Parasite | Eso | Sto | Cancer | ESD
[Helicobacter Á¦±ÕÄ¡·á] - End of document
1. ÀûÀÀÁõ
3. 1Â÷ Á¦±ÕÄ¡·á, 2Â÷ Á¦±ÕÄ¡·á ¹× ±âŸ ó¹æ
4. ¼øÂ÷ Ä¡·á, µ¿½Ã Ä¡·á, Ç×»ýÁ¦ °¨¼ö¼º ±â¹Ý Ä¡·á sequential therapy, concomitant therapy, culture-based therapy
5. Á¦±Õ Ä¡·á ÈÄ Á¦±Õ ¼º°ø ¿©ºÎ È®ÀÎ - Á¦±ÕÄ¡·á ÈÄ °á°ú È®ÀÎÀ» ¾È ÇßÀ» ¶§ÀÇ ¹®Á¦Á¡
6. Penicillin allergy ȯÀÚÀÇ Á¦±ÕÄ¡·á
7. Helicobacter Á¦±ÕÄ¡·á ÈÄ ¹ß»ýÇÒ ¼ö ÀÖ´Â ¹®Á¦µé - Hallucination/psychosis
8. Symposiums
10. FAQ
11. References
±×°£ Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á¿¡ ´ëÇØ¼´Â Àü¹®°¡µéÀÇ »ý°¢, ÇÐȸÀÇ Àǰ߰ú Á¤ºÎÀÇ ÁöħÀÌ ´Þ¶ó È¥¼±ÀÌ ÀûÁö ¾Ê¾Ò½À´Ï´Ù. Àü¹®°¡µé ȤÀº ÇÐȸÀÇ ÀÔÀåÀº Æø³Ð°Ô °Ë»çÇÏ°í Æø³Ð°Ô Ä¡·áÇÏÀÚ´Â °ÍÀ̾ú°í, Á¤ºÎ¿¡¼´Â Ä¡·á¹üÀ§¸¦ ±ØÈ÷ Á¦ÇÑÀûÀ¸·Î ÀÎÁ¤ÇØ ÁÖ¾ú½À´Ï´Ù. ¾Æ·¡´Â 2009³â°ú 2013³â ´ëÇÑÇ︮ÄÚ¹ÚÅÍÇÐȸ¿¡¼ ¹ßÇ¥ÇÏ¿´´ø °¡À̵å¶óÀÎÀÔ´Ï´Ù. ¹°·Ð Á¤ºÎ¿¡¼´Â ÀÎÁ¤ÇØÁÖÁö ¾Ê¾ÒÁö¿ä.
Àü¹®°¡ ±×·ì ³»¿¡¼µµ ÇÐȸ °¡À̵å¶óÀο¡ ´ëÇÑ ºÒ¸¸ÀÇ ¸ñ¼Ò¸®µµ ³ô¾Ò½À´Ï´Ù. ÇÐȸ¿¡¼ Á¦½ÃÇÑ °¡Àå Æø³ÐÀº ÀûÀÀÁõ¿¡µµ Æ÷ÇÔµÇÁö ¾Ê´Â °¨¿°ÀÚ(±×³É À§¾Ï ¿¹¹æÀ» À§ÇÏ¿© Ä¡·á¹Þ°í ½ÍÀº ¹«Áõ»ó °¨¿°ÀÚ)°¡ ¸¹±â ¶§¹®ÀÔ´Ï´Ù. ¸ðµç Ç︮ÄÚ¹ÚÅÍ °¨¿°ÀÚ¸¦ Ä¡·áÇÏ´Â °ÍÀÌ ÁÁ°Ú´Ù´Â ÁÖÀåÀÌ ±×°ÍÀε¥ Àúµµ ±×¿¡ µ¿ÀÇÇÏ´Â ¹Ù¿´½À´Ï´Ù. ´ÜÁö ºÒ¹ýÀ̶ó Á¶½É½º·¯¿üÀ» »ÓÀÌÁö¿ä.
±×·±µ¥ °©ÀÚ±â Á¤ºÎ°¡ ŵµ¸¦ ¹Ù²å½À´Ï´Ù. 2017³â±îÁö Á¤ºÎ¿¡¼´Â À§¾Ï°ú ¼Òȼº±Ë¾ç¿¡¼¸¸ Ä¡·á¸¦ ÀÎÁ¤ÇÏ¿´°í ±âŸ ¸ðµç °æ¿ì´Â ºÒ¹ýÀÌ°í »è°¨ ´ë»óÀ¸·Î °£ÁÖÇØ ¿Ô½À´Ï´Ù. ±×·¯³ª 2018³â 1¿ù 1ÀϺÎÅÍ ¸ðµç Ç︮ÄÚ¹ÚÅÍ °¨¿°Áõ Ä¡·á°¡ ÇÕ¹ýÀÌ µÇ¾ú½À´Ï´Ù. ´ÜÁö ÀûÀÀÁõ¿¡ µû¶ó ÀϹÝÀûÀÎ º¸Çè ±Þ¿© ȤÀº 100/100 ±Þ¿©(=¾à°¡ Àü¾× º»ÀÎ ºÎ´ã)·Î ³ª´· »ÓÀÌÁö¿ä. ÇÐȸÀÇ ÀûÀÀÁõº¸´Ù Á¤ºÎÀÇ ÀûÀÀÁõÀÌ ´õ ³Ð¾îÁø »ç»ó ÃÊÀ¯ÀÇ »çŰ¡ ¹ß»ýÇÑ °ÍÀÔ´Ï´Ù.
Hp Ä¡·á ÀûÀÀÁõ (½ÉÆò¿ø) | 2017³â±îÁö | 2018³âºÎÅÍ |
¼Òȼº±Ë¾ç, MALT ¸²ÇÁÁ¾ | ±Þ¿© | ±Þ¿© |
Á¶±âÀ§¾Ï ³»½Ã°æÄ¡·á ÈÄ | Àü¾×º»Àκδã (100/100 ±Þ¿© =ÇÕ¹ý) | ±Þ¿© |
ITP | ÀÓÀÇ ºñ±Þ¿© (=ºÒ¹ý) | ±Þ¿© |
±âŸ ¸ðµç °æ¿ì | ÀÓÀÇ ºñ±Þ¿© (=ºÒ¹ý) | Àü¾×º»Àκδã (100/100 ±Þ¿© =ÇÕ¹ý) |
Àú´Â 2018³â ¹ßÇ¥µÈ Á¤ºÎÀÇ ¹æÄ§¿¡ Âù¼ºÇÕ´Ï´Ù (100/100 ºÎºÐ¸¸ »©°í). Ç︮ÄÚ¹ÚÅÍ °¨¿°ÀÌ È®ÀÎµÈ ¸ðµç ȯÀڴ Ưº°ÇÑ contraindicationÀÌ ¾ø´Â ÇÑ Á¦±ÕÄ¡·á¸¦ ¹Þ´Â °ÍÀÌ ÁÁÀ» °ÍÀ¸·Î »ý°¢ÇÕ´Ï´Ù. ÀþÀº »ç¶÷¿¡¼´Â À§¾Ï ¿¹¹æ È¿°ú¸¦ ±â´ëÇÒ ¼ö ÀÖ°í, Á߳⿡¼´Â À§¿°ÀÌ ÁÙ¾î À§¾Ï °ËÁø ³»½Ã°æÀÇ È¿°ú°¡ ÁÁ¾ÆÁú ¼ö ÀÖ°í, °í·É¿¡¼´Â ´ÙÀ½ ¼¼´ë·ÎÀÇ ÀüÆÄ¸¦ ¸·À» ¼ö ÀÖ´Ù´Â Á¡À» ¸ðµÎ °í·ÁÇÑ ÆÇ´ÜÀÔ´Ï´Ù. ¹°·Ð °í·É ȯÀÚ¶ó°í º»Àο¡°Ô ÀüÇô µµ¿òµÇÁö ¾Ê´Â °ÍÀº ¾Æ´Õ´Ï´Ù (¸µÅ©).
Ä¡·á ÀûÀÀÁõ ºÎºÐÀº ÀÓ»ó¿¡¼ Å« ¹®Á¦°¡ ¾ø½À´Ï´Ù. Æø³ÐÀº Ä¡·á¸¦ ¼±ÅÃÇÑ ÀÇ»ç´Â Á¤ºÎ ¹æÄ§À» µû¸£¸é µÇ°í, ´Ù¼Ò Á¦ÇÑÀûÀ¸·Î Ä¡·áÇÏ´Â °ÍÀÌ ÁÁ°Ú´Ù°í ÆÇ´ÜÇÑ ÀÇ»ç´Â ÇÐȸ °¡À̵å¶óÀÎÀ» µû¸£¸é µË´Ï´Ù.
