개원의와함께하는임상강좌 2011 역류성식도질환제대로이해하기 Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea Jae-Young Jang, M.D., PhD. 개원의와함께하는임상강좌 2011 109
최신치료 : 일차진료기관에서흔히접하는환자의치료 Prevalence of Sx-Based GERD (Sx of heartburn or acid regurgitation occurring at least once a week) Western: 14-24%, 5% /year Western Asia: 20% Eastern Asia ~2004: 2.5-4.8% 2005-2010: 5.2-8.5% Korea 2000-2001: 4% 2005-2006: 5% J Neurogastroenterol Motil 2011;17:14-27 Aliment Pharmacol Ther 2008;27:173-185 증가는하고있는데다양한결과들은? Reflux Sx: at least once a week Heartburn Acid regurgitation Chest pain Hoarseness Globus sensation Cough Epigastric pain 왜증가하는가? 서구화된생활식습관 고령인구의증가 비만인구의증가 식도에대한관심증가 110 개원의와함께하는임상강좌 2011
장재영 : 역류성식도질환제대로이해하기 Contents 역류성식도질환의재정립 정의 분류 간과하지않아야할것들 증례들 Definition of GERD The Montreal Definition, 2006 A condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications Troublesome Sx? In population-based studies: Mild Sx occurring 2 or more days a week Moderate/severe Sx occurring more than 1 days a week In clinical practice: The patient should determine if their reflux Sx are troublesome 개원의와함께하는임상강좌 2011 111
최신치료 : 일차진료기관에서흔히접하는환자의치료 The Overall Definition of GERD Am J Gastroenterol 2006;101:1900-1920 Functional Dyspepsia The Goals of Treatment 삶의질을감소시키는증상을호전시키고 염증을감소시켜합병증을예방 112 개원의와함께하는임상강좌 2011
장재영 : 역류성식도질환제대로이해하기 Treatment Lifestyle modification Drugs Lifestyle Modification Weight reduction Elevation of the head of the bed Decreased fat intake Cessation of smoking Avoiding recumbency for 3h postprandially Avoiding certain foods Chocolate, alcohol, peppermint, coffee, onion, galic Drugs Antacid Prokinetics H2 receptor blockers Proton pump inhibitors 개원의와함께하는임상강좌 2011 113
최신치료 : 일차진료기관에서흔히접하는환자의치료 증상의심한정도 The Roles of Endoscopy in GERD 젊고, 전형적인증상을가지고있을때는내시경을시행하지않아도된다. 내시경시행 약물치료에반응이떨어지고 증상이심하고, 합병증이의심되고 Alarm symptoms F/70, Acid regurgitation Esophageal Symptomatic Syndrome Non Erosive Reflux Disease 114 개원의와함께하는임상강좌 2011
장재영 : 역류성식도질환제대로이해하기 전제조건 내시경소견과증상의유무, 증상의심한정도, 조직학적인염증정도와는연관성이없다. M/40, Globus Sensation Esophageal Symptomatic Syndrome? Syndromes with Esophageal Injury? LA Minimal Change White discoloration of Z line Blurring of Z line 개원의와함께하는임상강좌 2011 115
최신치료 : 일차진료기관에서흔히접하는환자의치료 Reflux Esophagitis LA-minimal change 의의미 재연성이떨어지고 관찰자간의진단율의차이가있다. 그러므로역류성식도염으로진단하는데있어서의미가낮다. M/55, No Symptoms Syndromes with Esophageal Injury Reflux Esophagitis Asymptomatic Reflux Esophagitis 치료? 추적검사? J Neurogastroenterol Motil 2004;10:100-1004 116 개원의와함께하는임상강좌 2011
장재영 : 역류성식도질환제대로이해하기 F/70, Dysphagia Syndromes with Esophageal Injury Reflux Stricture Complications of GERD Reflux esophagitis Hemorrhage Stricture Barrett s esophagus Adenocarcinoma Evolution of Barrett s Esophagus Definitions: 과거에는조직검사에서 specialized intestinal metaplasia가나오면확진 현재는 Endoscopically suspected esophageal metaplasia (ESEM) 가의심되는부위에서 columnar epithelium이진단되면확진 Barrett s esophagus with or without intestianl metaplasia 개원의와함께하는임상강좌 2011 117
최신치료 : 일차진료기관에서흔히접하는환자의치료 정리 역류성식도질환은만성질환중삶의질을악화시키는대표적질환이다. 현재생활환경의서구화로가파른증가추세에있다. 개념과자연경과를잘이해하여적절하게치료함으로써환자의삶의질을높여야한다. 118 개원의와함께하는임상강좌 2011