대한내과학회지 : 제 70 권제 6 호 2006 위식도역류질환환자의식이위험요인및삶의질 한양대학교의과대학내과학교실, 가정대학식품영양학과 2, 생화학분자생물학교실 3 양선영 이오영 김혜은 2 장유경 2 윤병철 최호순 정용건 3 조찬호 3 =Abstract= Dietary related risk factors and quality of life in patients with gastroesophageal reflux disease Sun Young Yang, M.D., Oh Young Lee, M.D., Hye Eun Kim 2, Yu Kyoung Chang 2, Byung Chul Yoon, M.D., Ho Soon Choi, M.D., Yong Gun Chung 3 and Chan Ho Cho 3 Departments of Internal Medicine, Food and Nutrition 2 and Biochemistry and Molecular Biology 3, Hanyang University College of Medicine, Seoul, Korea Background : The prevalence of gastroesophageal reflux disease (GERD) is increasing in Korea. The aim of this study is to evaluate the dietary habit which is commonly known as risk factor of GERD and the quality of life in GERD patients. Methods : This study enrolled 52 patients (ERD; erosive reflux disease 38, NERD; non-erosive reflux disease 14) as patient group. They were completed the questionnaires about dietary habit and quality of life. All datas were compared with 23 healthy volunteer group who visited same hospital for health screening. Results : Patient group had more dietary risk factors such as unbalanced diet, irregular diet, using lots of sauces, having snacks or meals within 3 hours of bedtime and suffering from epigastric discomfort after alcohol drinking (p<0.05). Patient group preferred to have spicy food, soft drink, coffee and tea, fried food, instant food and noodles (p<0.05). ERD group more frequently had snacks or meals just before sleep, suffered from discomfort after drinking, and preferred to have fried food (p<0.05). GERD patients reported significantly worse scores on 6 SF-36 scales, such as physical function, role limitations-physical, role limitations-emotional, mental health, social function, and general health perception. Conclusions : We found that ERD patients had more snacks or meals within 3 hours of bedtime and fried food. Also, they were suffering from epigastric discomfort after alcohol drinking. Patients with GERD experienced decrements in health-related quality of life compared with the control subjects.(korean J Med 70:627-635, 2006) Key Words : Gastroesophageal reflux, Dietary habit, Risk factors, Quality of life 접수 : 2005년 8월 25일 통과 : 2005년 10월 31일 교신저자 : 이오영, 서울시성동구행당동산17, 한양대학교병원소화기내과 (133-792) E-mail : leeoy@hanyang.ac.kr - 627 -