¹®Á¦´Â °Ë»ç ÀûÀÀÁõÀÔ´Ï´Ù. "°ËÁø ³»½Ã°æ¿¡¼ Ç︮ÄÚ¹ÚÅÍ °Ë»ç¸¦ ÇØ¾ß Çϴ°¡?"ÀÇ À̽´ ¸»ÀÔ´Ï´Ù. 2018³â 2¿ù ÇöÀç Àú´Â ´Ù¼Ò À¯º¸ÀûÀÎ ÀÔÀåÀ» °¡Áö°í ÀÖ½À´Ï´Ù. ¾Ï, ±Ë¾ç, ´ÜÀÏ ¹Ì¶õ µî ¶Ñ·ÇÇÑ ÀûÀÀÁõÀÌ ÀÖ´Â °æ¿ì¿¡¸¸ Á¶Á÷°Ë»ç¸¦ Çϰí Ç︮ÄÚ¹ÚÅÍ È®ÀÎÀ» À§ÇÑ universal Á¶Á÷°Ë»ç´Â ¾ÆÁ÷ ±× ¿ªÇÒÀÌ Á¤¸³µÇÁö ¾ÊÀº °ÍÀ¸·Î »ý°¢Çϰí ÀÖ½À´Ï´Ù.
2018³â 10¿ù ³»°úÇÐȸ¿¡¼ °ü·ÃµÈ °ÀǸ¦ ÇÏ¿´½À´Ï´Ù.
1Â÷: PPI based triple therpay
2Â÷: Quadruple therapy
1998³â Helicobacter °¡À̵å¶óÀÎ
2013³â Helicobacter °¡À̵å¶óÀÎ
2017 »ó¹Ý±â±îÁö »ç¿ëÇÏ¿´´ø ó¹æ. ÀÌÈÄ 2013³â °¡À̵å¶óÀÎÀ» 100% ÁöŰ´Â ¹æÇâÀ¸·Î º¯°æÇÔ.
2017 ÇϹݱâºÎÅÍ »ç¿ë ÁßÀΠó¹æ (2013³â °¡À̵å¶óÀÎ 100% Áؼö version)
3Â÷: PPI + levofloxacin 250mg + amoxicillin 1,000mg, ÇÏ·ç 2¹ø 1ÁÖ
Amoxicillin ¿ë·®ÀÌ º¸Åë 750mg-1,000 mg bid°¡ ¸¹ÀÌ ¾²À̰í ÀÖ½À´Ï´Ù. (J Gastroenterol 2013)
2. 1Â÷ Á¦±ÕÄ¡·á ¹× 2Â÷ Á¦±ÕÄ¡·á ¹× ±âŸ ó¹æ
Ä¡·á °¡À̵å¶óÀο¡ ¾ð±ÞµÈ 󹿹ý (°¡Å縯º´¿ø ¹ÚÀç¸í. 2015-8-22. ´ëÇÑ»óºÎÀ§Àå°üÇ︮ÄÚ¹ÚÅÍÇÐȸ ¿öÅ©¼¥)
¾ÆÁ÷±îÁö ¿ì¸®³ª¶ó¿¡¼ 2Â÷ Á¦±ÕÄ¡·áÀÇ Ç¥ÁØÀû ó¹æÀº 2013³â Helicobacter °¡À̵å¶óÀο¡ Á¦½ÃµÈ ¹æ¹ýÀÔ´Ï´Ù. ÇÏ·ç 2¹ø ¾àÀÌ ÀÖ°í, ÇÏ·ç 3¹ø ¾àÀÌ ÀÖ°í, ÇÏ·ç 4¹ø ¾àÀÌ ÀÖ¾î¼ ¹«Ã´ º¹ÀâÇÕ´Ï´Ù.
Bismuth´Â ¿©·¯ Á¾·ù°¡ Àִµ¥ ÇöÀç »ç¿ëµÇ´Â °ÍÀº tablet ÇüÅÂÀÇ DeNol (bismuth subcitrate)ÀÔ´Ï´Ù. Elemental bismuth 120mgÀº DeNol·Î´Â 300mgÀÔ´Ï´Ù. µû¶ó¼ °¡À̵å¶óÀο¡ bismuth 120mgÀ¸·Î µÇ¾î ÀÖ´Â °ÍÀº DeNol 300mgÀ¸·Î ó¹æÇØ¾ß ÇÕ´Ï´Ù (EndoTODAY FAQ DeNol ¿ë·®¿¡ ´ëÇÏ¿©)
Bismuth quadruple therpay¿¡ ´ëÇÑ »ó¼¼ÇÑ ¼³¸íÀº À̼±¿µ ±³¼ö´ÔÀÌ Graham ¹Ú»ç¿Í ÇÔ²² ¾´ ¸®ºä¸¦ Âü°íÇϱ⠹ٶø´Ï´Ù (Graham & Lee. Gastroenterol Clin North Am. 2015 )
[2Â÷ Á¦±ÕÄ¡·á ºÎÀÛ¿ë Áß °ËÀº º¯]
2Â÷ Á¦±ÕÄ¡·á·Î ¸¹ÀÌ ¾²ÀÌ´Â quadruple therapy¿¡¼ °£È¤ °ËÀº º¯ÀÌ ³ªÅ¸³³´Ï´Ù. DeNol ¶§¹®À¸·Î »ý°¢ÇÕ´Ï´Ù. ÀúÀý·Î ÁÁ¾ÆÁý´Ï´Ù.
[2Â÷ Á¦±ÕÄ¡·á(4Á¦¿ä¹ý)ÀÇ Á¦±Õ ½ÇÆÐÀ²]
PPI + clarithromycin + amoxicillin ¿ä¹ýÀÇ Á¦±ÕÀ²ÀÌ ³·¾ÆÁö°í ÀÖ´Ù´Â °ÍÀº Àß ¾Ë·ÁÁø »ç½ÇÀÔ´Ï´Ù. ±×·¯³ª 1Â÷ Á¦±Õ¿ä¹ý¿¡ ½ÇÆÐÇÑ È¯ÀÚ¿¡¼ »ç¿ëµÇ´Â PPI + Denol+ tetracycline + metronidazole 4Á¦ ¿ä¹ýÀÇ Á¦±ÕÀ² º¯È¿¡ ´ëÇÑ Á¤º¸´Â ¾ÆÁ÷ ºÎÁ·ÇÑ ½ÇÁ¤ÀÔ´Ï´Ù. ´ëÇÑ»óºÎÀ§Àå°üÇ︮ÄÚ¹ÚÅÍÇÐȸÁö 2015³â 9¿ùÈ£¿¡ ¹ßÇ¥µÈ â¿øÆÄƼ¸¶º´¿ø ÀÚ·á´Â Ãæ°ÝÀûÀÔ´Ï´Ù. ¿ë·®°ú ±â°£ µîÀÌ Ç¥ÁØÈµÇÁö ¾Ê¾ÒÁö¸¸ ÀüüÀûÀ¸·Î 2Â÷ Á¦±ÕÄ¡·áÀÇ ¼º°ø·üÀÌ Á¡Â÷ ³·¾ÆÁö°í ÀÖ´Ù´Â °ÍÀÔ´Ï´Ù.
7ÀϺ¸´Ù 14ÀÏÀÌ ÀÛÁö¸¸ ºÐ¸íÇÏ°Ô Á¦±ÕÀ²ÀÌ ³ôÀº °Í °°½À´Ï´Ù. ±×·¯³ª ¿ì¸®³ª¶ó¿¡¼´Â ¾ÆÁ÷ 7ÀϱîÁö¸¸ ó¹æÀÌ Çã¿ëµÇ°í ÀÖ¾î¼ °í¹ÎÀÔ´Ï´Ù. (2017³â 10¿ù ÇöÀç) Àú´Â 7ÀÏÀ» ó¹æÇϰí ÀÖÁö¸¸, 14ÀϱîÁö ó¹æÇصµ »è°¨µÇ´Â °æ¿ì´Â º°·Î ¾ø´Ù°í ÇÕ´Ï´Ù.
[2Â÷ Á¦±Õ ½ÇÆÐ ½Ã »ç¿ëÇÒ ¼ö ÀÖ´Â Ç×»ýÁ¦]
[4Á¦ ¿ä¹ýÀ» Ç︮ÄÚ¹ÚÅÍ 1Â÷ Á¦±ÕÄ¡·á¿¡ »ç¿ëÇÒ ¼ö Àִ°¡?]
