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[PPI ºÎÀÛ¿ë] - ðû

1. ºÎÀÛ¿ë ¿¬±¸ÀÇ ¾î·Á¿ò

2. PPI Àå±â ºÎÀÛ¿ë

3. PPI »ç¿ë°ú ¿¬°üµÈ À§Á¡¸·º´º¯

4. FAQs

±×°ÍÀÌ ¾Ë°í½Í´Ù, ¼ÒÈ­±â ³»°ú Áø·áÇöÀå¿¡¼­ ³ª¿Â ¾à¸®Çп¡ °üÇÑ Áú¹®µé (°¡Å縯´ëÇб³ ¾à¸®Çб³½Ç ÀÓµ¿¼®)


1. ºÎÀÛ¿ë ¿¬±¸ÀÇ ¾î·Á¿ò - 2017³â Gastroenterology review (Vaezi MF. Gastroenterology 2017 - PDF)

PPI ºÎÀÛ¿ë¿¡ ´ëÇÏ¿© ÀÇ·á°è¿Í ȯÀÚ »çȸ¿¡¼­ ¿ì·ÁÀÇ ¸ñ¼Ò¸®°¡ ³ô½À´Ï´Ù. ¾Æ·¡¿Í °°Àº ¿Â°® Àå±âÀÇ ¿Â°® ºÎÀÛ¿ëÀÌ ÀÇÇÐ ¹®Çå¿¡ ȤÀº ¾ð·Ð¿¡¼­ °Å·ÐµÇ°í ÀÖ½À´Ï´Ù.

±×·¯³ª Àΰú°ü°è¸¦ ÀÔÁõÇϱâ¶õ ½¬¿î ÀÏÀÌ ¾Æ´Õ´Ï´Ù. Hill criteria¸¦ ¸¸Á·ÇÏÁö °ËÅäÇØ¾ß ÇÕ´Ï´Ù.

Áö±Ý±îÁöÀÇ ÀÚ·á¿¡ ÀÇÇÏ¸é °Å·ÐµÇ´Â ºÎÀÛ¿ëÀÇ relative risk´Â ±×¸® ³ôÁö ¾Ê½À´Ï´Ù. °üÂû¿¬±¸ÀÇ bias¸¦ °í·ÁÇÒ ¶§ º¸Åë 3 ÀÌ»óÀº µÇ¾î¾ß Àǹ̰¡ ÀÖ½À´Ï´Ù. ÀÌ´Â Á¤È®È÷ ÃøÁ¤Çϱ⠾î·Á¿î confounding factor°¡ ¸¹±â ¶§¹®ÀÔ´Ï´Ù.

¾Æ·¡¿Í °°Àº ÁöÀûÀº ¸Å¿ì ÀûÀýÇÕ´Ï´Ù.

"Many recent publications have, however, pointed out that a great number of patients are receiving PPIs unnecessarily for conditions or symptoms for which they would not have been expected to provide benefit. Furthermore, many patients who are on PPI treatment for appropriate indications are receiving excessively high daily doses. It is a sound adage of medical practice that all drugs should be given in the lowest effective dose and for the shortest possible time. This is as true for PPIs as it is for any other drug class."

À̹ø ¸®ºä´Â ³Ê¹«³ª Ÿ´çÇÏ°Ôµµ ¾Æ·¡¿Í °°Àº °á·ÐÀ» ³»°í ÀÖ½À´Ï´Ù.

"Much of the current evidence linking PPI use to serious long-term adverse consequences is weak and insubstantial. It should not deter prescribers from using appropriate doses of PPIs for appropriate indications."

ÀÌ Á¾¼³À» 2017³â 8¿ù 8¿ù È­¿äÀú³ÎŬ·´¿¡¼­ ±è¼±È­ ¼±»ý´Ô²²¼­ ¹ßÇ¥Çϼ̽À´Ï´Ù. ¿©±â¸¦ Âü°íÇØ Áֽñ⠹ٶø´Ï´Ù.


2. PPI Àå±â ºÎÀÛ¿ë

1) Safety of Proton Pump Inhibitors Based on a Large, Multi-Year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin (Gastroenterology 2019)

¹è°æ: PPI´Â °¡Àå ¸¹ÀÌ ¼ÒºñµÇ´Â ¾à ÁßÀÇ ÇϳªÀ̸ç Àå±â°£ º¹¿ëÇÏ´Â °æ¿ì°¡ ÈçÇÏ´Ù. PPI Àå±â »ç¿ë ºÎÀÛ¿ë¿¡ ´ëÇÑ °üÂû ¿¬±¸¿¡ µû¸£¸é PPI »ç¿ëÀº Æó·Å, °ñÀý, C. difficile °ü·Ã ¼³»ç, Àå¿°, ½ÉÇ÷°ü Áúȯ, ¸¸¼º ½ÅºÎÀü, Ä¡¸Å ±×¸®°í Àüü »ç¸Á·ü°ú ¿¬°üÀÌ ÀÖ´Ù°í ¾Ë·ÁÁ® ÀÖ´Ù.

¸ñÀû: ÀÌ ¿¬±¸´Â ¹«ÀÛÀ§ ´ëÁ¶±º ¿¬±¸·Î¼­ ºñ±³Àû ¸¹Àº ȯÀÚµéÀ» ´ë»óÀ¸·Î °üÂû¿¬±¸¿¡¼­ º¸ÀÎ PPI Àå±â»ç¿ë ¾ÈÀü¼º¿¡ ´ëÇÑ °á°úµéÀ» È®ÀÎÇÏ°íÀÚ ÇÏ¿´´Ù.