-The Korean Journal of Medicine : Vol. 70, No. 6, 2006 - 서론위식도역류질환은서구에서는흔한만성질환으로알려져있다. 1988년미국의갤럽조사에의하면일반인들중적어도한달에한번이상전형적인위식도역류질환의증상을경험하는빈도가약 44% 에이른다. 다른보고에서는한달에한번증상을경험하는환자가 24%, 일주일에한번경험하는환자가 13%, 매일경험하는환자가 7% 1) 로높게나타나있다. 과거에는우리나라를포함한동양에서는위식도역류질환이서구에비해흔하지않았으나 2, 3), 최근대만에서는 14.5% 정도의증상발현을보였고, 일본에서전향적내시경조사를통해 16.3% 를보고하여서양에서의발생빈도와유사하였다 3, 4). 국내에서도 1994년에는우리나라의위식도역류질환발생빈도를약 2.4% 로보고하였고 5), 1998년에는일주일에한번이상가슴쓰림혹은산역류의증상이있는경우를위식도역류질환으로정의하였을때성인건강검진자 2,243 명중남성의 4.9%, 여성의 10.2% 로총유병율은 8.5% 로위식도역류질환의발생빈도가증가하고있다 6). 2002 년전국민을대상으로한전화설문조사에의하면응답자 1,044명중가슴쓰림증상이일주일에두번이상있는자가 3.5%, 일주일에한번있는자가 3.4%, 한달에한번있는자가 5.8%, 두달에한번있는자가 12.3% 이었으며, 산역류증상은각각 2.6%, 1.9%, 5.5%, 14.3% 이었다 7). 또한가슴쓰림증상과산역류증상의빈도가증가할수록삶의질이유의하게감소하였다. 위식도역류질환을일으키는원인은여러가지가제시되었는데, 유전적인요인이나생리학적인요인과함께생활습관의차이가있으며실험실연구에서식이, 담배, 술, 체중등의생활습관이역류를악화시킨다고보고하였다 8). 최근동양에서위식도역류질환의발생빈도가증가는서구화된식습관과같은생활습관의변화와관련이있다고추측된다. 또한우리나라의경우, 전통적인음식이매운경향이있으나이것이우리나라의위식도역류질환유병률에어떠한영향을주는지에대해서는아직알려져있지않다. 국내에서식이와연관되어위식도역류질환의유병률에대한연구는적은실정으로저자들은국내위식도역류질환환자들의발현증상과기호식품을조사하고식이습관을평가하여, 질환과어떠한상관관계를갖는지를살펴보았으며이질환이환자의삶의질에미치는영 향에대하여조사하였다. 대상및방법 1. 대상 1) 환자군 (1) 미란성식도염군 (erosive reflux disease; ERD) 2003년 4월부터 2003년 8월까지가슴쓰림이나산역류등의증상이있어한양대학교병원소화기내과를방문한환자들중위내시경으로역류성식도염이증명된환자들을미란성식도염군 (erosive reflux disease; ERD) 으로분류하였다. 내시경소견에의한병변의정도는로스엔젤레스 (LA) 분류에따라 grade A에서 D까지세분하였고, 미세한변화 (minimal change) 를보인환자는제외하였다. (2) 비미란성식도염군 (non-erosive reflux disease) 같은시기에가슴쓰림이나산역류증상으로위식도역류질환을진단받은환자들중위내시경에서는식도병변이없지만 24시간보행산도검사를시행하여병적역류가증명된자를비미란성식도염군 (non-erosive reflux disease; NERD) 으로정의하였다. 2) 건강대조군같은시기에한양대학교병원에건강검진을목적으로내원한사람들중환자군과성별과나이가비슷하고소화기질환및증상이없는사람들을대조군으로하였다. 이들은모두위내시경을시행하여위와식도에병변이없음을확인하였다. 환자군과대조군모두에서임상적으로심각한질환이있는자, 위식도역류질환이외의심각한소화기질환이있는자, 신체주요기관에악성종양이있는자및임산부는제외하였다. 2. 설문조사모든환자들은외래방문시반복훈련된설문자를통하여설문지를작성하게하였다. 본연구에이용된설문지는일반적인환자의특성, 발현증상, 식이습관, 삶의질측정등네가지항목으로구성되어있었다. 발현증상에관해서는다른연구에서알려진위식도역류질환의흔한증상열가지를택하여증상의종류및빈도를조사하였다 9). 식이에관한문항은식습관, 기호도로구 - 628 -
-Sun Young Yang, et al : Diet quality of life in gastroesophageal reflux disease - Table 1. General characteristics of subjects Variables ERD NERD control p value Sex * Age (yrear) Height (cm) Weight (kg) BMI (kg/m 2 ) WHR (%) Occupation * Family consists * Education level * Educational years Family income * (10,000 won/mon) Male Female Professionals Sales, service Manufacturers Students Housewives Unemployed Alone With spouse With spouse & children With married children Others uneducated Middle school High school College