¼±¸ÀÇ °¡À̵å¶óÀÎ, ¿ì¸®³ª¶óÀÇ °¡À̵å¶óÀÎ ¹× ¸¹Àº Àü¹®°¡ ÀǰßÀº 4Á¦ ¿ä¹ýÀ» 1Â÷ Á¦±ÕÄ¡·á¿¡ »ç¿ëÇÏ´Â °ÍÀÌ ÁÁ°Ú´Ù´Â °ÍÀÔ´Ï´Ù. ±×·¯³ª Àû¾îµµ 2019³â 7¿ù 31ÀÏ ÇöÀç ¿ì¸®³ª¶ó¿¡¼´Â Àû¹ýÇÏ°Ô »ç¿ëÇÒ ¼ö ¾ø½À´Ï´Ù. ½ÉÆò¿ø ´äº¯ÀÔ´Ï´Ù. ±Ù°Å°¡ ´Ù¼Ò ºÒÃæºÐÇÏ¿© ¾È µÈ´Ù´Â °ÍÀÔ´Ï´Ù. ÀÌ·±...
´ÙÇེ·´°Ô À̶§¹®¿¡ Àû±ØÀûÀÎ »è°¨ÀÌ ÀÌ·ç¾îÁö°í ÀÖÁö´Â ¾Ê´Â °Í °°½À´Ï´Ù.
4. ¼øÂ÷Ä¡·á, µ¿½ÃÄ¡·á, Ç×»ýÁ¦ °¨¼ö¼º ±â¹Ý Ä¡·á
(1) ¼øÂ÷Ä¡·á (sequential therapy)´Â Ç¥ÁØ 1Â÷ 3Á¦¿ä¹ý¿¡ ºñÇÏ¿© Á¦±Õ ¼º°ø·üÀÌ ¾à°£ ³ôÁö¸¸ 󹿰ú Åõ¾àÀÌ º¹ÀâÇÏ¿© °ÅÀÇ »ç¿ëµÇÁö ¾Ê½À´Ï´Ù.
(2) µ¿½ÃÄ¡·á (concomitant therapy)´Â non-Bismuth 4Á¦¿ä¹ýÀÔ´Ï´Ù. PPI¿Í ÇÔ²² metronidazole, clarithromycin, amoxicillinÀ» ¸ðµÎ »ç¿ëÇÏ´Â Ä¡·áÀÔ´Ï´Ù. ±âÁ¸ÀÇ 3Á¦¿ä¹ýº¸´Ù Á¦±ÕÀ²ÀÌ ´õ ³ôÀº °Í(70-75% vs 90%)À¸·Î Æò°¡µÇ°í ÀÖ¾î¼ ÇâÈÄ °¡Àå À¯¸ÁÇÑ Ä¡·á Áß ÇϳªÀÔ´Ï´Ù. ´Ù¸¸ ¾ÆÁ÷ ½ÉÆò¿ø¿¡¼ ÃÊÄ¡·á·Î Çã°¡ÇÑ ¿ë¹ýÀÌ ¾Æ´Ï¶ó´Â Á¡ÀÌ ¹®Á¦ÀÔ´Ï´Ù. (2019³â 11¿ù ÇöÀç).
Ç¥ÁØ»ïÁ¦¿ä¹ý (7ÀÏ), ¼øÂ÷Ä¡·á (10ÀÏ, lansoprazole, amoxicillin 5ÀÏ → lansoprazole, clarithromycin, metronidazole 5ÀÏ) ¹× µ¿½ÃÄ¡·á (10ÀÏ, lansoprazole, amoxicillin, clarithromycin, metronidazole)ÀÇ ºñ±³ (Kim BJ. Gut Liver 2019;13:531) ITT PP Ç¥ÁØ 3Á¦¿ä¹ý (7ÀÏ) 63.9% 71.4% ¼øÂ÷Ä¡·á (10ÀÏ) 76.3% 85.0% µ¿½ÃÄ¡·á (10ÀÏ) 81.2% 90.6%
Eradication rates in the three treatment groups in the per-protocol (PP) analysis. In the PP analysis, the eradication rate in the 10 days (10d)-ST group was significantly higher than that in the 7d-TT group (85.0% vs 71.4%, p<0.001). The eradication rate in the 10d-CT group was significantly higher than that in the 7d-TT group (90.6% vs 71.4%, p<0.001). (Kim BJ. Gut Liver 2019;13:531)
µ¿½ÃÄ¡·á´Â ´Ù·®ÀÇ Ç×»ýÁ¦¸¦ µ¿½Ã¿¡ »ç¿ëÇϹǷΠ¸»ÇÏÀÚ¸é Ç×»ýÁ¦ ³²¿ëÀÇ ¿ì·Áµµ ÀÖ½À´Ï´Ù. ³í¶õÀº ÀÖÁö¸¸ (1) sensitiveÇϸé ÇÑ °¡Áö Ç×»ýÁ¦¸¸ ½áµµ µÈ´Ù, (2) ÀúÇ×¼ºÀÌ ÀÖÀ¸¸é ±× Ç×»ýÁ¦´Â ºÒÇÊ¿äÇÏ´Ù°í °¡Á¤ÇÏ°í ½Ã³ª¸®¿À¸¦ ¸¸µé¸é ¾Æ·¡¿Í °°½À´Ï´Ù.
Risk of antibiotic overuse in concomitant therapy MET CLA Not required Sensitive Resistent CLA Resistent Sentivie MET Sensitive Sensitive CLA or MET Resistent Resistent CLA and MET
(3) Ç×»ýÁ¦ °¨¼ö¼º ±â¹Ý Ä¡·á´Â ¹è¾ç ÈÄ Ç×»ýÁ¦ °¨¼ö¼ºÀ» È®ÀÎÇÏ°í ±× °á°ú¿¡ µû¶ó Ä¡·áÇÏ´Â ¹æ¹ýÀε¥ °¡Àå ÀÌ»óÀûÀÌÁö¸¸ ¸Å¿ì º¹ÀâÇÏ°í ³Î¸® Àû¿ëÇÏ±â ¾î·Æ½À´Ï´Ù. RoutineÀ¸·Î ¹è¾ç°ú Ç×»ýÁ¦ °¨¼ö¼º °Ë»ç¸¦ ÇÒ ¼ö ÀÖ´Â ±â°üÀÌ °ÅÀÇ ¾ø±â ¶§¹®ÀÔ´Ï´Ù. ´ë½Å PCRÀ» ÀÌ¿ëÇÏ¿© clarithromycin °¨¼ö¼º À¯ÀüÀÚ °Ë»ç °á°ú¿¡ µû¶ó clarithromycinÀ» ³Ö°í »©´Â ¹æ¹ýÀÌ ¾²À̱⵵ ÇÕ´Ï´Ù.
[2020-5-7. Web seminar Áú¹®]
µ¿½Ã Ä¡·á¿¡ ½ÇÆÐÇÏ¿´À» °æ¿ì ºñ½º¹«½º ±â¹Ý 4Á¦ ¿ä¹ý »ç¿ëÀº ¾î¶»½À´Ï±î?
[2020-5-7. Web seminar ÀÌÁØÇà ´äº¯]
µ¿½Ã Ä¡·á´Â non-bismuth 4Á¦ ¿ä¹ýÀÔ´Ï´Ù. ÀüÅëÀûÀÎ ºñ½º¹«½º 4Á¦ ¿ä¹ý°ú PPI¿Í tetracyclineÀÌ °ãĨ´Ï´Ù. Non-bismuth 4Á¦ ¿ä¹ý ½ÇÆÐ ½Ã ºñ½º¹«½º 4Á¦ ¿ä¹ýÀ» ¾²¸é tetracyclineÀº °ãÄ¡Áö¸¸ bismuth¿Í metronidazoleÀº °ãÄ¡Áö ¾ÊÀ¸¹Ç·Î ½ÃµµÇØ º¼ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù¸¸, È¿°ú´Â ¹ÌÁö¼öÀÔ´Ï´Ù. ÀÌ¿¡ ´ëÇÑ ÁÁÀº ¿¬±¸ °á°ú¸¦ º¸Áö ¸øÇß½À´Ï´Ù. ±Ù°Å´Â ¾øÁö¸¸ ÃßÃø°Çµ¥ tetracycline ¸¶Àú »õ Ç×»ýÁ¦·Î ¹Ù²Ù´Â Àü·«ÀÌ ³´Áö ¾ÊÀ»Áö ¸ð¸£°Ú½À´Ï´Ù.
