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EndoTODAY ³»½Ã°æ ±³½Ç


[Dexlansoprazole]

1. 2017-4-4. ºÒÀÀ¼º GERD ȯÀÚÀÇ PPI Ä¡·á Àü·« (Dr. Peura, University of Virginia)

PPI only inhibit active proton pumps.

"PPIs are recommended to take before breakfast. But, many of my patients don't eat breakfast. They drink coffee..."

Virginia health systemÀÇ ¸í¿¹±³¼öÀÎ Puera ±³¼ö´ÔÀº dexlansoprazole (= R-enantiomer of lansoprazole)¿¡ ´ëÇÑ À̾߱⸦ ¸¹ÀÌ Çϼ̽À´Ï´Ù. Granule 1´Â À§¿Í »óºÎ¼ÒÀå¿¡¼­, granule 2´Â ÇϺΠ¼ÒÀå¿¡¼­ releaseµË´Ï´Ù. µû¶ó¼­ ¾à¹° Ç÷Áß ³óµµ°¡ µÎ °³ÀÇ peak¸¦ ÀÌ·ì´Ï´Ù. À̸¦ ÅëÇÏ¿© ÀÛ¿ë½Ã°£ÀÌ ±æ¾îÁö´Â ¸ð¾çÀÔ´Ï´Ù (dual release technology).


2013³â 11¿ù 25ÀÏ ¾î¶² ½ÉÆ÷Áö¾ö¿¡¼­µµ ÀúÀÇ ¹ßÇ¥¿¡ ¾Õ¼­ David Peura ¼±»ý´Ô²²¼­ »õ·Î¿î PPI¿¡ ´ëÇÏ¿© °­ÀÇÇϼ̽À´Ï´Ù. 2005³â¿¡ ¹Ì±¹¼ÒÈ­±âÇÐȸ ȸÀåÀÌ´ø ºÐÀÔ´Ï´Ù. ÁÖ¿ä ³»¿ëÀ» ¿ä¾àÇÕ´Ï´Ù. 2017³â 4¿ù 4ÀÏ °­ÀÇ¿¡¼­µµ °ÅÀÇ ºñ½ÁÇÑ À̾߱Ⱑ ÁøÇàµÇ¾ú½À´Ï´Ù.

PPI¸¦ »ç¿ëÇÏ´Â GERD ȯÀÚÀÇ 72ÆÛ¼¾Æ®°¡ °£È¤ Áõ»óÀ» °æÇèÇÕ´Ï´Ù. ½ÄÀü¿¡ ¸Ô¾î¾ß ÇÏ´Â °Íµµ ȯÀڵ鿡°Ô´Â Å« ºÒÆíÀÌ ¾Æ´Ò ¼ö ¾ø½À´Ï´Ù. ±âÁ¸ PPIÀÇ Áß¿ä limitationÀº ¹Ý°¨±â°¡ 1-2½Ã°£ÀÎ Á¡Àε¥ PPI°¡ È°¼ºÇü proton pump¸¸À» ¾ïÁ¦ÇÑ´Ù´Â Á¡À» °í·ÁÇÏ¸é »êºÐºñ¾ïÁ¦°¡ ºÎÁ·ÇÒ °¡´É¼ºÀÌ ÀÖ½À´Ï´Ù.

Proton pump´Â ½ÄÈÄ¿¡ activationµÇÁö¸¸ ¸ðµÎ È°¼ºÈ­µÇ±â ¾Ê°í 3/4Á¤µµ¸¸ È°¼ºÈ­µË´Ï´Ù. µû¶ó¼­ PPI¸¦ ½ÄÀü¿¡ ¸Ô´Â´Ù°í ÇÏ´õ¶óµµ 1/4´Â È°¼ºÈ­µÇ±â ¾Ê½À´Ï´Ù. È°¼ºÈ­µÇÁö ¸øÇÑ proton pump´Â ´ÙÀ½ ½Ä»ç¶§ È°¼ºÈ­µÇÁö¸¸ PPIÀÇ Ç÷Á߹ݰ¨±â°¡ ª±â ¶§¹®¿¡ ´ÙÀ½ ½Ä»ç¶§´Â °ÅÀÇ »ç¶óÁ®¹ö¸° »óÅ°¡ µË´Ï´Ù.

