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[20110522. Issues on duodenal ulcer (4): lessons from old textbook]

Ç︮ÄÚ¹ÚÅÍ°¡ ¾Ë·ÁÁø ÈÄ ¼ÒÈ­¼º±Ë¾ç Ä¡·á´Â Å©°Ô ¹ßÀüÇÏ¿´½À´Ï´Ù. ±×·¯³ª ³ªºüÁø ¸éµµ ÀÖ½À´Ï´Ù. °ú°ÅÀÇ °æÇèÀÌ ¹«½ÃµÈ´Ù´Â °ÍÀÔ´Ï´Ù. ¿¹¸¦ µé¸é longterm acid suppression °°Àº ÈǸ¢ÇÑ Ä¡·á¹ýÀÌ ÀØÇôÁ³½À´Ï´Ù. ¿äÁò Àü°øÀǵéÀº H2RA¸¦ ¹ã¿¡ ÇѾ˾¿ Åõ¾àÇÏ¿© ±Ë¾çÀç¹ßÀ» ¿¹¹æÇÏ´Â ÈǸ¢ÇÑ ÃʽÄÀ» ¾ËÁö ¸øÇÕ´Ï´Ù. ¿¹Àü Ã¥À» Æì¸é Àß ³ª¿ÍÀÖÁö¸¸, ¿äÁò¿¡´Â °ÅÀÇ ¾ð±ÞµÇÁö ¾Ê´Â ºñ¹æ°°Àº °ÍÀÔ´Ï´Ù. ¹¦ÇÑ ÀÏÀÔ´Ï´Ù.

´ä´äÇÑ ¸¶À½¿¡ Ç︮ÄÚ¹ÚÅÍ ÃÊâ±âÀ̸鼭 °ú°ÅÀÇ ±³ÈƵµ »ý»ýÇÏ°Ô ³²¾ÆÀÖ´ø ½ÃÀýÀÇ ±³°ú¼­¸¦ ã¾Æº¾´Ï´Ù. Á¦°¡ °í¸¥ Ã¥Àº 1994³âÆÇ Misievicz ÆíÀú, Diseases of the Gut and Pancreas (2nd ed)ÀÔ´Ï´Ù. 1994³âÀ̶ó¸é Àú´Â ·¹Áö´øÆ® 2³âÂ÷¿´½À´Ï´Ù. Ç︮ÄÚ¹ÚÅ͸¦ Á¦±ÕÇÏ¸é ±Ë¾çÀç¹ßÀ» ¸·À» ¼ö ÀÖ´Ù´Â °ÍÀÌ MGR ÅäÇÈÀÌ´ø ½ÃÀýÀÔ´Ï´Ù.

MisieviczÃ¥ 268ÂÊÀ» ÀοëÇÕ´Ï´Ù. More than half of patients with duodenal ulcer have a tendency to frequent recurrence, and the fear is that while the ulcer is present there will be a complication which might be life-threatening. This concern is particularly important if there has been a previous complication, when the likelihood of relapse and of further complication is substantially increased -- probably doubled (in the CURE study, from a complication rate 2.5%/year for those without, to about 5%/year for those with a previous complication). ÃÖ±Ù¿¡´Â ½ÊÀÌÁöÀå±Ë¾ç¿¡ ´ëÇÑ Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á¸¦ ½ÃÇàÇϱ⠶§¹®¿¡ ÇÕº´Áõ Àç¹ß·üÀÌ ÇöÀúÈ÷ ³·½À´Ï´Ù. ±×·¯³ª Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á¸¦ ÇÏÁö ¾Ê´Â ÇÑ, 1³â¿¡ 5%°¡ ÇÕº´Áõ Àç¹ßÀ» °æÇèÇÑ´Ù´Â °ÍÀº ¿©ÀüÈ÷ Èï¹Ì·Î¿î µ¥ÀÌÅÍÀÔ´Ï´Ù. ¿¹¸¦ µé¿¡ Á¦±ÕÄ¡·á¿¡ ¼º°øÇÏÁö ¸øÇÑ È¯ÀÚµéÀº ±× Á¤µµ Àç¹ßÇϱ⠶§¹®ÀÔ´Ï´Ù.

°°Àº ÆäÀÌÁö¿¡ ÀÌ·± ¸»µµ ÀÖ½À´Ï´Ù. Boyd et al were able to calculate that maintenance treatment with ranitidine, 150 mg at night, resulted in a probable cumulative relapse rate of 25% over 1 year if there were 6-monthly endoscopies, but that this would apparently rise to about 50% cumulative relapse over 1 year if the chek endoscopies were done monthly. ÇÕº´Áõ ¹ß»ýÀº ¸í¹éÇÑ Çö»óÀ̹ǷΠ°Ë»ç°£°Ý°ú ¹«°üÇÏ°Ô ÃøÁ¤µË´Ï´Ù. ±×·¯³ª ÇÕº´ÁõÀÌ ¾ø´Â ±Ë¾ç Àç¹ß·üÀº ³»½Ã°æ °Ë»ç¸¦ ÀÚÁÖÇϸé ÇÒ¼ö·Ï ³ô°Ô ÃøÁ¤µË´Ï´Ù. ¹«Áõ»ó Àç¹ßÀÌ ¸¹±â ¶§¹®ÀÌÁö¿ä. Follow-upÀ» ÀÚÁÖ ÇÏ´Â °ÍÀÌ ²À ÁÁÀº °ÍÀº ¾Æ´Õ´Ï´Ù. ¹«Áõ»ó ±Ë¾çÀ̸鼭 ÀúÀý·Î ÁÁ¾ÆÁú °ÍµéÀ» ¾µ¸ð¾øÀÌ µéÃ߾ °á°úÀÏ »ÓÀÔ´Ï´Ù. º´ÁÖ°í ¾àÁÖ°í °°Àº °ÍÀÔ´Ï´Ù.

Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á ÀÌÀüÀÇ À̾߱⸦ ÀÐÀ¸¸é ¸Å¿ì ¸¹Àº °ÍÀ» ¹è¿ï ¼ö ÀÖ½À´Ï´Ù. ÀØÇôÁø Àü¼³°°Àº °ÍÀÌÁö¿ä. °­·ÂÈ÷ ÃßõÇÕ´Ï´Ù.

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