5. Á¦±Õ Ä¡·á ÈÄ Á¦±Õ ¼º°ø ¿©ºÎ È®ÀÎ - Á¦±ÕÄ¡·á ÈÄ °á°ú È®ÀÎÀ» ¾È ÇßÀ» ¶§ÀÇ ¹®Á¦Á¡
ÇöÀç Ç︮ÄÚ¹ÚÅÍ 1Â÷ Á¦±ÕÄ¡·áÀÇ Á¦±Õ ¼º°ø·üÀÌ 70-80% ¼öÁØÀ̹ǷΠÁ¦±ÕÄ¡·á ÈÄ ¹Ýµå½Ã Á¦±Õ ¼º°ø ¿©ºÎ¸¦ È®ÀÎÇϵµ·Ï ±Ç°íµÇ°í ÀÖ½À´Ï´Ù.
±×·¯³ª ¾à¸¸ ¸Ô°í ÃßÀû °Ë»ç¸¦ ¹ÞÁö ¾Ê´Â ºÐÀÌ »ó´çÈ÷ ¸¹½À´Ï´Ù. ¸Å¿ì Á¤¼º½º·´°Ô ¼³¸íÀ» ÇØµµ ±×·¸½À´Ï´Ù. ¾Æ·¡ ȯÀÚ´Â °ËÁø ³»½Ã°æ¿¡¼ linear ulcer scar°¡ º¸¿´´ø ºÐÀ¸·Î Á¦±ÕÄ¡·á ¾àÀ» ó¹æÇÏ¿´´Âµ¥ UBT´Â ¹ÞÁö ¾ÊÀ¸¼Ì½À´Ï´Ù. 10°³¿ù ÈÄ symptomatic duodenal ulcer°¡ ¹ß»ýÇÏ¿´°í Ç︮ÄÚ¹ÚÅÍ ¾ç¼ºÀ̾ú½À´Ï´Ù. °í¹ÎÇÏ´Ù°¡ Bithmus ±â¹Ý 4Á¦¿ä¹ýÀ» ó¹æÇÏ¿´½À´Ï´Ù.
[2014-5-15. ¾Öµ¶ÀÚ Áú¹®]
·ÎÄÃÀÇ Çö½ÇÀÌ ³ì³ìÄ¡ ¾Ê´Ù´Â ¾ê±â´Â ¸¹ÀÌ µé¾úÁö¸¸ ½Ç»óÀº ´õ Âü´ãÇϳ׿ä. Á¦°¡ ÀÖ´Â °÷¿¡¼ µå¹°Áö ¾Ê°Ô ¸¸³ª´Â ÄÉÀ̽º°¡ Àִµ¥¿ä... 1Â÷ Á¦±ÕÀ» ¸¶¹«¸®Çϰí ÀÌÈÄ UBT µîÀÇ F/UÀ» 1-2³â ÇÏÁö ¾Ê´Ù°¡ ´Ù½Ã °ËÁø ½Ã±â°¡ µÇ¾î CLO³ª Á¶Á÷°Ë»ç¸¦ ½ÃÇàÇϸé Ç︮ÄÚ¹ÚÅÍ ¾ç¼ºÀÎ °æ¿ì°¡ ´õ·¯ ÀÖ½À´Ï´Ù. ÀÌ °æ¿ì 1Â÷ Á¦±ÕÀÇ ½ÇÆÐ¸¦ È®ÀÎÇÏÁö ¸øÇÑ °ÍÀ¸·Î º¸°í 2Â÷ Á¦±Õ¾àÀ» Åõ¿©ÇØ¾ß ÇÏ´ÂÁö, ȤÀº 1Â÷ Á¦±ÕÀº ¼º°øÇÑÁö ½ÇÆÐÇÑÁö ¸ð¸£³ª(ÀÏ´Ü ¼º°øÇÏ¿´À¸³ª Àç¹ßµÈ °ÍÀ¸·Î °£ÁÖÇϰí) ´Ù½Ã 1Â÷ ¾àÀ» Åõ¿©Çϰí UBT ÃßÀû°Ë»ç¸¦ ±×¶§ºÎÅÍ È®½ÇÈ÷ ÇØ¾ßÇÏ´ÂÁö Àß ¸ð¸£°Ú½À´Ï´Ù. ÀÌ·± °æ¿ì Ưº°È÷ »ç¿ëµÉ ¼ö ÀÖ´Â regimenÀ» ÃßÃµÇØÁÖ½Ç ¼ö ÀÖ´ÂÁö¿ä. ¹®ÇåÀ» ã¾ÆºÁµµ Àß ¸ð¸£°Ú°í ¸î¸î ¼ÒȱâÀü¹® ¼±»ý´Ôµé²² ¿©ÂåºÁµµ ÀǰßÀÌ °¥¸³´Ï´Ù. Ç㳪 2Â÷ Á¦±Õ¾àÀ» Åõ¿©ÇÏ´Â°Ô ¸Â´Ù´Â ºÐµéÀÌ ´õ ÀÖÀ¸½Å °Í °°±ä ÇÕ´Ï´Ù.
[2014-5-16. ÀÌÁØÇà ´äº¯]
¸ÕÀú Á¦±ÕÄ¡·áÀÇ ÀûÀÀÁõÀÎÁö ¾Æ´ÑÁö È®ÀÎÇÏ¿© ÀûÀÀÁõÀÌ ¾Æ´Ï¸é Ä¡·áÇÒ Çʿ䰡 ¾ø½À´Ï´Ù. ¸¸¾à ÀûÀÀÁõÀÌ ¸Â´Ù¸é, Àú °°À¸¸é ±×³É óÀ½À̶ó°í »ý°¢Çϰí Ä¡·áÇϰí ÀÖ½À´Ï´Ù. Ưº°ÇÑ regimenÀº ¾ø°í ±×³É º¸ÅëÀÇ PPI + amoxicillin + clarithromycinÀ» ¾¹´Ï´Ù. Âø½ÇÇÏ°Ô 8ÁÖ ÈÄ UBT¸¦ Çϵµ·Ï ±ÇÇÕ´Ï´Ù. ÀÇ»çÀÇ ÃßõÀ» µû¸£Áö ¾Ê´Â ȯÀÚ´Â ¾î¶»°Ô ÇØ º¼ ¼ö ¾ø½À´Ï´Ù.
[2014-7-16. ¾Öµ¶ÀÚ Áú¹®]
º¸Åë Á¦±ÕÀÌ ¼º°øÇß´ÂÁö ²À È®ÀÎÇÒ Çʿ䰡 ÀÖ´Â ÀûÀÀÁõÀÌ ¾Æ´Ï¸é Á¦±Õ¿ä¹ýÈÄ º°´Ù¸¥ È®ÀÎ ÀýÂ÷¸¦ Çϰí ÀÖÁö ¾Ê½À´Ï´Ù. ±³¼ö´ÔÀº ¾î¶»°Ô ÇϽôÂÁö¿ä. UBT°¡ ÀÖ´Â °÷À¸·Î º¸³»¼ È®ÀÎÇÏ´Â °Ô ³ªÀ»·±Áö °í°ß ¿©Âã½À´Ï´Ù.
[2014-7-30. ÀÌÁØÇà ´äº¯]
Á¦±ÕÄ¡·á°¡ ¼º°øÇß´ÂÁö ²À È®ÀÎÇØ¾ß ÇÏ´Â ÀûÀÀÁõÀÌ µû·Î ÀÖ´Â °ÍÀÌ ¾Æ´Õ´Ï´Ù. ¸ðµç Helicobacter Á¦±ÕÄ¡·á ÈÄ¿¡´Â ¹Ýµå½Ã Á¦±Õ ¼º°ø¿©ºÎ¸¦ È®ÀÎÇØ¾ß ÇÕ´Ï´Ù. Á¦±Õ ¼º°ø¿©ºÎ¸¦ È®ÀÎÇÏÁö ¾ÊÁö ¾Ê°í ±×³É Ç×»ýÁ¦¸¦ Åõ¿©ÇÏ´Â °ÍÀº ³ª»Û °üÇàÀÔ´Ï´Ù. Ʋ¸° ÀÇ·áÇàÀ§ÀÔ´Ï´Ù. °³¾÷°¡³ª °ÇÁø¼¾ÅÍ¿¡¼ Á¦±Õ ¼º°ø¿©ºÎ¸¦ È®ÀÎÇÏ´Â °ÍÀÌ ½¬¿î ÀÏÀº ¾Æ´Ò °ÍÀÔ´Ï´Ù. ±×·¯³ª ½±Áö ¾Ê´Ù´Â °ÍÀº Ʋ¸° ÀÇ·áÇàÀ§¿¡ ´ëÇÑ º¯¸íÀÏ ¼ö ¾ø½À´Ï´Ù. Á¤È®ÇÑ ÀûÀÀÁõ¿¡ µû¶ó Á¤È®È÷ Ä¡·áÇÏ´Â °ÍÀÌ ¿Ç½À´Ï´Ù. ¸ðµç Helicobacter Á¦±ÕÄ¡·á¿¡´Â Á¦±Õ ¼º°ø¿©ºÎ È®ÀΰúÁ¤ÀÌ ÇʼöÀÔ´Ï´Ù. UBT°¡ °¡Àå ÁÁ½À´Ï´Ù. CLOtest³ª Giemsa ¿°»öÀ» ¹Ýº¹ÇÒ ¼öµµ ÀÖ½À´Ï´Ù. ¿©ÇÏÆ° ¿øÄ¢Àº ÁöÄÑÁ®¾ß ÇÕ´Ï´Ù.
