EndoTODAY | EndoATLAS | OPD

Parasite | Eso | Sto | Cancer | ESD

Boxim | DEX | Sono | Schedule

Home | Recent | Blog | Links


[ColonTODAY 057 - ¼­¿ï¾Æ»êº´¿ø ¿°Áõ¼ºÀåÁúȯ¼¾ÅÍ ¹× Å©·Ðº´ Áß°³¿¬±¸¼¾ÅÍ Á¦5ȸ ½ÉÆ÷Áö¾ö]

Previous | Next

2016³â 8¿ù 21ÀÏ ¾Æ»êº´¿ø ¿°Áõ¼ºÀåÁúȯ ½ÉÆ÷Áö¾ö¿¡ ´Ù³à¿Ô½À´Ï´Ù. Àú´Â ¿ÀÀü ÇÁ·Î±×·¥¸¸ Âü°¡Çߴµ¥¿ä, ¸Å¿ì ¾ËÂ÷°Ô ÁغñµÈ Çà»ç¶ó´Â ÀλóÀ» ¹Þ¾Ò½À´Ï´Ù. ÀÌ ¸ðµç ÀÏÀ» ÁÖ°üÇϽŠ¾ç¼®±Õ ±³¼ö´ÔÀ» Á¸°æÇÕ´Ï´Ù.

ÇÑ °¡Áö ¾Æ½¬¿î Á¡Àº µî·Ïºñ°¡ °øÂ¥¶ó´Â Á¡ÀÔ´Ï´Ù. ÀÌ·± ¸ÚÁø Çà»ç´Â ´ç¿¬È÷ µ·À» ¹Þ¾Æ¾ß ÇÑ´Ù°í »ý°¢ÇÕ´Ï´Ù. µ· ³»°í °øºÎÇսôÙ! µ· Á» ¹Þ¾ÆÁÖ¼¼¿ä.

¼­¿ï¾Æ»êº´¿ø ¿°Áõ¼ºÀåÁúȯ¼¾ÅÍ È¨ÆäÀÌÁö


1. Evolving strategy to achieve long-term success. °í½Å´ë ¹®¿ø

¿°Áõ¼º ÀåÁúȯÀÇ disease activity¸¦ º¸±âÀ§ÇÑ ÁöÇ¥´Â ´Ù¾çÇÕ´Ï´Ù. ´ëºÎºÐ º¹ÀâÇÕ´Ï´Ù. ÃÖ±Ù¿¡´Â PRO (patient-reported outcomes)¿¡ ´ëÇÑ °ü½ÉÀÌ ³ô½À´Ï´Ù.

Peyrin-Biroulet L. Am J Gastroenterol 2015

Peyrin-Biroulet L. Am J Gastroenterol 2015

¶Ç ´Ù¸¥ Ãø¸éÀº mucosal healingÀÔ´Ï´Ù. Áï ³»½Ã°æ ¼Ò°ßÀÌ ÁÁ¾ÆÁ®¾ß ÇÑ´Ù´Â °ÍÀÔ´Ï´Ù.

* Ä¡·á ÈÄ Áõ»óÀÌ ¾ø´Â ȯÀÚ¿¡¼­ ³»½Ã°æÀû ¿°ÁõÀÌ ³²¾ÆÀÖ´Â °æ¿ì mucosal healingÀ» À§ÇØ Ä¡·áÇØ¾ß Çϴ°¡¿¡ ´ëÇÑ ¶ß°Å¿î Åä·ÐÀÌ ÀÖ¾ú½À´Ï´Ù. ±è¿øÈ£ ¼±»ý´Ô°ú ÃÖ±Ô¿ë ¼±»ý´Ô²²¼­´Â ¾à°£ ºÎÁ¤ÀûÀÎ ÀÇ°ßÀ» ¸»¾¸Çϼ̽À´Ï´Ù. Mucosal healingÀ» Áß¿äÇÏ°Ô »ý°¢ÇÏ¸é ¾Æ¹«·¡µµ °úÀ× Åõ¾à, °úÀ× °Ë»ç°¡ µÇ±â ½¬¿ï °Í °°½À´Ï´Ù.


2. anti-TNF Åõ¿© ȯÀÚ¿¡¼­ ¸é¿ª¾ïÁ¦Á¦ »ç¿ë. ¼­¿ï´ë ÀÓÁ¾ÇÊ

Remission induction¿¡´Â anti-TNF ȤÀº thiopurine ´Üµ¶º¸´Ù´Â combinationÀÌ ´õ È¿°úÀûÀÔ´Ï´Ù.