Dual Release Technology¸¦ Àû¿ëÇÑ dexlansoprazoleÀº ±ä ¹Ý°¨±â ¶§¹®¿¡ ÀÌ·± limitationÀ» ³Ñ¾î¼³ °¡´É¼ºÀÌ ÀÖ½À´Ï´Ù. DexlansoprazoleÀº °­ÇÏÁöµµ ¾Ê°í ÀÛ¿ë±âÀüµµ »õ·ÓÁö ¾Ê½À´Ï´Ù. ´ÜÁö ¹Ý°¨±â°¡ ±æ »ÓÀÔ´Ï´Ù. ±×·±µ¥ ÀÌ ±ä ¹Ý°¨±â°¡ Àǹ̰¡ ÀÖ´Â °ÍÀÔ´Ï´Ù. MetzÀÇ 2009³â APT ¿¬±¸¿¡ µû¸£¸é dexlansoprazole·Î 6°³¿ù°£ À¯Áö¿ä¹ýÀ» ÇÏ¿´À» ¶§ ÁÖ°£ Áõ»óÀÇ 96ÆÛ¼¾Æ®, ¾ß°£ Áõ»óÀÇ 99ÆÛ¼¾Æ®°¡ ¾ø¾îÁ³½À´Ï´Ù. ¾ÆÁ÷ ´Ù¸¥ ¾àÁ¦¿ÍÀÇ head to head comparisonµî clinical trialÀº ºÎÁ·ÇÏÁö¸¸ Àü¸ÁÀº ¹à´Ù°í »ý°¢µË´Ï´Ù.


Special GERD population for whom dexlansoprazole dual release treatment is ideally suited

1. Patient with nocturnal heartburn and poor sleep quality
2. Patient not responding to once daily or using twice daily PPI
3. Patient who eat irregular meals - shift workers (patient-friendly medication)
4. Patient with regurgitation - Puera. APT 2013;38:1303 - heartburnÀº ³·Àº ¿ë·®À¸·Îµµ Àß Á¶ÀýµÇÁö¸¸ regurgitation¿¡´Â °í¿ë·®À» ½á¾ß ÇÏ´Â °æ¿ì°¡ ¸¹´Ù.
5. Overweight and obese patients with GERD


Dexlansoprazole dual release should be considered:

1. A new diagnosis of GERD
2. Symptomatic nonerosive GERD
3. All grades of EE
4. A need for maintaining of EE healing
5. A need for 24 hour heartburn symptom relief
6. Night time symptoms that interfere with sleep quality
7. Poor response to once daily PPI
8. A need for dosing flexibility
- Eat meals at irregular times
- Shift workers - dose at different times
- Difficulty swallowing pills
9. Regurgitation as well as heartburn
10. Obesity
11. Concern for drug interaction especially clopidogrel


2016³â 4¿ù 2ÀÏ ¿îµ¿ÇÐȸ ·±Ãµ ½ÉÆ÷Áö¾ö¿¡¼­µµ dexlansoprazole¿¡ ´ëÇÑ °­ÀÇ°¡ ÀÖ¾ú½À´Ï´Ù (Ching-Liang Lu, Taiwan).

PPI ȸ»ç°¡ ÁÖÃÖÇÏ´Â ·±Ãµ¿¡¼­ PPI overuse, ºÎÀÛ¿ë µîÀÌ ´Ù·ïÁø Á¡Àº ±àÁ¤ÀûÀÔ´Ï´Ù. Àü¹®°¡ Áý´ÜÀÇ ÀÚÁ¸½É °°Àº °ÍÀÌÁö¿ä.

PPI°¡ dementia¿Í °ü·ÃµÉ ¼ö ÀÖ´Ù´Â º¸°í°¡ Èï¹Ì·Î¿ü½À´Ï´Ù (Gomm W. JAMA 2016).