¹æ¹ý: 33°³±¹¿¡¼­ ¼öÇàµÈ ¹«ÀÛÀ§ ´ëÁ¶±º ¿¬±¸·Î ÃÖÁ¾ÀûÀ¸·Î PPI Ä¡·á±º¿¡ 8791¸í, ´ëÁ¶±º¿¡ 8807¸íÀÌ ¹èÁ¤µÇ¾ú´Ù. pantoprazole 40mg ¶Ç´Â À§¾àÀ» ÇÏ·ç Çѹø º¹¿ëÇÏ¿´´Ù. ¿¬±¸´Â 3³â°£ ¼öÇàµÇ¾úÀ¸¸ç ¿¬±¸ ½ÃÀÛ ÈÄ 1°³¿ù, 6°³¿ù¿¡ ¹æ¹®À» °èȹÇÏ¿´°í ÀÌÈķδ 6°³¿ù¸¶´Ù Á¶»ç¸¦ ½ÃÇàÇÏ¿´´Ù. ÃßÀû °üÂûÀÇ Áß¾Ó°ªÀº 3.01³â À̾úÀ¸¸ç ÃÑ 53,152 Àγ⠰üÂûÇÏ¿´´Ù.

°á°ú:

  1. PPI º¹¿ë±º°ú ´ëÁ¶±º °£ ½É±Ù°æ»ö, ³ú°æ»ö, ¶Ç´Â ½ÉÇ÷°üÁúȯ¿¡ ÀÇÇÑ »ç¸Á À§ÇèµµÀÇ Â÷ÀÌ°¡ ¾ø¾ú´Ù. (HR 1.04, 95% CI 0.93-1.15)
  2. ´ëÁ¶±º¿¡ ºñÇØ PPI º¹¿ë±º¿¡¼­ °¨¿°¼º Àå¿° ¹ß»ý À§Çèµµ°¡ Áõ°¡ÇÏ¿´´Ù. (HR 1.33, 95% CI 1.01-1.75, P value = 0.04)
  3. À§Ã༺ À§¿°, Æó·Å, °ñÀý, C. difficile °ü·Ã ¼³»ç, ¸¸¼º Æó¼â¼º ÆóÁúȯ, ´ç´¢, ¸¸¼º ½ÅºÎÀü, Ä¡¸Å ¹ß»ýÀÇ °¢°¢¿¡ ´ëÇÑ À§Çèµµ Â÷ÀÌ´Â ¾ø¾ú´Ù.

Á¦ÇÑÁ¡: ºñ±³Àû ¸¹Àº ȯÀÚµéÀ» ´ë»óÀ¸·Î ¹«ÀÛÀ§ ´ëÁ¶±º ¿¬±¸¸¦ ½ÃÇàÇÏ¿´Áö¸¸ ¹ß»ý °Ç¼ö°¡ Àû´Ù´Â Á¦ÇÑÁ¡ÀÌ ÀÖ´Ù. ƯÈ÷ Àüü C.difficile °¨¿° ¹ß»ý °Ç¼ö°¡ PPI º¹¿ë±º¿¡¼­´Â 9°Ç, ´ëÁ¶±º¿¡¼­´Â 4°ÇÀ¸·Î HR (2.26, 95% CI 0.70-7.34) ´Â Áõ°¡ÇÏ´Â °æÇâÀ» º¸¿´Áö¸¸ Åë°èÀûÀ¸·Î À¯ÀǼºÀ» º¸ÀÌÁø ¸øÇÏ¿´´Ù.

°á·Ð: °¨¿°¼º Àå¿°À» Á¦¿ÜÇÏ°í´Â PPI Àå±â »ç¿ë¿¡ ÀÇÇÑ ºÎÀÛ¿ëÀÌ Áõ°¡ÇÏÁö ¾Ê¾Ò´Ù. ±×·¯¹Ç·Î PPI ÀÇ ÀûÀýÇÑ »ç¿ëÀº Çغ¸´Ù µæÀÌ ¸¹À» °ÍÀ̸ç ÀûÀýÇÑ ÀûÀÀÁõ¿¡ ´ëÇؼ­´Â Å« ¿ì·Á¾øÀÌ »ç¿ëÀÌ °¡´ÉÇÏ°Ú´Ù.

ÀÚ·á Á¦°ø: ±èÅÂÁØ ±³¼ö´Ô

2) PPI Àå±â »ç¿ë°ú À§¾Ï PDF

3) [2022-4-27. ¸Þµð°ÔÀÌÆ®´º½º] ½Äµµ¿° ¾àÀ» ¿À·¡ ¸Ô¾îµµ ±¦ÂúÀ»±î¿ä?