[2016-7-5. ¾Öµ¶ÀÚ Áú¹®]
¾È³çÇϼ¼¿ä. Àú´Â ÇöÀç 1Â÷ local¿¡¼ ±Ù¹« ÁßÀÔ´Ï´Ù. ÀÛÀºº´¿øÀÌÁö¸¸ ¿Â°® ȯÀÚ¸¦ ¸¸³ª´Ùº¸´Ï »õ·Î¿î Àç¹Ìµµ ´À³¢°í ÀÖ½À´Ï´Ù. ¿¹»óÇÏÁö ¸øÇß´ø ÀϵéÀÌ ¸¹°í °¡À̵å¶óÀε ³ª¿ÀÁö ¾Ê´Â »óȲÀ» Á¢ÇÒ ÀÏÀÌ ¸¹¾Æ °í¹ÎÀ» ¸¹ÀÌ ÇϰԵ˴ϴÙ. Áú¹®ÀÌ ÀÖ¾î¼ ¸ÞÀÏÀ» µå¸³´Ï´Ù.
½ÊÀÌÁöÀå±Ë¾ç ¹ÝÈçÀÌ ÀÖ¾î 2014³â 12¿ù¿¡ 1Â÷ Á¦±ÕÄ¡·á¸¦ Çß°í 2015³â 10¿ù À§³»½Ã°æ Á¶Á÷°Ë»ç HP(+)°¡ È®ÀεǾú´Âµ¥ 2Â÷Ä¡·á´Â ÇÏÁö ¾Ê¾Ò´ø ȯÀÚ¸¦ 6¿ù¿¡ °Ç°°ËÁø À§³»½Ã°æÀ» Çß½À´Ï´Ù. 1Â÷Ä¡·á ½ÇÆÐ¸¦ °í·ÁÇØ Á¶Á÷°Ë»ç¸¦ ½ÃÇàÇߴµ¥ Giemsa ¿°»ö¿¡¼ HP(+)°¡ È®ÀÎÀÌ µÇ¾ú½À´Ï´Ù.
ù Á¦±ÕÄ¡·á ÈÄ Á¶Á÷°Ë»ç°¡ 10°³¿ù Á¤µµÀÇ °£°ÝÀÌ ÀÖ¾î¼ 1Â÷ ½ÇÆÐÀÎÁö Á¦±Õ ÈÄ Àç°¨¿°ÀÎÁö ÆÇ´ÜÀÌ ¾î·Á¿ü½À´Ï´Ù. ÀÌ °æ¿ì ¾î¶»°Ô Ä¡·á¸¦ ÇÏ´Â °ÍÀÌ ÁÁÀ»±î¿ä?
[2016-7-9. ÀÌÁØÇà ´äº¯]
ÁÁÀº ¹®Á¦¿¡ ÁÁÀº ´äÀÌ ÀÖ½À´Ï´Ù. ¿øÄ¢ÀÌ Á¸ÁßµÇÁö ¾Ê´Â ÀÇ·á ÇöÀåÀÇ ¿©·¯ ¹®Á¦¿¡ ´ëÇÑ ÁÁÀº ´äÀº ã±â ¾î·Æ½À´Ï´Ù. ÇöÀç ¿ì¸®³ª¶ó ÀÇ·á ÇöÀåÀº 500¿øÂ¥¸® Â¥Àå¸é°°Àº ¾îó±¸´Ï ¾ø´Â »óȲÀÔ´Ï´Ù. µµ¹«Áö ¿øÄ¢À» Áöų ¼ö ¾ø´Â ½Î±¸·Á ´ë·® »ý»ê ½Ã½ºÅÛÀÔ´Ï´Ù.
¹®ÀÇÇϽŠÁõ·Ê´Â 1Â÷ Á¦±ÕÄ¡·á ÈÄ Á¦±Õ ¼º°ø¿©ºÎ¸¦ È®ÀÎÇÏÁö ¾Ê°í ÇÑÂü ÈÄ °Ë»ç¿¡¼ Ç︮ÄÚ¹ÚÅÍ ¾ç¼ºÀ¸·Î ³ª¿Ô½À´Ï´Ù. ¿©·¯ ¼±»ý´Ôµé¿¡°Ô ¹°¾îº¸¾Ò´Âµ¥ ´Ùµé ´Ù¸¥ À̾߱⸦ Çϰí ÀÖ¾ú½À´Ï´Ù. 1-2³â À̳»¿¡ Ç︮ÄÚ¹ÚÅÍ ¾ç¼ºÀ¸·Î ³ª¿Ô´Ù¸é 2Â÷ Á¦±ÕÄ¡·á¸¦ ±ÇÇÑ´Ù´Â ºÐµéÀÌ ¸¹¾Ò½À´Ï´Ù. ³ª¸§ Ÿ´çÇÑ À̾߱âÀÔ´Ï´Ù. ±×·¯³ª 'Á¦±ÕÄ¡·á ÈÄ¿¡´Â Á¦±Õ ¼º°ø¿©ºÎ È®ÀÎÀÌ ÇÊ¿äÇÏ´Ù'´Â ³Ê¹«³ª ´ç¿¬ÇÑ ¿øÄ¢ÀÌ ÁöÄÑÁöÁö ¾Ê¾Ò´ø »óȲÀ̹ǷÎ, Àú´Â ¿øÄ¢ÀûÀÎ Á¢±ÙÀ» ÇÕ´Ï´Ù. °ú°Å¿¡ ½ÃÇàµÇ¾ú´ø ¾ûÅ͸® Ä¡·á´Â ¾ÈÇß´ø °ÍÀ¸·Î Ĩ´Ï´Ù. Á¦±Õ ¼º°ø¿©ºÎ¸¦ È®ÀÎÇÏÁö ¾ÊÀº °ÍÀº ¾ûÅ͸® Ä¡·áÀÔ´Ï´Ù.
Àú´Â ȯÀÚ¿¡°Ô 'Á¦±Õ ¼º°ø¿©ºÎ È®ÀÎÀÌ ÇÊ¿äÇÏ´Ù'´Â Á¡À» È®½ÇÈ÷ ¾Ë¸° ÈÄ Ã³À½ºÎÅÍ ´Ù½Ã Ä¡·áÇϰí ÀÖ½À´Ï´Ù. 1-2³â Àü¿¡ ¾àÀ» ºüÁü ¾øÀÌ Àß ¸Ô¾ú´ÂÁö ±â¾ïÇÏÁö ¸øÇÏ´Â °æ¿ì°¡ ´ëºÎºÐÀ̶ó´Â Á¡µµ °í·ÁÇÑ °áÁ¤ÀÔ´Ï´Ù. Ưº°ÇÑ regimenÀº ¾ø½À´Ï´Ù. ±×³É º¸ÅëÀÇ PPI + amoxicillin + clarithromycin 1ÁÖ ¿ä¹ýÀ» ¾¹´Ï´Ù. 8ÁÖ ÈÄ UBT¸¦ Çϵµ·Ï ±ÇÇÕ´Ï´Ù. ȯÀÚ°¡ ÀÇ»çÀÇ ¸»À» µèÁö ¾ÊÀ¸¸é ¾î¿ ¼ö ¾ø½À´Ï´Ù. ±×·¯³ª ÀÇ»ç´Â Á¦´ë·Î ÇØ¾ß ÇÕ´Ï´Ù. Á¦±Õ ¼º°ø¿©ºÎ È®ÀÎÀ» ²À ±ÇÇսôÙ.
