헬리코박터 제균 요법이 기능성 소화불량증 환자와 소화성 궤양 환자의 증상 호전에 미치는 효과
The effect of Helicobacter pylori eradication on the improvement of the symptoms in patients with functional dyspepsia and peptic ulcer disease
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목적 : 헬리코박터 제균 요법은 소화성 궤양 환자의 치료에서 필수적인 부분이나, 기능성 소화불량증 환자의 치료에 있어서는 아직 그 유용성에 대하여 논란이 많은 상태이다. 본 연구에서는 기능성 소화불량증 환자와 소화성 궤양 환자에 있어서 제균 요법 이후의 증상 호전 상태를 추적, 비교함으로써 기능성 소화불량증 환자에서의 제균 요법의 유용성을 평가하고자 하였다.방법 : 2003년 3월부터 2004년 2월에 걸쳐 헬리코박터 감염이 증명된 기능성 소화불량증 환자 123명과 소화성 궤양 환자 80명을 대상으로 하여 1주 또는 2주 간의 rabeprazole을 포함한 3제 제균 요법을 시행하였으며, 치료 종결로부터 최소 4주가 경과한 후 제균 상태를 확인하였다. 증상척도 변화에 대한 추적 조사는 치료 전 및 치료 후 최장 18개월까지 3개월 간격으로 시행하였으며, 평균 추적기간은 12개월이었다.결과 : 평균 제균율은 82.8%로 소화성 궤양군과 기능성 소화불량증군 간에 의미 있는 차이는 없었으며, 1주 또는 2주의 제균 기간에 따른 유의한 차이도 없었다. 치료 후 3개월째 양 군 모두에서 치료 전(소화성 궤양군; 3.5±1.1 vs. 기능성 소화불량증군; 3.4±0.1)에 비하여 유의한 증상의 호전을 보였으며(1.4±0.4 vs. 1.6±0.5), 이러한 증상의 호전은 상당수의 환자에서(72.5% vs. 67.4%) 12개월 이상의 추적기간동안 유지되었다. 양 군에서 모두 제균에 실패한 경우 유의한 증상의 악화를 보였으며, 제균에 성공한 경우에 비해 유의하게 높은 누적 재발률(66.7% vs. 25.5% ; 57.1% vs. 21.2%)을 보였다.
Abstract
Background : In the functional dyspepsia, Helicobacter pylori has been suggested as a causative agent. But, the effect of H. pylori eradication is still debated on functional dyspesia. The purpose of this study was to evaluate the effectiveness of the H. pylori eradication therapy in the improvement of the symptoms in patients with functional dyspepsia. Methods : The convenience sample consisted of 123 patients with functional dyspepsia and 80 patients with peptic ulcer diseases who were infected with H. pylori. All patients had received eradication therapy of H. pylori for one or two weeks and additional therapy with H2RA or PPI for one to five weeks. After the treatment was completed, the patients were asked about their symptomatic improvement every three months. The degree of symptom was rated on a five-point Likert scale. Results : Overall eradication rate of H. pylori was 82.8% (168/203), and there were no significant differences in the eradication rate between the two groups and between one-week and two-week eradication therapies. The mean follow-up period was 12 months. The symptomatic improvement in both group was maintained over 12 months in most patients (PUD 72.5% vs. FD 67.4%). In addition, the symptomatic improvement in the patients with eradication success was maintained significantly longer than those with eradication failure in both group (FD p=0.007 vs. PUD p=0.014). Conclusions : The eradication therapy of H. pylori can be one of the therapeutic options for patients with functional dyspepsia and that eradication failure may cause the recurrence of the symptom. (Korean J Med 71:141-148, 2006)
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