4) À§»ê¾ïÁ¦Á¦°¡ ±ÙÀ§ºÎ º´º¯À» À¯¹ßÇÏ´Â ±âÀü


3. PPI »ç¿ë°ú ¿¬°üµÈ À§Á¡¸·º´º¯ (2020-2-1. ºÎ»êÁöȸ ½ÉÆ÷Áö¾ö°ú Gut and Liver 2021 ºÎ»êÀÇ´ë ±è±¤ÇÏ)

PPI »ç¿ëÀÚÀÇ À§³»½Ã°æ¿¡¼­ ¹ß°ßµÇ´Â ¿©·¯ ¼Ò°ß¿¡ ´ëÇÏ¿© ±è±¤ÇÏ ±³¼ö´Ô²²¼­ ¾Ë±â ½±°Ô ¼³¸íÇϼ̽À´Ï´Ù. µÎ °¡Áö ±âÀüÀÌ Á¦½ÃµÇ¾ú½À´Ï´Ù. (1) Fundic glandÀÇ parietal cellÀÌ lumen ³»·Î buldging µÇ¸é¼­ glandÀÇ ductal dilatationµÇ´Â ±âÀü°ú (2) foveolar epithelial hyperplasiaÀÔ´Ï´Ù. (1)Àº fundic gland polypÀ̳ª cobble stone appearanceÀÇ ¿øÀÎÀÌ°í (2)´Â hyperplastic polypÀ̳ª white flat elevated lesionÀÇ ¿øÀÎÀ¸·Î ¼³¸íµÇ°í ÀÖ½À´Ï´Ù.

Gut and Liver 2021

Histopathological features of proton pump inhibitor-related gastric mucosal changes. (A) Oxyntic mucosa with parietal cell protrusions (H&E, ¡¿200). (B) Cystic changes in fundic glands (H&E, ¡¿200). (C) Foveolar epithelial hyperplasia (H&E, ¡¿40).

Endoscopic features of proton pump inhibitor-related gastric mucosal changes. (A) Fundic gland polyps. (B) Hyperplastic polyp. (C, D) Multiple white and flat elevated lesions. (E) Cobblestone-like mucosa. (F) Black spots.

Suggested mechanisms of proton pump inhibitor (PPI)-related gastric mucosal changes.

[2020-2-1. ±è±¤ÇÏ ±³¼ö´Ô comment]

¾ÆÁ÷ Á¤È®ÇÑ ÀÚ·á´Â ¾øÀ¸³ª FAP¿¡¼­ °üÂûµÇ´Â fundic gland polyposis´Â solid portionÀÌ ¸¹¾Æ¼­ÀÎÁö ³»½Ã°æ ¼Ò°ßÀÌ Ãæ½ÇÇÑ Á¾¾çÀ¸·Î º¸ÀÌ°í, PPI °ü·ÃµÈ fundic gland polyp¿¡¼­´Â fluid°¡ ÅÊÅÊÇÏ°Ô Â÷ ÀÖ´Â °ÍÀ̹ǷΠÁ¶±Ý cysticÇØ º¸ÀÌ´Â °Í °°½À´Ï´Ù.

[2022-4-30. ¼øõ¸¸³»½Ã°æ¼¼¹Ì³ª ±è±¤ÇÏ ±³¼ö´Ô °­ÀÇ]

Cracked mucosa. Cobblestone-like mucosaÀÇ Àü´Ü°è·Î »ý°¢µÇ°í area gastricae°¡ ÇöÀúÇÏ°í È®´ëÇϸé pit°¡ ¶Ñ·ÇÇØ º¸ÀÔ´Ï´Ù.

VonoprazanÀ» ¿À·¡ »ç¿ëÇϸé stardust°¡ º¸ÀÏ ¼ö ÀÖ½À´Ï´Ù.

[2023-5-27. ÇÑ ±³À°ÀÚ·á¿¡¼­]

Multiple white and flat elevated lesions

Cobblestone-like mucosa

[ÀÌÁØÇà Çؼ³] Multiple white and flat elevated lesionsÀº °£È¤ metaplastic gastritis¿Í ±¸ºÐÀÌ ¾î·Á¿îµ¥ À§Ä¡¿Í ¸ð¾çÀÌ ´Ù¸¨´Ï´Ù. Multiple white and flat elevated lesionsÀº gastric fundic glandÀÇ pit »óÇÇ (= foveolar epithelium)ÀÌ °úÁõ½ÄÇÑ °ÍÀÔ´Ï´Ù. PPI¿¡ ÀÇÇÑ oxytic mucosaÀÇ º¯È­´Â foveolar epitheilum¿¡µµ ¹ß»ýÇÒ ¼ö ÀÖ°í oxyntic gland proper¿¡¼­µµ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù. ÀüÀÚÀÇ ´ëÇ¥°¡ multiple white and flat elevated lesionsÀÌ°í ÈÄÀÚÀÇ ´ëÇ¥°¡ fundic gland polypÀÔ´Ï´Ù. ¾Æ·¡ ¸µÅ©¸¦ Âü°íÇϽʽÿÀ.


[More cases]

PPI Àå±â »ç¿ë¿¡ ÀÇÇÑ cracked mucosa


[FAQ]