[2014-7-8. ¾Öµ¶ÀÚ Áú¹®]

±³¼ö´Ô ¾È³çÇϽʴϱî? Áö¹æ¿¡ °³¾÷ÇØ ÀÖ´Â ³»°úÀÇÀÔ´Ï´Ù. µ¦½Ç¶õÆ®°¡ ÃÖ±Ù¿¡ ³ª¿Â PPI Áß °¡°ÝÀÌ Àú·ÅÇÏ°í È¿°ú°¡ ÁÁ´Ù°í ÇÏ¿© ÃÖ±Ù ¼Ó¾²¸² ¹× µîÅëÁõÀ¸·Î ½ÃÇàÇÑ À§³»½Ã°æ °á°ú DU(A1)ÀÖ¾î ȯÀÚ¿¡°Ô µ¦½Ç¶õÆ®¸¦ ó¹æÇÏ¿´½À´Ï´Ù. ±×·±µ¥ ±¹³» Çã°¡»çÇ×ÀÌ ½Äµµ¿°À¸·Î¸¸ µÇ¾îÀ־¿ä. ½ÊÀÌÁöÀå±Ë¾ç¿¡´Â ÀÌ ¾àÀÌ È¿°ú°¡ ¾ø´Â°Ç°¡¿ä? ´Ù¸¥ PPI·Î º¯°æÇØ¾ß ÇÒ±î¿ä?


[2014-7-8. ÀÌÁØÇà ´äº¯]

ÁÁÀº Áú¹® °¨»çÇÕ´Ï´Ù. ¿ì¸®³ª¶ó ÀÇ»ç´Â ¿ì¸® ÀÇ·áÁ¦µµÀÇ Æ² ¾È¿¡¼­ Áø·áÇØ¾ß ÇÑ´Ù°í »ý°¢ÇÕ´Ï´Ù. ¹°·Ð ȯÀÚ¿¡°Ô ²À ÇÊ¿äÇÏÁö¸¸ ´ë¾ÈÀÌ ¾ø¾î¼­ Çã°¡¹ÞÁö ¸øÇÑ Áø·á¸¦ ÇÒ ¼ö ¹Û¿¡ ¾ø´Â °æ¿ìµµ ÀÖ½À´Ï´Ù. ÀÇ»çµéÀÌ ¼±ÀÇÀÇ ¸ðÇèÀ» ÇÏ´Â °ÍÀÌÁö¿ä. »·È÷ 100% »è°¨µÇ´Â ÁÙ ¾Ë¸é¼­ ±×³É Áø·áÇÒ ¼ö ¹Û¿¡ ¾ø´Â »óȲÀÔ´Ï´Ù. Àúµµ Á¾Á¾ ±×·± °æ¿ì°¡ ÀÖ½À´Ï´Ù. ±×·¯³ª Çã°¡µÈ ´ë¾ÈÀÌ ÀÖ´Â °æ¿ì±îÁö Çã°¡µÇÁö ¾ÊÀº Áø·á¸¦ ÇÒ ÀÌÀ¯´Â ¾øÀ» °Í °°½À´Ï´Ù.

È¿°ú°¡ ÀÖ´Ù°í ´Ù Çã°¡µÈ °ÍÀº ¾Æ´Õ´Ï´Ù. ½Å¾àÀÌ Æ¯Á¤ ÀûÀÀÁõ¿¡ ´ëÇÑ Çã°¡¸¦ ¹Þ±â À§Çؼ­´Â ÀûÀýÇÑ ÀÓ»ó µ¥ÀÌŸ°¡ ÀÖ¾î¾ß ÇÏ°í, ȸ»ç¿¡¼­ °ü°è±â°ü¿¡ Á¤½ÄÀ¸·Î ½ÅûÇÏ¿© ½ÂÀÎÀ» ¹Þ¾Æ¾ß ÇÕ´Ï´Ù. È¿°ú°¡ ÀÖÀ» °ÍÀÌ Æ²¸²¾ø´Ù°í »ý°¢µÇ´õ¶óµµ, ÀûÀýÇÑ ÀÓ»ó µ¥ÀÌŸ°¡ ¾ø°Å³ª, Çã°¡ÀýÂ÷°¡ ³¡³ªÁö ¾Ê¾ÒÀ¸¸é »ç¿ëÇÒ ¼ö ¾ø½À´Ï´Ù.

ÇöÀç dexlansoprazoleÀº ¼ÒÈ­¼º±Ë¾ç¿¡ »ç¿ëÇÒ ¼ö ¾ø½À´Ï´Ù. ¾àÈ¿°¡ ¾ø±â ¶§¹®ÀÌ ¾Æ´Ï°í ÀûÀÀÁõÀ» ¸ø ¹Þ¾Ò±â ¶§¹®ÀÔ´Ï´Ù. ¾Æ·¡´Â Á¦¾àȸ»ç¿¡ ¹®ÀÇÇÏ¿© ¹ÞÀº ´äº¯ÀÔ´Ï´Ù.



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