Graduate school < 50 50-149 150-299 300-499 500 22 (57.9) 16 (42.1) 51.5±2.2 163.2±1.3 63.4±1.7 ) 23.8±0.6 0.87±0.0 7 (18.4) 13 (34.2) 3 (7.9) 1 (2.6) 8 (21.1) 6 (15.8) 2 (5.3) 10 (26.3) 23 (60.5) 1 (2.6) 2 (5.3) 3 (7.9) 10 (26.3) 12 (31.6) 10 (26.3) 3 (7.9) 11.8±0.8 1 (2.6) 10 (26.3) 12 (31.6) 9 (23.7) 6 (15.8) 4 (28.6) 10 (71.4) 53.1±4.4 158.5±2.0 56.3±1.9 22.4±0.5 0.83±0.0 4 (28.6) 7 (50) 9 (64.3) 3 (21.4) 6 (42.9) 7.1±1.5 10 (71.4) 10 (43.5) 13 (56.5) 56.2±2.0 162.6±1.6 63.2±1.7 23.9±0.4 0.88±0.0 2 (8.7) 4 (17.4) 8 (34.8) 9 (39.1) 2 (8.7) 18 (78.3) 2 (8.7) 8 (34.8) 11 (47.8) 3 (13.0) 11.7±0.6 5 (21.7) 15 (65.2) Values are the mean±sem. * ; n(%), ERD, erosive reflux disease; NERD, non erosive reflux disease; BMI, body mass index; WHR, waist hip ratio. 0.150 0.399 0.164 0.043 0.227 0.109 0.094 0.660 0.019 0.002 0.103 성된총 13개문항으로각각의문항은이전에다른연구에서시행되었던위험요인을기초로작성하였다 10-12). 모든문항에대한답변은 전혀아니다 (0점), 대체로아니다 (1점), 그저그렇다 (2점), 대체로그렇다 (3점), 매우그렇다 (4점) 로점수화하였다. 삶의질측정에관한설문은 SF-36 (short form 36 health survey) 으로이는신체적기능과정신적인기능을모두측정한지표이다 13). 3. 통계분석증상의종류와빈도에대해서는나타나는숫자 (n) 와백분율 (%) 로표현하였고, 식습관의선호도는평균 ± 표 준오차로기록하였다. LA 분류법에의한위식도역류질환의병변의정도와식습관의관계및역류성식도염의악화에따른삶의질의정도는 pearson 상관관계분석을이용하였다. 모든통계처리에있어서 p-value가 0.05 미만에서통계적인유의성을갖는다고정의하였다. 결과 1. 일반적인환자의특성위식도역류질환환자군 52명과대조군 23명을대상으로하였다. 위식도역류질환환자중미란성식도염군은 - 629 -
- 대한내과학회지 : 제 70 권제 6 호통권제 550 호 2006 - Table 2. The incidence of symptoms in GERD group Symptoms ERD NERD Heartburn 28 (73.7) Acid regurgitation 24 (63.2) Dyspepsia 19 (50.0) Globus sensation 14 (36.8) Bloating 12 (31.6) Belching 6 (15.8) Chest pain 4 (10.5) Dysphagia 4 (10.5) Hoarseness 2 (5.3) Chronic cough 2 (5.3) Others 3 (7.9) n(%) ERD, erosive reflux disease; NERD, non erosive reflux disease. 9 (64.3) 10 (71.4) 4 (28.6) Table 3. Frequency of symptoms in GERD group Symptoms Frequency ERD NERD Heartburn More the once per two months More than once a month More than once a week More than twice a week Acid regurgitation More the once per two months More than once a month More than once a week More than twice a week Dyspepsia More the once per two months More than once a month More than once a week More than twice a week Globus sensation More the once per two months More than once a month More than once a week More than twice a week n(%) ERD, erosive reflux disease; NERD, non erosive reflux disease. 