Q. Ŭ·ÎÇǵµ±×·¤°ú ¾à¹°»óÈ£ÀÛ¿ë¿¡ ´ëÇÏ¿© ¼³¸íÇØ Áֽñ⠹ٶø´Ï´Ù.

A. ClopidogrelÀº ȯÀÚº°·Î ¾àÈ¿Â÷°¡ Å« °ÍÀ¸·Î À¯¸íÇÕ´Ï´Ù.

2006³â Gilard°¡ clopidogrel¸¦ omeprazole°ú ÇÔ²² ¾²¸é antiplatelet È¿°ú°¡ ÁÙ¾îµç´Ù°í º¸°í(J Thromb Haemost 2006)ÇÑ ÈÄ Çѵ¿¾È Å« È¥¶õÀÌ ÀÖ¾ú½À´Ï´Ù. ½ÉÀå³»°ú ¼±»ý´Ôµé²²¼­ ¼ÒÈ­±â³»°ú¿¡ ȯÀÚ¸¦ ÀÇ·ÚÇÒ ¶§ "Àý´ë·Î PPI ¾²Áö ¸¶¼¼¿ä"¶ó°í ºÓÀº ±Û¾¾·Î Ç¥½ÃÇϱ⵵ ÇÏ¿´½À´Ï´Ù. ±× ÀÌÈÄ ¸¹Àº ¿¬±¸°¡ ÀÖ¾ú´Âµ¥ 2015³â ÇöÀç´Â Å« ¹®Á¦°¡ ¾Æ´Ñ ÂÊÀ¸·Î ÀÇ°ßÀÌ ¸ðÀÎ »óÅÂÀÔ´Ï´Ù. Non-randomized trial¿¡¼­´Â PPI¸¦ ¾²¸é À§ÇèÇÑ °ÍÀ¸·Î ÃßÁ¤µÇ¾úÁö¸¸ randomized trial¿¡¼­´Â ¸ðµÎ Â÷ÀÌ°¡ ¾ø´Ù´Â °á·ÐÀ̾ú±â ¶§¹®ÀÔ´Ï´Ù. BhattÀÇ 2010³â New England Journal of Medicine ³í¹®ÀÌ ´ëÇ¥ÀûÀÔ´Ï´Ù. ÀÌÈÄ ¸ÞŸºÐ¼®¿¡¼­µµ °°Àº °á°ú¿´½À´Ï´Ù. ¿ä¾àÇϸé PPI´Â clopidogrelÀÇ antiplatelet action¿¡ ´ëÇÑ °Ë»ç ¼öÄ¡¸¦ ¾à°£ º¯È­½ÃÅ°Áö¸¸, ÀÓ»óÀûÀ¸·Î ÀǹÌÀÖ´Â º¯È­¸¦ ÃÊ·¡ÇÏÁö ¾Ê´Â °ÍÀ¸·Î »ý°¢µË´Ï´Ù.

Á¤¸®ÇÕ´Ï´Ù. PPI°¡ clopidogrel ¾àÈ¿¿¡ ¹ÌÄ¡´Â ÀÓ»óÀû ¿µÇâÀº °ÅÀÇ ¾ø½À´Ï´Ù. Àú´Â clopidogrelÀ» »ç¿ëȯÀÚ¿¡¼­ °¡±ÞÀû omeprazole°ú esomeprazoleÀ» ÇÇÇÏ´Â ¼±¿¡¼­ ó¹æÇÏ°í ÀÖ½À´Ï´Ù. »ç½Ç ÀڷḸ º¸¸é ±×·² ÇÊ¿äµµ ¾øÀ» °Í °°½À´Ï´Ù¸¸, °ú°Å ¹Ì±¹ FDA¿¡¼­ ¿ö³« ¿ä¶õÇÏ°Ô ¹®Á¦¸¦ »ï¾Ò±â ¶§¹®¿¡ ¾ÆÁ÷ Á¶½ÉÇÏ°í ÀÖ½À´Ï´Ù.


Q. PPIÀÇ ºÎÀÛ¿ëÀº ¾î¶² °ÍÀÌ ÀÖ½À´Ï±î?

A. ´Ü±â ºÎÀÛ¿ë°ú Àå±â ºÎÀÛ¿ëÀÌ ÀÖ½À´Ï´Ù. ´Ü±â ºÎÀÛ¿ëÀº ¼³»ç, º¯ºñ, Å»¸ð, ¹ßÁø, °ú¹Î¹ÝÀÀ µîÀÔ´Ï´Ù. ¾àÁ¦¸¶´Ù ºÎÀÛ¿ë profileÀº »ó´çÈ÷ ´Ù¸¨´Ï´Ù. ºÎÀÛ¿ëÀÌ ÀÇ½ÉµÇ¸é ¾àÁ¦¸¦ ¹Ù²Ù±â ¹Ù¶ø´Ï´Ù.

Àå±â ºÎÀÛ¿ëÀº °ñ´Ù°øÁõ, C. difficile °¨¿° µîÀÌ ¾ð±ÞµÇ°í ÀÖ½À´Ï´Ù. Clopidogrel È°¼ºÈ­ ¾ïÁ¦¿¡ ´ëÇؼ­´Â °ú°Å¸¸Å­ ¿ì·ÁÇÏÁö ¾Ê°í ÀÖ½À´Ï´Ù.