[2018-10-23. ¾Öµ¶ÀÚ Áú¹®]
¾È³çÇÏ½Ê´Ï±î ±³¼ö´Ô ¾Öµ¶ÀÚ XXXÀÔ´Ï´Ù. ¿À·£¸¸¿¡ Àλçµå¸³´Ï´Ù. ¿À´Ã ÀúÈñ º´¿ø Æç·Î¿ìµé »çÀÌ¿¡¼ Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á ÈÄ f/u °Ë»ç¿¡ ´ëÇØ ¿¶í Åä·ÐÀÌ ¹ú¾îÁ³½À´Ï´Ù. Á¦°¢°¢ °Ë»ç¹ýÀÌ ´Þ¶ú±â ¶§¹®ÀÔ´Ï´Ù
±³¼ö´Ô²²¼´Â EndoTODAY¿¡ "¸ðµç Helicobacter Á¦±ÕÄ¡·á¿¡´Â Á¦±Õ ¼º°ø¿©ºÎ È®ÀΰúÁ¤ÀÌ ÇʼöÀÔ´Ï´Ù. UBT°¡ °¡Àå ÁÁ½À´Ï´Ù. CLOtest³ª Giemsa ¿°»öÀ» ¹Ýº¹ÇÒ ¼öµµ ÀÖ½À´Ï´Ù"¶ó°í ±â¼úÀ» ÇØ³õÀ¸¼Ì½À´Ï´Ù. Àú´Â DU+ H. pylori¿¡´Â ´ç¿¬È÷ UBT·Î È®ÀÎÇÕ´Ï´Ù. ±»ÀÌ ³»½Ã°æÀ¸·Î ´Ù½Ã º¼ Çʿ䰡 ¾øÀ¸´Ï±î¿ä. ÇÏÁö¸¸ GU+H. pylori´Â ´Ù¸¨´Ï´Ù. À§±Ë¾ç¿¡ Á¦´ë·Î Ä¡À¯µÇ°í ÀÖ´ÂÁö È®ÀÎÇϱâ À§ÇØ F/U EGD°¡ ÇÊ¿äÇϱ⠶§¹®¿¡ ³»½Ã°æÇÏ¸é¼ Bx with silver stainÀ¸·Î Á¦±Õ Ä¡·á ¿©ºÎ¸¦ È®ÀÎÇÏ¸é µÈ´Ù°í »ý°¢Ç߱⠶§¹®ÀÔ´Ï´Ù. ±×·¡¼ ³»½Ã°æÇÏ´Â »ç¶÷µé¿¡°Ô UBT¸¦ Áߺ¹À¸·Î °Ë»çÇϰí ÀÖÁö´Â ¾Ê½À´Ï´Ù. ÇÏÁö¸¸ »ç¶÷µé ¸¶´Ù ÀǰßÀÌ ´Ù¸¨´Ï´Ù
1. Àú ó·³ silver stain¸¸ ó¹æÇÏ´Â »ç¶÷
2 . UBT¸¸ ó¹æÇÏ´Â »ç¶÷
3. CLO¸¸ ó¹æÇÏ´Â »ç¶÷
4. UBT + SilverÇÏ´Â »ç¶÷
5. UBT + CLO ÇÏ´Â »ç¶÷..Àú´Â Á¦±ÕÄ¡·á ÈÄ È®Àμö´ÜÀ¸·Î CLO´Â ¼±È£ÇÏÁö ¾Ê½À´Ï´Ù. À§±Ë¾çÀ» È®½ÇÇÏ°Ô Ä¡·áÇÏ°í ½Í¾î¼ µ¿³×º´¿ø°¡¼ PPI¸¦ Ãß°¡·Î ´õ º¹¿ëÇÏ°í ¿Â È¯ÀÚ¸¦ º» ÀûÀÌ Àֱ⠶§¹®ÀÔ´Ï´Ù.
"UBT°¡ °¡Àå ÁÁ´Ù"´Â ±Ù°Å°¡ ÀÖ´ÂÁö¿ä? °¡À̵å¶óÀο¡´Â UBTµµµÇ°í silver µµ µÇ°í.. ÀÌ·±½ÄÀ¸·Î¸¸ ³ª¿ÍÀÖ½À´Ï´Ù¸¸... ¸¸¾à¿¡ UBT°¡ silver stainº¸´Ù ´õ ¹Î°¨µµ°¡ ³ô´Ù´Â ±Ù°Å°¡ ÀÖ´Ù¸é¾ÕÀ¸·Î´Â UBT¸¦ ó¹æÇÒ »ý°¢ÀÔ´Ï´Ù. ¹Ù»Ú½Åµ¥ ´Ã °¨»çµå¸³´Ï´Ù.
[2018-10-24. ÀÌÁØÇà ´äº¯]
¹Ý°©½À´Ï´Ù. "¿À´Ã ÀúÈñ º´¿ø Æç·Î¿ìµé »çÀÌ¿¡¼ Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á ÈÄ f/u °Ë»ç¿¡ ´ëÇØ ¿¶í Åä·ÐÀÌ ¹ú¾îÁ³½À´Ï´Ù."¶ó´Â ºÎºÐ¿¡¼ ´õ¿í ¹Ý°¡¿ü½À´Ï´Ù. Áú¹®Çϰí, ´äº¯Çϰí, Åä·ÐÇϰí, ³í¹ÚÇÏ´Â °úÁ¤¿¡¼ ÀÇ·á¿Í Çй®Àº ¹ßÀüÇϱ⠸¶·ÃÀÔ´Ï´Ù. ´õ¿í °¡¿Â÷°Ô Åä·ÐÇϱ⠹ٶø´Ï´Ù.
¾ð±ÞÇϽŠ¹Ù¿Í °°ÀÌ 2013³â °¡À̵å¶óÀο¡´Â ¾Æ·¡¿Í °°ÀÌ µÇ¾î ÀÖ½À´Ï´Ù. Ç︮ÄÚ¹ÚÅÍ 1Â÷ Á¦±ÕÄ¡·á ÈÄ ¾î¶² °Ë»ç°¡ °¡Àå sensitivity°¡ ÁÁÀºÁö head-to-head comparison¿¡¼ ¾î¶² °á°ú°¡ ÀÖ¾ú´ÂÁö ã¾Æº¸Áö ¸øÇß½À´Ï´Ù.
Á¦ styleÀ» ¼Ò°³ÇÏ´Â °ÍÀÌ ³ªÀ» °Í °°½À´Ï´Ù. Àúµµ ¼±»ý´Ô°ú ¸¶Âù°¡Áö·Î ½ÊÀÌÁöÀå ±Ë¾ç ÃßÀû°Ë»ç¿¡¼´Â UBT¸¦ Çϰí ÀÖ½À´Ï´Ù. À§±Ë¾ç ÃßÀû°Ë»ç¿¡¼´Â UBT¿Í Giemsa stainingÀ» ÇÕ´Ï´Ù. (1) À§±Ë¾ç¿¡¼´Â ¾îÂ¥ÇÇ ÃßÀû ³»½Ã°æ °Ë»ç°¡ ÇÊ¿äÇϰí, (2) Ç︮ÄÚ¹ÚÅÍ¿¡ ´ëÇØ¼´Â ÇÑ °¡Áö °Ë»çº¸´Ù µÎ °¡Áö °Ë»ç¸¦ ½ÃÇàÇÏ¿© ¸ðµÎ À½¼ºÀÏ ¶§ º¸´Ù Á¤È®ÇÏ°Ô Á¦±Õ ¼º°øÀ» È®ÀÎÇÒ ¼ö Àֱ⠶§¹®ÀÔ´Ï´Ù.
CLOtest´Â Giemsa testº¸´Ù ÆíÇÑ Ãø¸éµµ ÀÖÁö¸¸, ºÒÆíÇÑ Ãø¸éµµ ÀÖ½À´Ï´Ù. °Ë»çÀÚ°¡ CLOtest kit¸¦ º¸°üÇÏ¿© ÀûÀýÇÑ ½Ã°£¿¡ ÆÇµ¶ÇÏ°í ±× °á°ú¸¦ Àü»ê¿¡ ÀÔ·ÂÇÏ´Â °ÍÀÌ ¿©°£ ºÒÆíÇÏÁö ¾Ê½À´Ï´Ù. °Ô´Ù°¡ »ç¿ëÇÑ CLOtest kit´Â ¾Æ¹« °÷¿¡ ¹ö¸®¸é ¾È µË´Ï´Ù. ÀÎü Á¶Á÷À̰í ID°¡ ºÙ¾îÀֱ⠶§¹®¿¡ Á¤½ÄÀ¸·Î ÀÎü À¯·¡ Æó±â¹° ó¸® ÀýÂ÷¿¡ µû¶ó ¹ö·Á¾ß ÇÕ´Ï´Ù. ÃÖ¼ÒÇÑ ÀÏ¹Ý ¾²·¹±âÅë¿¡ ¹ö¸®¸é ¾ÈµË´Ï´Ù.