1 (3.6) 7 (25.0) 20 (71.4) 3 (12.5) 7 (29.2) 14 (58.3) 3 (15.8) 6 (31.6) 10 (52.6) 3 (21.4) 6 (42.9) 1 (11.1) 1 (11.1) 7 (77.8) 1 (10.0) 1 (10.0) 8 (80) 3 (60) 2 (40) 1 (20) 1 (20) 3 (60) 38명이었고, 비미란성식도염군은 14명이었다. 환자군과대조군의임상적특성을비교해보면평균연령은미란성식도염군 51.5세, 비미란성식도염군 53.1세, 대조군 56.2세로통계적인유의한차이가없었다. 체중은미란성식도염군이 63.4±1.7 kg, 비미란성식도염군 56.3± 1.9 kg, 대조군 63.2±1.7 kg으로미란성식도염군이비미란성식도염군에비해유의하게높았다 (p<0.05). 그러 나체질량지수 (BMI) 와허리엉덩이둘레비는세군간에유의한차이는없었다. 연령, 키, 직업, 가족구성원과월수입은세군간에유의한차이가없었으나평균교육수준정도는다른두군보다비미란성식도염군에서유의하게낮은것으로나타났다 (p<0.05)( 표 1). 미란성식도염환자 38명을로스엔젤레스분류법으로분류하였을때대다수인 29명 (79.3%) 의환자가 A로분 - 630 -
- 양선영외 7 인 : 위식도역류질환환자의식이위험요인및삶의질 - Table 4. Comparison of dietary habits between GERD and control subjects Diet related risk factors GERD Control p-value Dietary habit Overeating 2.37±0.20 1.74±0.25 0.118 Eating rapidly Spicy sauce 2.94±0.20 2.77±0.24 2.43±0.24 1.87±0.25 0.122 0.003 * Unbalanced diet 1.19±0.23 1.22±0.24 0.002 * 3 meals per day Irregular intake 0.77±0.19 1.23±0.21 0.74±0.21 1.04±0.25 0.139 0.043 * Eating before sleep 2.17±0.24 1.57±0.25 Discomfort after alcohol drink 1.40±0.25 0.57±0.19 Food Preference Spicy food 2.79±0.22 1.96±0.24 0.002 * Soft drink 1.42±0.21 0.96±0.20 Coffee or tea 1.77±0.24 1.61±0.27 0.001 * Fried food 1.92±0.24 1.22±0.23 Instant food 1.71±0.25 1.48±0.24 Noodles 2.67±0.22 2.00±0.26 0.038 * Values are the mean±sem. * ; p<0.05 by independent t-test, GERD, gastroesophageal reflux disease. 류되었으며, B는 7명 (18.4%), C는 2명 (5.3%) 이었고, D로진단된환자는없었다. 2. 발현증상미란성식도염군과비미란성식도염군에서가장흔하게나타나는증상은가슴쓰림, 위산역류, 소화불량, 인후이물감의순으로나타났다 ( 표 2). 가슴쓰림증상의경우미란성식도염군에서는일주일에두회이상증상이나타나는경우가 71.4% 이었고, 비미란성식도염군에서도일주일에두회이상증상이나타나는경우가 77.8% 로가장많았다. 산역류증상의경우도미란성식도염군은 58.3%, 비미란성식도염군은 80% 로일주일에두회이상증상이나타나는경우가가장많았다 ( 표 3). 3. 위식도역류질환과식습관위식도역류질환군과대조군을비교하였을때고추장등의소스사용의선호 (p=0.003), 편식습관 (p=0.002), 식사의불규칙성 (p=0.04), 야식선호 (p<0.001), 음주후속쓰림 (p<0.001) 등의식습관점수가유의하게높았다. 매운음식 (p=0.002), 탄산음료 (p<0.001), 커피혹은차 (p= 0.001), 기름진음식 (p<0.001), 인스턴트식품 (p<0.001), 밀가루음식의선호 (p=0.04) 도위식도역류질환군에서유 의하게높았다 ( 표 4). 환자군중미란성식도염군에서비미란성식도염군보다야식을하는경향 (p=0.02) 과음주후속쓰림이나타나는경향 (p=0.04) 이있었으며, 튀김음식에대한선호 (p=0.03) 가유의하게높았다 ( 표 5). 4. 위식도역류질환과삶의질위식도역류질환환자군을건강대조군과비교하였을때 SF-36에명시된여덟가지항목중신체적기능 (physical function), 신체적역할제한 (role limitationsphysical), 감정적역할제한 (role limitations-emotional), 정신건강 (mental health), 사회적기능 (social function), 일반건강 (general health perceptions) 의여섯가지항목에서유의하게삶의질이낮았다 (p<0.05)( 그림 1). 비미란성식도염군과미란성식도염군으로나누었을때에도두군모두건강대조군에비해이여섯가지항목에서삶의질이낮았다 (p<0.05). 고찰위식도역류질환의발생원인에대해서는여러가지가제시되고있으나명백하게정립이되어있지않은실정으로현재많은연구가진행되고있다. 지금까지제시된위식도역류의기전으로는하부식도괄약근의기능부전, - 631 -