Q. 1³â ÀÌ»ó PPI¸¦ ¾²´Â ȯÀÚ¿¡¼­ BMD (bone mineral density)¸¦ Á¤±âÀûÀ¸·Î °Ë»çÇÏ°í, ¹º°¡ÀÇ Á¶Ã³¸¦ ÇØ¾ß Çմϱî?

A. PPI Àå±â º¹¿ëÀº °ñ´Ù°øÁõÀ» ÀÏÀ¸Å³ ¼ö ÀÖ½À´Ï´Ù. PPI Àå±â º¹¿ëÀÌ °ñ´ë»ç¿¡ ¿µÇâÀ» ¹ÌÄ¡´Â ±âÀüÀº (1) Ä®½· Èí¼ö ¾ïÁ¦, (2) ÆÄ°ñ¼¼Æ÷(osteoclast)ÀÇ ÇÁ·ÎÅæ ÆßÇÁ ¾ïÁ¦, (3) ºñŸ¹Î B12 ºÎÁ·, (4) °í°¡½ºÆ®¸°Ç÷Áõ¿¡ ÀÇÇÑ ºÎ°©»óÈ£¸£¸ó Áõ°¡ µîÀÌ ¾ð±ÞµÇ°í ÀÖ½À´Ï´Ù. ½ÇÁ¦·Î ¿ªÇבּ¸¿¡¼­ PPI Àå±â »ç¿ë¿¡ µû¸¥ °ñÀýÀ§Çè Áõ°¡µÊÀÌ ¹àÇôÁ³½À´Ï´Ù. ±×·¯³ª, °í·É, ½ºÅ×·ÎÀ̵å, À½ÁÖ/Èí¿¬ µî °íÀ§Ç豺¿¡¼­´Â °ñÀýÀ§Çèµµ°¡ ³ô¾ÆÁø ¹Ý¸é, °ñÀý À§Çè¿äÀÎÀÌ ¾ø´Â ȯÀÚ¿¡¼­´Â odds ration 0.66À¸·Î °ñÀýÀ§ÇèÀÇ ¹®Á¦°¡ ¾ø¾ú½À´Ï´Ù. °íÀ§Ç豺¿¡¼­ °í¿ë·®À» Àå±â»ç¿ëÇÒ ¶§¿¡¸¸ °ñ¹Ðµµ °Ë»ç¸¦ ¼±ÅÃÀûÀ¸·Î ½ÃÇàÇØ º¼ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù. Routine °Ë»ç·Î´Â ºÎÀûÇÕÇÕ´Ï´Ù.

Ä®½·Àº ÀûÀýÈ÷ ¼·ÃëÇϸé ÁÁÀº ¿µ¾ç¼ÒÀÔ´Ï´Ù. ¹°·Ð ¾àº¸´Ù ½ÄÇ°ÀÌ ´õ ÁÁ½À´Ï´Ù. ²À ÇÊ¿äÇÏ¿© supplement¸¦ »ç¿ëÇÒ ¶§¿¡´Â calcium citrate¸¦ ¼±ÅÃÇ϶ó°í µÇ¾î ÀÖ½À´Ï´Ù. ÀÌ ÇüÅ°¡ À§»êÀÌ ÀûÀº »óȲ¿¡¼­µµ Èí¼öÀ²ÀÌ ÁÁ´Ù°í ÇÕ´Ï´Ù.

°ñ´Ù°øÁõÀ» ¿¹¹æÇϱâ À§Çؼ­´Â PPI¸¦ Áõ»óÁ¶Àý¿¡ ÇÊ¿äÇÑ ÃÖ¼Ò·®¸¸ ¾²´Â °ÍÀÌ ÁÁ½À´Ï´Ù. Àú´Â threshold therapy¸¦ ±ÇÇÕ´Ï´Ù. ÀÌƲÀ̳ª »ïÀÏ¿¡ Çѹø Àý¹Ý¿ë·®ÀÇ PPI·Î Áõ»óÀÌ Àß Á¶ÀýµÇ´Â ºÐµéÀÌ ¸¹½À´Ï´Ù. Àû´çÇÑ ¿îµ¿°ú Àϱ¤¿åµµ ÁÁ½À´Ï´Ù. »À°¡ Æ°Æ°ÇØÁý´Ï´Ù.


Q. PPI º¹¿ëÈÄ severe ÇÑ allergic reactionÀÌ °¡´ÉÇմϱî? PPI º¹¿ë 30ºÐÈÄ post auricular areaºÎÅÍ erythema ¹× edema ¼Ò°ßÀ¸·Î ÀÌÈÄ dyspnea±îÁö ¹ß»ýÇÑ °æ¿ì°¡ ÀÖ¾ú½À´Ï´Ù. ±³¼ö´Ô²² PPI Á¦Àç¿¡ ´ëÇÑ ½ÉÇÑ ¾Ë·¯Áö °æÇèÀÌ ÀÖÀ¸½ÅÁö ¿©Âã½À´Ï´Ù.

A. °³ÀÎÀûÀ¸·Î´Â ½ÉÇÑ ¾Ë·¯Áö¸¦ °æÇèÇÑ ÀûÀº ¾øÁö¸¸ °¡º­¿î ºÎÀÛ¿ëÀº »ó´çÈ÷ ¸¹½À´Ï´Ù. PPI°¡ ºÎÀÛ¿ëÀÌ Àû´Ù´Â °ÍÀº H2RA¿¡ ºñÇÏ¿© ¹ß±âºÎÀüÀ̳ª ¿©¼ºÇü À¯¹æ°ú °°ÀÌ ´«¿¡ ¶ç´Â °ÍÀÌ Àû´Ù´Â À̾߱âÀÏ »ÓÀÔ´Ï´Ù. »ç¼ÒÇÑ È¤Àº µå¹°Áö¸¸ ½ÉÇÑ ºÎÀÛ¿ë±îÁö °í·ÁÇÏ¸é °áÄÚ ºÎÀÛ¿ëÀÌ ¾ø´Â ¾àÀÌ ¾Æ´Õ´Ï´Ù. ¼±»ý´Ô²²¼­ °æÇèÇÑ ºÎÀÛ¿ëÀÌ ¾Ë·¯ÁöÀÎÁö ȤÀº ºñ¾Ë·¯Áö¼º °ú¹Î¹ÝÀÀ (non-allergic anaphylaxis)ÀÎÁö Á¤È®ÇÏÁö´Â ¾ÊÁö¸¸ ¹®Çå¿¡´Â Àß º¸°íµÇ¾î ÀÖ½À´Ï´Ù. ¿©ÇÏÆ° ȯÀںв²¼­ ÁÁ¾ÆÁö¼Ì´Ù´Ï ´ÙÇàÀÔ´Ï´Ù. Àú´Â ¾ÆÁ÷ Dexilant´Â Çѹøµµ ½á º¸Áö ¾Ê¾Ò½À´Ï´Ù. Àú´Â »õ·Î ³ª¿Â ¾àÀº ¾à°£ õõÈ÷ »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù. ÀÌ·± Àú·± ÀÌÀ¯·Î...

