and enterochromaffin-like-cell hyperplasia", Aliment Pharmacol Ther, 13(Suppl 5), pp.5~10 (1999)
  29. Larsson H, "Time-course of development and reversal of gastric endocrine cell hyperplasia after inhibition of acid secretion. Studies with omeprazole and ranitidine in intact and antrectomized rats", Gastroenterology, 95, pp.1477~1486 (1988)
  30. Klinkenberg-Knol EC, "Long-term omeprazole treatment in resistant gastroesophageal reflux disease: efficacy, safety, and influence on gastric mucosa", Gastroenterology, 118, pp.661~669 (2000)
  31. Waldum HL, "Antiulcer drugs and gastric cancer", Dig Dis Sci, 50(Suppl 1), pp.S39~S44 (2005)
  32. Kuipers EJ, "Proton pump inhibitors and gastric neoplasia", Gut, 55, pp.1217~1221 (2006)
  33. Uemura N, "Helicobacter pylori infection and the development of gastric cancer", N Engl J Med, 345, pp.784~789 (2001)
  34. Wang TC, "Synergistic interaction between hypergastrinemia and Helicobacter infection in a mouse model of gastric cancer", Gastroenterology, 118, pp.36~47 (2000)
  35. Fox JG, "Helicobacter pylori-associated gastric cancer in INS-GAS mice is gender specific", Cancer Res, 63, pp.942~950 (2003)
  36. Hagiwara T, "Long-term proton pump inhibitor administration worsens atrophic corpus gastritis and promotes adenocarcinoma development in Mongolian gerbils infected with Helicobacter pylori", Gut, 60, pp.624~630 (2011)
  37. Peek RM Jr, "Helicobacter pylori and gastrointestinal tract adenocarcinomas", Nat Rev Cancer, 2, pp.28~37 (2002)
  38. Hirai I, "Assessment of East Asian-type cagA-positive Helicobacter pylori using stool specimens from asymptomatic healthy Japanese individuals", J Med Microbiol, 58, pp.1149~1153 (2009)
  39. Weston AP, "Prospective evaluation of the prevalence of gastric Helicobacter pylori infection in patients with GERD, Barrett's esophagus, Barrett's dysplasia, and Barrett's adenocarcinoma", Am J Gastroenterol, 95, pp.387~394 (2000)
  40. Vicari JJ, "The seroprevalence of cagA-positive Helicobacter pylori strains in the spectrum of gastroesophageal reflux disease", Gastroenterology, 115, pp.50~57 (1998)

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