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영양, 대사 및 감염에 미치는 프로톤펌프억제제의 영향: Unsafe 측면

The Effects on Nutrition, Metabolism and Infection by Proton Pump Inhibitors: Unsafe Perspective

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대한내과학회 (The Korean Association Of Internal Medicine)|2011.07|대한내과학회지 (The Korean Journal of Medicine)|제81권 제1호|pp. 17-25

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프로톤펌프억제제; 부작용Proton pump inhibitors; Adverse effects
주제분류내과학

초록

장기적인 프로톤펌프억제제의 사용이 증가하면서 최근 부작용에 대한 보고가 빈번해지고 있다. 장기적인 프로톤펌프억제제 사용으로 인해 지속적으로 위산분비가 억제되어 비타민 B12, 철분, 마그네슘, 칼슘 등의 흡수장애가 발생할 수 있으며, 비타민 B12와 칼슘 대사이상으로 인해 골절의 위험도가 커지고, 호흡기 감염과 장내 감염에 대한 감수성이 증가할 수 있다. 이에 모든 위산분비억제제의 사용에 적용되겠지만, 프로톤펌프억제제는 정확한 적응증(소화성 궤양, 출혈성 궤양, 위식도역류질환, Helicobacter pylori 제균 치료 등)에서만 사용하고, 적절한 증상완화 수준을 미리 결정하여 장기적인 혹은 고용량 사용에 따른 부작용 발생을 최소화하려는 노력이 필요하다. 또한, 현재까지 프로톤펌프억제제의 부작용에 대한 연구는 대부분 교란변수 등에 취약한 관찰 연구이거나 소규모의 연구이므로 향후 그 신뢰도를 높일 수 있는 많은 연구들이 필요하다.

Abstract

Proton pump inhibitors (PPI) are very effective drug used frequently in acid-related disorders. Long-term use of PPI is becoming increasingly common, often without appropriate indications. The debate had focused on the adverse effects related to long-term use of PPI during the last years. This article is a detailed review of the evidence on this topic, focusing on the adverse effects of long-term PPI use that have developed the greatest concern; vitamin B12 deficiency, iron deficiency, impaired calcium absorption, bony fracture, hypomagnesemia, increased susceptibility to pneumonia and enteric infections. Although PPIs have been used with a high margin of safety, the clinicians should consider reducing the dose of PPIs and reassessing the treatment duration to prevent adverse effects of PPIs. (Korean J Med 2011;81:17-25)

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