¿À·¡µÈ À̾߱â¶ó ´©±¸¿´´ÂÁö ±â¾ïÀÌ Àß ³ªÁö ¾ÊÁö¸¸, À§ EMR ȯÀÚ¿¡¼­ IV PPI¸¦ Åõ¾àÇÑ ÈÄ shock¿¡ µé¾î°¬´ø ȯÀÚ¸¦ °æÇèÇÑ ÀÇ»ç À̾߱⸦ µéÀº Àûµµ ÀÖ½À´Ï´Ù.


Q. PPI Àå±â º¹¿ë°ú lymphocytic colitis, collagenous colitis¿Í °ü·Ã¼ºÀÌ ÀÖ½À´Ï±î?

A. Gut and Liver 2015³â 3¿ùÈ£¿¡ ÇѾç´ëÇб³ º´¿ø¿¡¼­ ¹ßÇ¥ÇÑ Does Lymphocytic Colitis Always Present with Normal Endoscopic Findings?¸¦ Âü°íÇϽñ⠹ٶø´Ï´Ù. ÀÌ ³í¹®Àº lymphocytic colitis Áß Àý¹Ý¿¡¼­ ³»½Ã°æÀû mucosal lesionÀÌ ÀÖ´Ù´Â Á¡À» ÁÖÀåÇÏ°í ÀÖ½À´Ï´Ù. ±×·±µ¥ ³»½Ã°æÀ¸·Î È®ÀÎÇÒ ¼ö ÀÖ´Â mucosal lesionÀ» °¡Áø 7¿¹ Áß 3¿¹°¡ GERD·Î lansoprazoleÀ» º¹¿ëÇÏ°í ÀÖ¾ú½À´Ï´Ù. ¹®Çå¿¡´Â lansoprazoleÀÌ collagenous colitis³ª microscopic colitis¿Í °ü·ÃµÇ¾ú´Ù´Â ³í¹®ÀÌ º¸°íµÈ ¹Ù ÀÖ½À´Ï´Ù.


°ø±³·Ó°Ôµµ Á¦½ÃµÈ 3¿¹ ¸ðµÎ lansoprazole-associated lymphocytic colitis¿´½À´Ï´Ù.

µû¶ó¼­ ¾ÆÁ÷ È®Á¤ÀûÀÌÁö´Â ¾ÊÁö¸¸ ÀϺΠPPI°¡ lymphocytic colitis¿Í °ü·ÃµÉ °¡´É¼ºÀº ÀÖ´Ù°í º¸´Â °ÍÀÌ ¾ÈÀüÇÒ °Í °°½À´Ï´Ù. PPI-induce collagenous colitisÀÇ ³»½Ã°æ ¼Ò°ß Áß Çϳª·Î linear mucosal defects°¡ ¾Ë·ÁÁ® ÀÖ½À´Ï´Ù (Linear mucosal defects: a characteristic endoscopic finding of lansoprazole-associated collagenous colitis. Endoscopy 2010). 2021³â °Ç±¹´ë À̼±¿µ ±³¼ö´Ô ÄûÁî¿¡¼­ ÇØ´ç ³»¿ëÀÌ ÀÖ¾î ¿Å±é´Ï´Ù.


Q. WarfarinÀ» ¾²°í Àִ ȯÀÚ¿¡¼­ PPI Á¾·ù¿¡ µû¶ó¼­ ÀÓ»óÀûÀÎ Àǹ̳ª ÁÖÀÇÇÒ Á¡ÀÌ ÀÖ½À´Ï±î?

A. PPI°¡ ²À ÇÊ¿äÇϸé Åõ¿©ÇØ¾ß ÇÏ°ÚÁö¸¸, °£È¤ prothrombin timeÀ» ÃøÁ¤ÇØ¾ß ÇÕ´Ï´Ù. ¾Æ·¡ Ç¥¿¡ ÀÇ°ÅÇÏ¿© Àú´Â ÁÖ·Î pantoprazoleÀ» ¼±ÅÃÇÏ°í ÀÖ½À´Ï´Ù.