-The Korean Journal of Medicine : Vol. 70, No. 6, 2006 - Table 5. Comparison of dietary habits and food preference in each group Dietary related risk factors ERD NERD Control p-value Dietary habit Overeating Eating rapidly Spicy sauce Unbalanced diet 3 meals per day Irregular intake Eating before sleep Discomfort after alcohol drink 2.50±0.23 3.10±0.22 2.66±0.28 1.42±0.29 0.74±0.22 1.21±0.24 2.50±0.25 a 1.61±0.30 a 2.00±0.44 2.50±0.44 3.07±0.45 0.57±0.31 0.86±0.39 1.29±0.45 1.29±0.45 b 0.86±0.40 b 1.73±0.25 2.43±0.24 1.87±0.19 1.22±0.24 0.74±0.21 1.04±0.25 1.57±0.25 ab 0.57±0.19 ab 0.108 0.130 0.060 0.209 0.951 0.861 0.015 * 0.036 * Food preference Spicy food Soft drink Coffee or tea Fried food Instant food Noodles 2.74±0.27 1.63±0.25 1.92±0.28 2.18±0.28 a 1.92±0.30 2.74±0.25 2.93±0.41 0.86±0.36 1.38±0.51 1.21±0.43 b 1.14±0.44 2.50±0.49 1.96±0.24 0.96±0.20 1.61±0.27 1.22±0.23 ab 1.47±0.24 2.00±0.26 0.083 0.082 0.505 0.030 * 0.269 0.189 Values are mean±sem. * : p<0.05 by one way ANOVA, : values with different alphabets within the same row are significantly different among group at α=0.05 by Duncan s multiple range test, ERD, erosive reflux disease; NERD, non erosive reflux disease. 식도열공헤르니아의존재, 식도의산청소능감소및식도점막의저항성감소등이있고 14, 15), 최근일과성하부식도괄약근이완 (transient lower esophageal sphincter relaxation) 이위식도산역류의주원인기전으로알려져있다 16, 17). 위식도역류질환과체중의관계는이전연구에서체질량지수가높아질수록위식도역류질환으로인한입원율이증가된다는보고가있었고 18), 비만한사람들을대상으로위식도역류질환의발생에대해연구하였을때비만한자들에서마른사람보다는역류가빈번히일어난다는보고가있었다 10). 이론적으로비만이상복부압력을증가시켜위산역류를촉진한다고알려져있어치료에체중감량을권유하기도하지만, 실제로환자대상연구에서는체중감량이위식도역류질환의객관적, 주관적임상양상을호전시키는지에대해상반된결과를가지고있다 19, 20). 본연구에서는미란성식도염환자군에서대조군이나비미란성식도염환자군에비해체중이높게측정되었으나체질량지수는유의한차이를보이지않아통계적의미를두기어려웠다. 최근에다기관에서시행한다른연구에의하면미란성식도염의위험요인과관련된인자는남성, 과체중, Figure 1. Comparison of quality of life by sf 36 between gerd and control group. GERD, Gastroesophageal reflux disease; PF, physical function; RP, role limitationsphysical, RE, role limitations-emotional; BP, bodily pain; VT, vitality; MH, mental health; SF, social function; GH, general health perception. 알코올, 1년이상의위식도역류질환병력, 흡연이었고, 높은교육수준과헬리코박터균감염은미란성식도염의위험을낮추었다 21). 그러나아시아인을대상으로한다른연구에서는건강한사람과비교하였을때미란성식도염환자와비미란성식도염환자에서교육수준이더높아교육수준의차이가실제로위식도역류질환의위험요인인지에대해서는아직까지명백하지않다 22). 위식도역류질환의증상은여러가지이며그중가슴쓰림은가장흔하고, 또한가장중요한증상이다. 지역사 - 632 -