Lee. Intest Res 2015

Lee. Intest Res 2015

Combination Ä¡·á ÁßÀΠȯÀÚ¿¡¼­ immunomodulator Áß´Ü °áÁ¤Àº ¾ÆÁ÷ °³º°È­ÇÒ ¼ö ¹Û¿¡ ¾øÀ» °Í °°½À´Ï´Ù. ¸¹Àº ¿¬±¸°¡ ÁøÇàµÇ°í ÀÖ´ÙÁö¸¸ ¾ÆÁ÷ ¶Ñ·ÇÇÑ °¡À̵å¶óÀÎÀº ¾ø´Â ¸ð¾çÀÔ´Ï´Ù.

Lee. Intest Res 2015

Thiopurine¿¡ µû¸¥ À§Ç輺À» °í·ÁÇÏ¿© Ä¡·á¹æħÀ» Á¤ÇØ¾ß ÇÒ °Í °°½À´Ï´Ù. ¹°·Ð ȯÀÚ¿¡°Ôµµ Àß ¼³¸íÇØ¾ß ÇÕ´Ï´Ù. ¿¹¸¦ µé¾î thiopurine »ç¿ë ½Ã ¸²ÇÁÁ¾ À§ÇèÀÌ ¾à 5¹è ³ô¾ÆÁý´Ï´Ù. ´ÙÇེ·´°Ô ¾àÀ» ²÷À¸¸é ±× À§Ç輺Àº ´Ù½Ã °¨¼ÒµË´Ï´Ù (Kotlyar. Clin Gastroenterol Hepatol 2015;13:847-858).

Neeraj Prasad. http://www.intechopen.com/

¾Æ»êº´¿ø ¼Ò¾Æ°ú ±è°æ¸ð ±³¼ö´Ô²²¼­´Â ¼Ò¾Æ¿¡¼­´Â ¾Ï¹ß»ýÀ§ÇèÀÌ ³ô¾Æ¼­ combination Ä¡·á¸¦ ÇÏ´Â °æ¿ì°¡ Àû´Ù°í commentÇϼ̽À´Ï´Ù.


3. Å©·Ðº´ ¼ö¼ú ÀüÈÄ °ü¸®. °¡Å縯´ëÇб³ °­»ó¹ü

¾à¹°Ä¡·á°¡ ¹ßÀüÇÏ°í ÀÖÀ½¿¡µµ ºÒ±¸ÇÏ°í ¾ÆÁ÷ ¼ö¼ú¹Þ´Â ȯÀÚ´Â ¸¹½À´Ï´Ù. IBD 2014;20:488

¿¬ÀÚ´Â °¡Àå ¸ÕÀú Psychological help¸¦ ¾ð±ÞÇϼ̽À´Ï´Ù.

¿µ¾ç°ø±Þµµ Áß¿äÇÕ´Ï´Ù. ¿µ¾ç scoring systemÀ» È°¿ëÇÒ ¼ö ÀÖ½À´Ï´Ù.

McClave SA. Am J Gastroenterol 2016


4. Big data. ¿ï»êÀÇ´ë ¼øȯ±â³»°ú ±è¿µÇÐ

¿ÜºÎ ÀÚ·á¿Í º´¿ø ÀڷḦ linkÇϱâ´Â ¾î·Æ½À´Ï´Ù. ÇöÀç´Â NECA¸¦ ÅëÇÏ¿© ÀϺΠ°¡´ÉÇÕ´Ï´Ù.

Unstructured data·ÎºÎÅÍ natural language processing¸¦ ÅëÇÏ¿© ÀÚ·áÃßÃâÀÌ °¡´ÉÇÕ´Ï´Ù.

¹Ì±¹¿¡¼­´Â moon shot project°¡ ÁøÇàµÇ°í ÀÖ½À´Ï´Ù.


5. PRO: are we ready to use? °æÈñ´ëÇб³ Â÷Àç¸í

ȯÀÚ´Â improved symptom, clinical remissionÀ» ¿øÇÏ°í ÀÇ»ç´Â mucosal healing, deep remissionÀ» ¿øÇÕ´Ï´Ù.

ÀÇ»ç¿Í ȯÀÚÀÇ perception gapÀ» »ó´çÇÕ´Ï´Ù (Rubin DT. Inflamm Bowel Dis 2009;15:581).

