EndoTODAY | EndoATLAS | OPD

Parasite | Eso | Sto | Cancer | ESD

Boxim | DEX | Sono | Schedule

Home | Recent | Blog | Links

EndoTODAY ³»½Ã°æ ±³½Ç


[Refractory GERD] - ðû

µÎ °¡Áö Á¢±Ù¹ýÀÌ ÀÖ½À´Ï´Ù. °Ë»ç¸¦ ÇÏÁö ¾Ê´Â Á¢±Ù¹ý°ú °Ë»ç¸¦ ÅëÇÏ¿© subtypeÀ» ³ª´² Á¢±ÙÇÏ´Â Àü·«ÀÔ´Ï´Ù.


1. pH-impedance-based approach

ÀÌdz·Ä ±³¼ö´ÔÀÇ Çؼ®:

"pH-impedence °Ë»ç¸¦ ÅëÇÏ¿© 4°³ÀÇ phenotypeÀ¸·Î ³ª´­ ¼ö ÀÖ½À´Ï´Ù. 1ÇüÀº À§»êÀ» ´õ¿í °­·ÂÇÏ°Ô ¾ïÁ¦ÇØ¾ß ÇÕ´Ï´Ù. 2ÇüÀº À§»ê¿¡ ´ëÇÑ ½Äµµ°ú¹Î¼ºÀÔ´Ï´Ù. TCA³ª SSRIµîÀ» ¾µ ¼ö ÀÖ½À´Ï´Ù. 3ÇüÀº »ê¿ª·ù´Â ÀÖÀ¸³ª Áõ»óÀº ÀÌ¿Í ¹«°üÇÑ °æ¿ìÀÔ´Ï´Ù. 3Çü¿¡¼­ »ê¿ª·ù¿Í °ü·ÃµÈ Áõ»ó(heartburn)°ú »ê¿ª·ù¿Í °ü·ÃµÇÁö ¾Ê´Â Áõ»ó(globus)À» ÇÔ²² °¡Áú ¼ö ÀÖ½À´Ï´Ù. ÀÌ·± °æ¿ì PPI¸¦ ÁÖ¸é »ê¿ª·ù Áõ»óÀº ÁÁ¾ÆÁöÁö¸¸ globus´Â ÁÁ¾ÆÁöÁö ¾Ê½À´Ï´Ù. Globus°¡ PPI ¹ÝÀÀÀÌ ¾øÀ» °ÍÀÓÀ» ¹Ì¸® ¼³¸íÇÏ¿© ÀÌÇؽÃÅ°¸é ȯÀÚ°¡ ¾È½ÉÀ» Çϸ鼭 Áõ»óÀÌ ÀúÀý·Î ÁÁ¾ÆÁö±âµµ ÇÕ´Ï´Ù. 4ÇüÀº GERD°¡ ¾Æ´Ï¹Ç·Î ¸ðµç ¾àÀ» ²÷¾î¾ß ÇÕ´Ï´Ù.
Phenotype 2´Â °£´ÜÇÕ´Ï´Ù. »ê¿ª·ù´Â Áõ»óÀ̳ª symptom associationÀÌ ÀÖ´Â °æ¿ìÀÔ´Ï´Ù. Á¤»ó ¹üÀ§ÀÇ »ê¿ª·ù¿¡ ´ëÇÑ °ú°¨°¢ÀÌ ÀÖ´Â °æ¿ìÀ̹ǷΠ±âº»ÀûÀ¸·Î PPI¸¦ Áָ鼭 pain modulator¸¦ ÇÔ²² ½á ÁÖ´Â °ÍÀÌ ÁÁ½À´Ï´Ù. °¡Àå ¾ÈÀüÇÑ amitryptilineÀ» »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù.
Phenotype 3´Â º¹ÀâÇÕ´Ï´Ù. »ê¿ª·ù´Â ÀÖÀ¸³ª ±×¿Í ¹«°üÇÏ°Ô globus°¡ ÀÖ´Â °æ¿ìÀÔ´Ï´Ù. Globus Áõ»ó°ú °ü·Ã¼ºÀÌ ¾ø´Â °ÍÀÔ´Ï´Ù. ÀÏ´Ü ¾àÀ» ²÷°í »ê¿ª·ù Áõ»ó¸¸ °ü¸®ÇÏ½Ã¸é µË´Ï´Ù."

ÇÑ ¿¬±¸¿¡ ÀÇÇϸé PPI-refractory ¿¡ ´ëÇÑ pH °Ë»ç¿¡¼­ ¾à 16%¿¡¼­´Â ¿©ÀüÈ÷ abnormal acid exposure°¡ ÀÖ´Ù°í ÇÕ´Ï´Ù. º¸´Ù ÀûÀýÇÏ°í °­·ÂÇÑ À§»êºÐºñ¾ïÁ¦ Ä¡·á°¡ ÀϺΠȯÀÚ¿¡¼­ µµ¿òÀÌ µÉ °ÍÀ¸·Î »ý°¢µË´Ï´Ù.

2019-10-27 ±è¹üÁø ±³¼ö´Ô °­ÀÇ Áß (Nat Rev Gastroenterol Hepatol 2016)


2. Empirical approach

PPI-refractory GERD¿¡¼­ º¸´Ù °­·ÂÇÑ À§»êºÐºñ¾ïÁ¦Á¦¸¦ »ç¿ëÇÏ´Â ¹æ¹ýÀÔ´Ï´Ù. pH-impedence¸¦ ½ÃÇàÇϱ⠾î·Á¿î 1-2Â÷ ÀÇ·á ȯ°æ¿¡¼­´Â ÁÖ·Î PPI doublingÀ» Çϰųª P-CABÀ» »ç¿ëÇØ º¼ ¼ö ÀÖ´Ù°í »ý°¢µË´Ï´Ù. ÃÖ±Ù review¿¡¼­ ÀϺ»ÀÇ Suzuki ¼±»ýÀÇ µµÇ¥´Â ¾Æ·¡¿Í °°½À´Ï´Ù.


3. P-CAP


[References]

1. EndoTODAY FAQ refractoy GERD

2. EndoTODAY ÀÌdz·Ä ±³¼ö´Ô Ư°­ Áß refractoy GERD ºÎºÐ

3. ºÒÀÀ¼º ¿ª·ù¼º ½Äµµ¿°ÀÇ »õ·Î¿î Ä¡·á¹ý, ÄÉÀÌĸ PDF 1.3M, ¾Æ»êº´¿ø ±èµµÈÆ ±³¼ö´Ô

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng. (since 1999-8-23)