-Sun Young Yang, et al : Diet quality of life in gastroesophageal reflux disease - 회를대상으로한역학연구에서가슴쓰림이가장흔한증상이고, 비교적높은진단적특이도를갖는것으로보고되어있다 1). 이번연구에서도미란성식도염과비미란성식도염모두에서전형적인증상인가슴쓰림, 위산역류의증상발현이가장많았다. 흉통, 연하곤란, 애성, 만성기침등의비전형적인증상은비미란성식도염에서더나타나는경향을보였으나통계적인유의성은없었다. 많은사람들이특정한식이습관이나생활양식이위식도역류질환의증상을악화시킨다고생각하였다. 또한일란성, 이란성쌍생아연구에서증상이있는위식도역류질환의약 31% 에서유전적요인이있다고보고하였다 23). 이러한유전적인요인에는환경요인이중요하게작용하기때문에식이습관이나생활양식도많이관여할것으로생각된다. 특히비만은여성에서내적인환경요인에크게기여한다고알려져있고외적요인으로는담배, 음주, 커피나차, 아스피린이나다른소염진통제의규칙적인복용등의생활습관이있다 10, 24). 최근생활습관과연관된위식도역류질환의위험인자를분석한연구에서흡연과식탁에서의소금섭취가통계적으로유의한역류의위험인자이었고, 식이섬유와신체적운동이위식도역류를보호하는효과가있으나술, 커피, 차등은위험인자와관련이없었다 25). 이에생활습관등의외부요인이위식도역류질환의발생에어느정도중요함을보여주고있으나연구들마다결과에차이를보이고있다. 국내에서는열량과부피를일정하게맞춘고지방의치즈버거식사와저지방의김밥식사를건강인에게주었을때역류기간과빈도에는차이가없었으나치즈버거식사에서하부식도괄약근압의감소와연하유발성역류를보이고김밥식사에서일시적하부식도괄약근이완이주된기전으로작용하여식이에따른역류기전의차이를보여주는연구가있었다 26). 또한음주와흡연이역류성식도염에일부관여할가능성을보여주었으나다변량분석에서는유의한독립적인위험인자를찾지못하였다 27). 우리나라는서구화된식생활변화와전통적으로매운음식을선호하는경향이있어매운음식에포함된 capsaicin이위식도역류질환의위험인자로작용할수있는지의문을갖게된다. Capsaicin은위산과펩신의분비를증가시키고칼륨손실을일으켜직접적으로점막손상에관여한다 28). 실제로매운맛을내는고추에의해 펩신의분비가촉진되고위내표피의박피가촉진되어위출혈을일으킬수있다는연구와매운음식으로인해식도점막의민감성이높아지고가슴쓰림이나인후고통증상이커진다는연구가있었다 29, 30). 그러나국내에서위식도역류질환환자들이실제로매운음식을얼마나선호하는지, 또한매운음식을섭취하였을때식도병변이나증상이심해지는지등에관한연구는아직없다. 본연구에서는설문을통하여위식도역류질환환자들을일반인과비교하였을때어떤음식을선호하는지조사하였고, 특히환자군을미란성식도염군과비미란성식도염군으로나누어비교하였다. 위식도역류질환군에서대조군에비해특정한식습관과식품선호도가있었고, 미란성식도염군과비미란성식도염군을비교하면미란성식도염군이야식을하는경향과음주후속쓰림, 튀김음식을선호하는경향을보였다. 그러나그외의문항은두군간에유의한차이가없어식도병변의유무에상관없이이러한특정한식습관과식품선호도가증상을유발하거나악화시킬수있다고생각되었다. LA 분류법에의한위식도역류질환의병변의정도와식습관의관계를 pearson 상관관계분석으로비교해보았을때과식이나빠른식사속도가 LA 분류에의한식도병변의심한정도와유의한상관관계 (p<0.05) 를보였으나대부분의환자들이 LA A 분류에해당하는경미한식도염환자들로구성되어있어통계적인의미를두기는어려웠다. 위식도질환환자들에게삶의질을측정해보았을때신체적기능, 신체적역할제한, 감정적역할제한, 정신건강, 사회적기능, 일반건강의여섯가지항목에서유의하게낮은값을보여위식도역류질환환자들의건강과연관된삶의질이저하되어있었다. 이는이전연구에서같은방법을사용하여일반인과위식도역류질환환자들을비교하였을때여덟가지항목모두에서삶의질이낮았던것 31) 과유사한결과이다. 역류성식도염의악화에따른삶의질의정도를알아보기위하여 LA 분류법에따른상관관계분석시에 LA 분류법에서식도염의정도가심할수록사회적기능이낮았다 (p<0.05). 대상자의수가많지않아통계적인수치가모호하고, 미란성식도염을내시경소견으로분류했을때대부분이경미한식도염으로중증미란성식도염환자가적었다는것이이번연구의제한점이다. 향후좀더많은위 - 633 -
- 대한내과학회지 : 제 70 권제 6 호통권제 550 호 2006 - 식도역류질환환자들을대상으로한국인위식도역류질환환자들의구체적인식생활자료를조사하여위식도역류질환의위험요인을제시할수있는연구가필요할것이다. 또한생활습관과식습관의차이가위식도역류질환의치료에주는효과에대하여명백하게규정된바는없지만, 삶의질에영향을주지않는한치료를시작할때개개인환자의상태를잘파악하여증상과병변을악화시킬수있는습관에대해서는교정을권유하는것이증상개선에도움이된다고생각된다. 요약목적 : 우리나라위식도역류질환자들의식습관실태를파악하고질환의위험요인으로생각되는식품에대한섭취기호도및식이습관을조사하여질환정도와의관련성을파악하며건강과관련된신체적, 정서적삶의질을평가하였다. 방법 : 한양대학교병원에내원하여위식도역류질환의증상이있는환자중내시경병변이있는미란성식도염군과내시경병변이없으나병적역류가증명된비미란성식도염군을대상군으로하고, 비슷한시기에건강검진을위해방문한수진자중소화기증상이없고내시경병변이없는자 23명을대조군으로하였다. 