Q. PPI¿Í öºÐÁ¦¸¦ °°ÀÌ Åõ¿©ÇÒ ¶§ ±³¼ö´ÔÀº ¾î¶»°Ô ó¹æÇϽʴϱî?

A. PPI¸¦ Àå±â »ç¿ëÇϸé öºÐ Èí¼ö°¡ ÀúÇصȴٴ ÀϺΠ¿¬±¸°¡ ÀÖÀ¸³ª ±×´ÙÁö ½Å·ÚÇϱâ´Â ¾î·Æ½À´Ï´Ù. À½½Ä¹°ÀÇ Fe3+°¡ Èí¼öµÇ±â À§Çؼ­´Â Fe 2+·Î ¹Ù²î¾î¾ß Çϴµ¥ ÀÌ °úÁ¤¿¡¼­ À§»êÀÌ ÇÊ¿äÇÕ´Ï´Ù. ±×·¯³ª öºÐ¾àÀÇ Fe 2+¼ººÐÀº ±×´ë·Î Èí¼öµÉ ¼ö À־ PPI·ÎºÎÅÍÀÇ ¿µÇâÀº ÀûÀ» °Í °°½À´Ï´Ù. Àú´Â öºÐ¾à°ú PPIÀÇ »óÈ£ÀÛ¿ëÀº º°·Î °í·ÁÇÏÁö ¾Ê°í ±×³É ó¹æÇÏ°í ÀÖ½À´Ï´Ù.

Nonheme iron (ferric, Fe3+) constitutes the majority of dietary iron consumed. To be absorbed by duodenal enterocytes, this iron subsequently must undergo a reduction into the ferrous state (Fe 2+), mediated by hydrochloric acid released from the stomach. In vivo data have shown that this absorption is related directly to the release of ferric iron by gastric juice. There also is evidence suggesting that this process is related more specifically to the vitamin C released in gastric secretions, which acts as a reducing agent and prevents the formation of insoluble compounds. Although there is concern regarding evidence that PPIs may reduce the bioavailability of ingested vitamin C, long-term follow-up evaluation of patients taking chronic daily PPIs for up to 7 years has not shown iron absorption to be clinically apparent. Further, most cases of iron malabsorption can be managed clinically with the use of medicinal iron supplements that are absorbed independent of gastric acid and vitamin C.


Q. PPI¿Í ±Þ¼º½É±Ù°æ»öÁõÀÇ °ü°è´Â ¾î¶°Çմϱî?

A. 2015³âµµ 10¿ùÈ£ Gastroenterology¿¡ ½Ç¸° Proton Pump Inhibitors and Myocardial InfarctionÀ̶ó´Â ±â°í¸¦ Âü°íÇϸé ÁÁ°Ú½À´Ï´Ù. ¿ä¾àÇϸé ÀÌ·¸½À´Ï´Ù.

Clopidogrel »ç¿ëȯÀÚ¿¡¼­ PPI°¡ cytochrome 2C19À» competitive inhibitionÇÏ¿© ¾àÈ¿¸¦ ³·Ãâ °¡´É¼ºÀº Àß ¾Ë·ÁÁ® ÀÖ½À´Ï´Ù. ÈÄÇâÀû ¿¬±¸¿¡¼­´Â °£È¤ °ü·Ã¼ºÀÌ º¸°íµÇ±âµµ ÇÏÁö¸¸ Cogent trialÀ̶ó´Â ÀüÇâÀû ¿¬±¸¸¦ ÅëÇÏ¿© °ü·Ã¼ºÀÌ °ÅÀÇ ¾ø´Â °ÍÀ¸·Î ¹àÇôÁ³½À´Ï´Ù.

Clopidogrel »ç¿ë°ú ¹«°üÇÏ°Ô PPI°¡ ±Þ¼º½É±Ù°æ»öÁõ°ú °ü·ÃµÉÁö ¸ð¸¥´Ù´Â ¿ì·Á°¡ Á¦±âµÈ ¹Ù ÀÖ½À´Ï´Ù. Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General PopulationÀ̶ó´Â ¹«Ã´ º¹ÀâÇÑ ¿¬±¸ÀÔ´Ï´Ù. ±âÀüÀº ¾Æ·¡ ±×¸²°ú °°½À´Ï´Ù. PPI¸¦ ¾²¸é ADMA ³óµµ°¡ ³ô¾ÆÁ® Ç÷°üÀÇ contractility¿Í relaxation¿¡ ¿µÇâÀÌ ÀÖ´Ù´Â °ÍÀÔ´Ï´Ù.

±×·¯³ª ÀÌ·¯ÇÑ È¿°ú´Â PPI Åë»ó ¿ë·®À» ÈξÀ ÃÊ°úÇÏ´Â »óȲ¿¡¼­ °üÂûµÉ »ÓÀÔ´Ï´Ù. PPI´Â plasma concentrationÀÌ ±Ý¹æ ³·¾ÆÁö±â ¶§¹®¿¡ DDAHÀ» ¿À·¡ ¾ïÁ¦ÇÒ ¼ö ¾ø½À´Ï´Ù. PPI°¡ MI¸¦ Áõ°¡½ÃÅ°´Â°¡¿¡ ´ëÇÑ Àӻ󿬱¸ °á°ú´Â ´Ù¾çÇÏÁö¸¸ ÀüÇâÀû ¿¬±¸¿¡¼­´Â negative °á°ú¿´½À´Ï´Ù.

¾ÆÁ÷±îÁö ±Þ¼º½É±Ù°æ»öÁõÀ» ¿ì·ÁÇÏ¿© PPI¸¦ ¾²Áö ¾ÊÀ» ÀÌÀ¯´Â ¾øÁö¸¸, À§»êºÐºñ¾ïÁ¦°¡ ÇÊ¿äÇÑÁö Á¤±âÀûÀ¸·Î È®ÀÎÇÏ°í °¡±ÞÀû ÀûÀº ¿ë·®À» »ç¿ëÇÏ´Â Á¤µµÀÇ ÁÖÀÇ´Â ÇÊ¿äÇÏ´Ù°í »ý°¢µË´Ï´Ù.