Áø·á ÇöÀå¿¡¼´Â °¢ °Ë»çÀÇ sensitivity¿Í specificity°¡ ¾ö¹ÐÇÑ Àӻ󿬱¸º¸´Ù ³·°Ô ³ª¿À´Â °æÇâÀÌ ÀÖ½À´Ï´Ù. UBT¿Í Giemsa test¸¦ µ¿½Ã¿¡ ½ÃÇàÇØº¸¸é ÇÑ °¡Áö¸¸ ¾ç¼ºÀ¸·Î ³ª¿À´Â ¿¹°¡ ¸Å¿ì ¸¹½À´Ï´Ù. ¿äÁò °¢ º´¿ø º´¸®°ú Àü°øÀǰ¡ ºÎÁ·ÇؼÀÎÁö Helicobacter¸¦ ÀÚ¼¼È÷ ºÁ ÁÖÁö ¾Ê°í ÀÖ´Â °Í °°´Ù´Â ´À³¦µµ °¡Áö°í ÀÖ½À´Ï´Ù. »ç½Ç ¿ì¸®³ª¶ó º´¸®°ú ÀÇ»çµéÀÇ ¾÷¹«·®Àº ³Ê¹« ¸¹½À´Ï´Ù. ³»½Ã°æ Àǻ絵 ¸¶Âù°¡ÁöÀÌÁö¸¸...... ¿©ÇÏÆ° »ç¶÷¿¡¼ ÃæºÐÇÑ ½Ã°£À» ÁÖÁö ¾ÊÀ¸¸é ±â°è°¡ »ç¶÷º¸´Ù ³ªÀ» ¼ö ÀÖ½À´Ï´Ù.
Helicobacter Á¶Á÷°Ë»ç¿Í serologyÀÇ Â÷ÀÌ´Â »ó´çÇÕ´Ï´Ù. ÀÌ¿¡ ´ëÇØ¼´Â °Ç±¹´ë À̼±¿µ ±³¼ö´Ô²²¼ »ó¼¼È÷ ºÐ¼®ÇÑ ¹Ù ÀÖÀ¸´Ï Âü°íÇϱ⠹ٶø´Ï´Ù (Kim JH, Lee SY. Helicobacter 2018). Á¶Á÷°Ë»çÀÇ false positive°¡ »ó´çÈ÷ ¸¹Àºµ¥ ±× ÀÌÀ¯¿¡ ´ëÇÏ¿© ºÐ¼®µÇ¾î ÀÖ½À´Ï´Ù.
"Àú´Â Á¦±ÕÄ¡·á ÈÄ È®Àμö´ÜÀ¸·Î CLO´Â ¼±È£ÇÏÁö ¾Ê½À´Ï´Ù. À§±Ë¾çÀ» È®½ÇÇÏ°Ô Ä¡·áÇÏ°í ½Í¾î¼ µ¿³×º´¿ø°¡¼ PPI¸¦ Ãß°¡·Î ´õ º¹¿ëÇÏ°í ¿Â È¯ÀÚ¸¦ º» ÀûÀÌ Àֱ⠶§¹®ÀÔ´Ï´Ù." ºÎºÐÀº Á¤È®È÷ ÀÌÇØÇϱⰡ ¾î·Á¿ü½À´Ï´Ù. PPI¸¦ Ãß°¡·Î ¸Ô±â ¶§¹®¿¡ °Ë»çÀÇ sensitivity°¡ ¶³¾îÁö´Â °ÍÀº ºñ´Ü CLOtest¸¸ÀÇ ¹®Á¦°¡ ¾Æ´Ï±â ¶§¹®ÀÔ´Ï´Ù. (ÀÌÁØÇà ñÉ: ÆíÁöÁֽŠºÐ²² ´äº¯À» ¹Þ¾Ò½À´Ï´Ù. "Àú´Â CLOTest ¿Í biopsyÁß¿¡ Çϳª¸¦ ÇØ¾ß°íÇÑ´Ù¸é biopsy¸¦ ¼±È£ÇÑ´Ù´Â ¶æÀ̾ú½À´Ï´Ù.")
Âü, CLO´Â ¿ÇÀº À̸§ÀÌ ¾Æ´Õ´Ï´Ù. ÇÑ rapid urease test kitÀÇ »óǰ¸íÀÌ CLOtestÀÔ´Ï´Ù. CLOtest¶ó´Â Á¤½Ä À̸§À» ½á Áֽñ⠹ٶø´Ï´Ù. CLO¿Í test »çÀÌ¿¡ ¶ç¾î ¾²±â°¡ ¾øÀ½¿¡ À¯ÀÇÇØ ÁÖ¼¼¿ä.
»ï¼º¼¿ïº´¿ø ³»½Ã°æ½Ç quick reference Áß ÇØ´ç ºÎºÐÀ» ¿Å±é´Ï´Ù.
»ï¼º¼¿ïº´¿ø ³»½Ã°æ½Ç À§±Ë¾ç °Ë»ç Áöħ óÀ½ ¹ß°ßÇÑ active/healing stage gastric ulcer: Á¶Á÷°Ë»ç 3°³ + Ç︮ÄÚ¹ÚÅÍ Giemsa Á¶Á÷°Ë»ç (ÀüÁ¤ºÎ 1°³ + À§Ã¼ºÎ 1°³) óÀ½ ¹ß°ßÇÑ scar stage gastric ulcer: Á¶Á÷°Ë»ç 3°³ + Ç︮ÄÚ¹ÚÅÍ Giemsa Á¶Á÷°Ë»ç (ÀüÁ¤ºÎ 1°³ + À§Ã¼ºÎ 1°³)
Active/healing stage gastric ulcerÀÇ Ã¹ ÃßÀû ³»½Ã°æ¿¡¼ º¸ÀÌ´Â ulcer scar: Á¶Á÷°Ë»ç 3°³ + Ç︮ÄÚ¹ÚÅÍ Giemsa Á¶Á÷°Ë»ç (ÀüÁ¤ºÎ 1°³ + À§Ã¼ºÎ 1°³)
- Âü°í 1: UBT ó¹æÀÌ ÀÖ´õ¶óµµ Ç︮ÄÚ¹ÚÅÍ Á¶Á÷°Ë»ç´Â ÇØ ÁÖ¼¼¿ä. Dual check °³³äÀÔ´Ï´Ù.
- Âü°í 2: ÃÖÃÊ °Ë»ç¿¡¼ Ç︮ÄÚ¹ÚÅÍ À½¼ºÀ̾ú´õ¶óµµ ù ÃßÀû ³»½Ã°æ¿¡¼´Â Ç︮ÄÚ¹ÚÅÍ °Ë»ç¸¦ ÇØ ÁÖ¼¼¿ä. ÃÖÃÊ °Ë»çÀÇ false positive¸¦ °í·ÁÇØ¾ß ÇÕ´Ï´Ù.±Ë¾ç Ä¡·á 1³â ÈÄ ÃßÀû ³»½Ã°æ: Á¶Á÷°Ë»ç 3°³ (Ç︮ÄÚ¹ÚÅÍ Á¶Á÷°Ë»ç´Â ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù)
±Ë¾ç Ä¡·á 2³â ÈÄ ÃßÀû ³»½Ã°æ: ƯÀÌ ¼Ò°ß ¾ø´Â Æò¹üÇÑ ±Ë¾ç ¹ÝÈçÀ̶ó¸é Á¶Á÷°Ë»ç, Ç︮ÄÚ¹ÚÅÍ °Ë»ç ¸ðµÎ ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù.
[2020-5-7. Web seminar Áú¹®]
Á¦±ÕÄ¡·á ÈÄ UBT (-)·Î È®ÀÎµÈ ºÐÀÌ °°Àº ³¯ ½ÃÇàÇÑ CLOtest¿¡¼ (+) ¶Ç´Â Á¶Á÷°Ë»ç¿¡¼ Hp (+)·Î È®À뵃 °æ¿ì ¾î¶»°Ô ÇØ¼®ÇØ¾ß ÇÒ±î¿ä?
[2020-5-7. Web seminar ÀÌÁØÇà ´äº¯]
Ç︮ÄÚ¹ÚÅÍ¿¡ ´ëÇÑ ¸ðµç °Ë»ç´Â ´ë·« 10-20%ÀÇ false negative°¡ ÀÖ½À´Ï´Ù. ¿©·¯ °Ë»ç¸¦ ½ÃÇàÇÏ¿© Çϳª¶óµµ ¾ç¼ºÀÌ¸é ¾ç¼ºÀÔ´Ï´Ù. Á¦±ÕÀÌ µÇÁö ¾ÊÀº °ÍÀ¸·Î ÆÇ´ÜÇϽñ⠹ٶø´Ï´Ù.
[2020-5-7. Web seminar Áú¹®]
Á¦±Õ Ä¡·á 8ÁÖ ÈÄ UBT °Ë»ç »ó À½¼ºÀ¸·Î Àüȯ ÈÄ, 1³â ÈÄ F/U»ó ¾ç¼ºÀ¸·Î ³ª¿À¸é ¾î¶»°Ô ÇØ¼®ÇϽóª¿ä?