Cons of PROs (NEJM 2013;368:201-203)
1) PROM is not credible because of patients lack formal medical trainig.
2) PROM could be confounded by factors not directly associated with the quality of process
3) PROM may reflect fulfillment of patients' a prior desires

4 criteria of PROM: validity, reliability, responsiveness, precision

Àú´Â ´ÙÀ½ µÎ °¡Áö¸¦ comment Çß½À´Ï´Ù. (1) ÇÚµåÆù app µîÀ» »ç¿ëÇÏ¿© Áõ»ó Àϱ⸦ ¾²¶ó°í Çϸé ȯÀÚ°¡ Áö³ªÄ¡°Ô Áúº´¿¡ ÁýÂøÇÒ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù. Áõ»óÀ» ÀÚ¼¼È÷ ½á ¿Ô´Âµ¥ Àǻ簡 ¹Ù»Û ¿Ü·¡¿¡¼­ Å« °ü½ÉÀ» º¸¿©ÁÖÁö ¾ÊÀ¸¸é ½Ç¸ÁÇÒ ¼öµµ ÀÖ½À´Ï´Ù. (2) ¿°Áõ¼º ÀåÁúȯÀÇ ¸ðµç Áõ»óÀ» ¿ÏÀüÈ÷ ¾ø¾Ù ¼ö ÀÖ´ÂÁö Àǹ®ÀÔ´Ï´Ù. ¾à°£ÀÇ residual symptomÀÌ ³²À» ¼ö ÀÖÀ» °Í °°½À´Ï´Ù. ¸ðµç Áõ»óÀ» ¿ÏÀüÈ÷ ¾ø¾Ø´Ù´Â ÀÌ»óÀûÀÎ ¸ñÇ¥º¸´Ù´Â ¾î´Â Á¤µµ Áõ»óÀÌ ³²À» ¼ö ÀÖ´Ù´Â Çö½ÇÀûÀÎ ¸ñÇ¥¸¦ °®µµ·Ï ¹Ì¸® ¾Ë·ÁÁÖ´Â °ÍÀº ¾î¶³±î¿ä? »ç½Ç GERDÀÇ ÃÖ±Ù Ä¡·á °æÇâ Áß Çϳª´Â 'ȯÀÚÀÇ ±â´ë ¼öÁØÀ» ³·Ãç¶ó'´Â °ÍÀÔ´Ï´Ù. ¸ðµç Áõ»óÀÇ ´Ù ¾ø¾Ö·Á°í ¾Ö¾²´Ùº¸¸é °úÀ× Ä¡·á·Î ¿¬°áµÉ ¼ö Àֱ⠶§¹®ÀÔ´Ï´Ù.


6. Communication and shared decision making. ÀÌÈ­ÀÇ´ë Á¤¼º¾Ö

Àǻ絵 ¿©·¯ ŸÀÔÀÌ ÀÖ½À´Ï´Ù. Paternalistic doctor, Informative doctor, Shared doctor

SDM (shared decision making): ȯÀÚµµ ¿øÇÏ°í Àǻ絵 ÇÊ¿äÇÏ´Ù°í »ý°¢ÇÏÁö¸¸, ¾î¶»°Ô ÇØ¾ß ÇÒÁö, ¾ó¸¶¸¸Å­ ¾Ë·ÁÁÙ °ÍÀÎÁö µî ¾î·Á¿î Á¡ÀÌ ¸¹½À´Ï´Ù.

¼ÒÅëÀº µÎ °¡Áö ´Ü°è°¡ ÀÖ½À´Ï´Ù. (1) ÀÌÇØÇϱâ understanding, (2) ¸¶À½À» ¿­°Ô Çϱâ connection before correction

* Á¤¼º¾Ö ±³¼ö´Ô °­ÀǸ¦ µéÀ¸¸é¼­ ÀÚ½ÅÀ» µ¹¾Æº¸¾Ò½À´Ï´Ù. Àú´Â informative doctorÀÎ °Í °°½À´Ï´Ù. Shared doctor·Î º¯½ÅÇØ¾ß ÇÒ °Í °°½À´Ï´Ù¸¸, Çö½ÇÀûÀ¸·Î´Â ½±Áö ¾Ê¾Æ º¸ÀÔ´Ï´Ù.


7. Role of IBD nursing professionals for better care of IBD. ¼­¿ï¾Æ»êº´¿ø Á¶À±°æ

Àü¹®°£È£»ç(CNS, clinical nurse specialist)ÀÇ ¿ªÇÒ

¼­¿ï¾Æ»êº´¿ø ¿°Áõ¼ºÀåÁúȯ¼¾ÅÍ È¨ÆäÀÌÁö Å©·Ðº´ ȯÀÚ¼³¸íÀÚ·á (µ¿¿µ»ó)

¼­¿ï¾Æ»êº´¿ø ¿°Áõ¼ºÀåÁúȯ¼¾ÅÍ È¨ÆäÀÌÁö ±Ë¾ç¼º ´ëÀå¿° ȯÀÚ¼³¸íÀÚ·á (µ¿¿µ»ó)


[References]

1) EsoTODAY - Esophageal diseases

2) SmallTODAY - Small bowel diseases

3) ColonTODAY - Colorectal diseases

4) Dr. Sinn's LiverTODAY - Liver diseases

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