[2018-9-19] ¼­Ãʱ¸ ³»°ú ÀÇ»çȸ ¸ðÀÓ¿¡ °­ÀÇÂ÷ ´Ù³à¿Ô½À´Ï´Ù. ¾Æ·¡ Áõ·Ê¸¦ Æ÷ÇÔÇÏ¿© ¸î °¡Áö Áõ·Ê¿Í GERD, NSAID µî¿¡ ´ëÇÏ¿© µÎ·ç ³íÀÇÇÏ¿´½À´Ï´Ù.

Mixed paraesophageal herniaÀÇ hiatal opening ±Ùó¿¡¼­ ¹ß»ýÇÑ À§¾Ï

[2018-9-19. ¼­Ãʱ¸ ³»°ú ÀÇ»çȸ Áú¹®]

·ù¸¶Æ¼½º ÁúȯÀ¸·Î NSAID¿Í PPI º¹ÇÕÁ¦¸¦ ó¹æÇÏ´Â ¿¹°¡ ¸¹½À´Ï´Ù. ó¹æ ±â°£ÀÌ ±æ¾îÁö¸é¼­ PPIÀÇ longterm adverse effect¿¡ ´ëÇÑ ¿ì·Á°¡ ÀÖ½À´Ï´Ù. ¾î¶»°Ô »ý°¢ÇϽʴϱî?

[2018-9-19. ÀÌÁØÇà ´äº¯]

NSAID¿Í PPI º¹ÇÕÁ¦´Â 1,000¾ï´ë ½ÃÀåÀ̶ó°í ¾Ë·ÁÁ®ÀÖ°í °æÀïÀÌ Ä¡¿­ÇÕ´Ï´Ù (°ü·Ã ±â»ç 2005).

http://medipana.com 2017

´ëºÎºÐÀÇ ¾àÁ¦´Â PPI°¡ half dose Á¤µµ µé¾î°¡ ÀÖ½À´Ï´Ù. ±×·±µ¥ ÇÏ·ç µÎ¹ø º¹¿ëÇÏ´Â °æ¿ì°¡ ¸¹¾Æ 1ÀÏ ¿ë·®À¸·Î µûÁö¸é PPI standard dose Á¤µµÀÔ´Ï´Ù. µû¶ó¼­ ¸ÅÀÏ standard dose¸¦ Àå±â º¹¿ëÇÒ ¶§ ¾î´À Á¤µµÀÇ À§Ç輺ÀÌ Àִ°¡ÀÇ ¹®Á¦ÀÎ ¼ÀÀÔ´Ï´Ù.

PPIÀÇ Àå±â ºÎÀÛ¿ëÀº óÀ½ ¿ì·ÁÇß´ø °Í¸¸Å­ ÇöÀúÇÏÁö ¾Ê¾Æ¼­ 2017³â Gastroenterology review¿¡¼­´Â "It should not deter prescribers from using appropriate doses of PPIs for appropriate indications." Áï ²À ÇÊ¿äÇÒ ¶§¿¡´Â ó¹æÇ϶ó°í ±ÇÇÏ°í ÀÖÀ» Á¤µµÀÔ´Ï´Ù (Vaezi MF. Gastroenterology 2017). Á¦°¡ µå¸®°í ½ÍÀº ¸»¾¸Àº ¸ðµç ¾à¿¡´Â ¾î´À Á¤µµÀÇ ºÎÀÛ¿ëÀÌ Àֱ⠸¶·ÃÀÌ°í, PPIµµ ¿¹¿Ü´Â ¾Æ´Ï¶ó´Â °ÍÀÔ´Ï´Ù. PPIÀÇ ºÎÀۿ븸 °ÆÁ¤ÇÒ °ÍÀÌ ¾Æ´Ï°í NSAIDÀÇ ºÎÀÛ¿ëµµ °ÆÁ¤ÇØ¾ß ÇÕ´Ï´Ù. µû¶ó¼­ PPIÀÇ ºÎÀÛ¿ëÀ» °í¹ÎÇϱ⺸´Ù´Â ¾î¶»°ÔÇϸé NSAID¸¦ Àû°Ô »ç¿ëÇÒÁö °í¹ÎÇÏ´Â °ÍÀÌ ¿ÇÀº ¹æÇâÀÏ °Í °°½À´Ï´Ù.


[References]

1) 2017³â Á÷¿ø ±³À° ÀÚ·á¿¡¼­

2) PPI and risk of COVID-19 ACG immediate release

PDF

3) Relative potency

Interchangeable use of PPIs based on relative potency (Clin Gastroenterol Hepatol 2018)
Drug at lowest available dosageOmeprazole equivalent
Pantoprazole 20 mg4.5 mg
Lansoprazole 15 mg13.5 mg
Omeprazole 20 mg20 mg
Esomeprazole 20 mg32 mg
Rabeprazole 20 mg36 mg

4) [2022-4-27. ¸Þµð°ÔÀÌÆ®´º½º] ½Äµµ¿° ¾àÀ» ¿À·¡ ¸Ô¾îµµ ±¦ÂúÀ»±î¿ä?



© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.