미란성식도염군은내시경병변을 LA 분류법에따라구분하였고, 설문지를이용하여일반적특성및신체적특성, 식습관, 기호도를조사하고 SF-36을이용하여삶의질을평가하였다. 결과 : 위식도역류질환환자군 52명중미란성식도염환자는 38명, 비미란성식도염은 14명이었으며, 대조군은 23명이었다. 위식도역류질환군은대조군에비해고추장등의소스사용의선호, 편식습관, 식사의불규칙성, 야식선호, 음주후속쓰림등의식습관점수가유의하게높았으며매운음식, 탄산음료, 커피혹은차, 기름진음식, 인스턴트식품, 밀가루음식의선호도가유의하게높았다. 환자군을미란성식도염군과비미란성식도염군으로나누어대조군과비교하였을때미란성식도염에서비미란성식도염군보다야식을하는경향과음주후속쓰림이나타나는경향이있었으며튀김음식에대한선호도가유의하게높았다. SF-36을이용한삶의질에대한평가시위식도역류질환환자에서삶의질이유의하게낮았다. 결론 : 특정한식습관과식품선호도가위식도역류질 환환자군에서대조군에비해통계적으로유의한차이를보였고, 위식도역류질환환자군은대조군에비해신체적, 정서적삶의질이저하되어있었다. 중심단어 : 위식도역류질환, 식습관, 위험요인, 삶의질 REFERENCES 1) Locke GR 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3rd. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted Country, Minnesota. Gastroenterology 112: 1448-1456, 1997 2) Kang JY, Tay HH, Yap I, Guan R, Lim KP, Math MV. Low frequency of endoscopic esophagitis in Asian patients. J Clin Gastroenterol 16:70-73, 1993 3) Furukawa N, Iwakiri R, Koyama T, Okamoto K, Yoshida T, Kashiwagi Y, Ohyama T, Noda T, Sakata H, Fujimoto K. Proportion of reflux esophagitis in 6010 Japanese adults: prospective evaluation by endoscopy. J Gastroenterol 34:441-444, 1999 4) Yeh C, Hsu CT, Ho AS, Sampliner RE, Fass R. Erosive esophagitis and Barrett s esophagus in Taiwan: a higher frequency than expected. Dig Dis Sci 42:702-706, 1997 5) 이선영, 이성구, 김명환, 한동수, 김정원, 민영일. 건강검진자의역류성식도염에대한임상적고찰. 대한내과학회지 46:514-520, 1994 6) 전성국, 손정일, 김지은, 박기호, 황일순, 김은주, 박창영, 김병익, 전우규, 정을순, 이풍렬, 최규완, 이화영. 성인건강검진자에서위식도역류증상의빈도. 대한내과학회지 58:145-151, 2000 7) 박근태, 이오영, 박영태, 배상철, 이성희, 배남영, 윤병철, 최호순, 한동수, 함준수. 한국인에서역류성식도염증상의빈도와삶의질에미치는영향. 대한내과학회지 63(Suppl 1):S61, 2002 8) Kitchin LI, Castell DO. Rationale and efficacy of conservative therapy for gastroesophageal reflux disease. Arch Intern Med 151:448-454, 1991 9) Rothman M, Farup C, Stewart W, Helbers L, Zeldis J. Symptoms associated with gastroesophageal reflux disease: development of a questionnaire for use in clinical trials. Dig Dis Sci 46:1540-1549, 2001 10) Locke GR 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3rd. Risk factors associated with symptoms of gastroesophageal reflux. Am J Med 106:642-649, 1999 11) Becker DJ, Sinclair J, Castell DO, Wu WC. A comparison of high and low fat meals on postprandial esophageal acid exposure. Am J Gastroenterol 84: - 634 -
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