[2020-5-7. Web seminar ÀÌÁØÇà ´äº¯]
µÎ °¡Áö À̽´°¡ ÀÖ½À´Ï´Ù.
1) Àç°¨¿°°ú ÀçȰ¼ºÈ Áß Çϳª¸¦ °í¸£¶ó°í Çϸé ÀçȰ¼ºÈÀÇ °¡´É¼ºÀÌ ³ô½À´Ï´Ù. UBTÀÇ false negative¸¦ °í·ÁÇÏÁö ¾ÊÀ» ¼ö ¾ú½À´Ï´Ù.
2) ±×º¸´Ù ´õ Áß¿äÇÑ °ÍÀº ÀÏ´Ü À½¼ºÀ¸·Î È®ÀÎµÈ È¯ÀÚ¿¡¼ Ưº°ÇÑ ÀÌÀ¯ ¾øÀÌ 1³â ÈÄ Ç︮ÄÚ¹ÚÅÍ °Ë»ç¸¦ ´Ù½Ã ÇÒ ÀÌÀ¯°¡ ¾ø½À´Ï´Ù. ºÒÇÊ¿äÇÑ °Ë»ç¸¦ ½ÃÇàÇÏ¿© ¹ß»ýÇÑ ºÒÇÊ¿äÇÑ °í¹ÎÀ̶ó°í »ý°¢ÇÕ´Ï´Ù.
6. Æä´Ï½Ç¸° ¾Ë·¯Áö ȯÀÚÀÇ Á¦±ÕÄ¡·á
[2016-7-19. ¾Öµ¶ÀÚ Áú¹®]
Æä´Ï½Ç¸° ¾Ë·¯Áö°¡ Àִ ȯÀÚ¿¡¼ Ç︮ÄÚ¹ÚÅÍ 1Â÷ Á¦±ÕÄ¡·á ó¹æ¿¡ ´ëÇÏ¿© Áú¹®µå¸³´Ï´Ù. °¡²û Æä´Ï½Ç¸° ¾Ë·¯Áö°¡ ÀÖ´Â »ç¶÷¿¡¼ ±Ë¾çÀ̳ª ±Ë¾ç ¹ÝÈçÀÌ ÀÖ°í CLOtest ¾ç¼ºÀÌ ³ª¿À´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. ÀÌ·² °æ¿ì ó¹æÀº ¾îÂî ÇϽôÂÁö ±Ã±ÝÇÕ´Ï´Ù.
¿ì¸®³ª¶ó¿¡´Â ¿ö³« clarithromycin ³»¼ºÀÌ ¸¹¾Æ 3Á¦ ¿ä¹ý¿¡¼ amoxicillinÀ» »©°í ó¹æÇÑ´Ù¸é Á¦±Õ·üÀÌ ¸¹ÀÌ ¶³¾îÁú °Í °°½À´Ï´Ù. ±×·¸´Ù°í ¹Ù·Î 2Â÷¾àÁ¦¸¦ ó¹æÇϱ⵵ Á¶±× ±×·¸°í..... °ËÁø±â°üÀ̶ó ¹Ù·Î quinolone º´ÇÕ Ã³¹æÀ» Çϱ⵵ ºÎ´ãÀÌ µË´Ï´Ù.
ÀÏ´Ü ¿À´Ã ¹æ¹®ÇÑ È¯Àڴ ó¹æÇÏÁö ¾Ê°í »ó±ÞÀÇ·á±â°ü¿¡¼ refer¸¦ º¸³»±â´Â Çß½À´Ï´Ù. ÃßÈÄ¿¡ ÀÌ·± ȯÀÚµéÀÌ ¿Ã °æ¿ì °è¼Ó refer¸¦ º¸³»´Â °ÍÀÌ ÁÁÀ»Áö ¾Æ´Ï¸é ÀûÀýÈ÷ ó¹æÇϰí UBT f/uÀ» ÇÏ´Â °ÍÀÌ ÁÁÀ»Áö¿ä.
À½.... »ç½Ç º´¿ø¿¡ ÀÖÀ» ¶§ ÀÌ·± °í¹ÎµéÀ» º°·Î ÇØ º» ÀûÀÌ ¾ø¾ú´Âµ¥ (¿Ö ±×·¨´ÂÁö´Â Àß ¸ð¸£°Ú½À´Ï´Ù^^;;) °È£¿¡ ³ª¿Í ȯÀÚ¸¦ Áø·áÇÏ°í ³»½Ã°æÀ» ÇÏ´Ùº¸´Ï ±Ã±ÝÇÑ Á¡µéÀÌ Á¡Á¡ ´õ ¸¹¾ÆÁö´Â °Í °°¾Æ¼.... °ÆÁ¤ÀÔ´Ï´Ù ¤Ð¤Ð
[2016-8-7. ÀÌÁØÇà ´äº¯]
ÁÁÀº Áú¹®ÀÔ´Ï´Ù. Àúµµ ȯÀÚ Áø·á°¡ ´Ã ¾î·Æ½À´Ï´Ù. »ý°¢ÇÏÁö ¸øÇß´ø ¹®Á¦¸¦ ¸¸³ª´Â °æ¿ì°¡ ÇѵιøÀÌ ¾Æ´Õ´Ï´Ù. ¹®ÇåÀ» ã¾Æº¸°í µ¿·á ¼±ÈĹè¿Í Åä·ÐÇÏ´Â ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. 'ȯÀÚ Áø·á = ³¡¾ø´Â °øºÎ'ÀÔ´Ï´Ù.
º´·Â¿¡¼ Æä´Ï½Ç¸° ¾Ë·¯Áö°¡ Àִٴ ȯÀÚ Áß ½ÇÁ¦·Î Æä´Ï½Ç¸° ¾Ë·¯Áö°¡ Àִ ȯÀÚ´Â »ý°¢º¸´Ù ¸¹Áö ¾Ê½À´Ï´Ù. ¹®Á¦´Â ÀûÀýÇÑ skin test ¾øÀÌ ÁøÂ¥ ¾Ë·¯Áö¸¦ ¾Ë ¼ö ¾ø´Ù´Â °ÍÀÔ´Ï´Ù. Âü°í¹®Çå(Sanjib Bhattacharya. J Adv Pharm Technol Res 2010)À» Á¶±Ý ±æ°Ô ¿Å±é´Ï´Ù.
"Clinicians commonly encounter patients with a history of allergy to penicillin and other ©¬-lactam antibiotics. However, it is known that about 90% of these patients are not truly allergic and could safely receive ©¬-lactam antibiotics. The seriousness of the problem posed by drug allergies is perhaps overblown in part because of the loose use of the word ¡°allergy,¡± to refer to all immunologically mediated reactions. When assessing an allergy to penicillin the first issue is to establish whether or not a true allergic IgE mediated reaction has taken place. Instead, these patients are often treated unnecessarily with an alternate broad spectrum antibiotic, which could increase costs and contribute to the development and spread of multiple drug-resistant bacteria.
The frequently cited figures of 10 % cross reactivity between penicillin and cephalosporin is perhaps an overestimate. The degree of cross-reactivity between cephalosporins and penicillins depends on the generation of cephalosporins, being higher with earlier generation cephalosporins. Cross reactivity between penicillin and second and third generation cephalosporin is low and may be lower than the cross reactivity between penicillin and unrelated antibiotics. In addition, the frequency of immediate allergic reactions to cephalosporins is considerably lower compared to penicillins, and cross-reactivity among cephalosporins is lower compared to cross-reactivity between penicillin and cephalosporins."
¾Ë·¯Áö Àü¹®°¡¿¡ ÀÇ·ÚÇÏ¿© Æä´Ï½Ç¸° ¾Ë·¯Áö À¯¹«¸¦ È®ÀÎÇϱâ Àü±îÁö´Â Á¶½ÉÇØ¼ ó¹æÇÏ´Â ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. º¸Åë µÎ °¡Áö ¹æ¹ý Áß Çϳª¸¦ ¾¹´Ï´Ù. (1) PPI + clarithromycin + metronidazole ¶Ç´Â (2) bismuth-based quadruple therapyÀÔ´Ï´Ù.
Àú´Â Æä´Ï½Ç¸° ¾Ë·¯Áö ȯÀÚÀÇ Ã¹ Ä¡·á·Î 4Á¦ ¿ä¹ýÀ» ó¹æÇϰí ÀÖ½À´Ï´Ù. 2013³â ´ëÇÑ»óºÎÀ§Àå°ü,Ç︮ÄÚ¹ÚÅÍÇÐȸ °¡À̵å¶óÀÎ(Kim SK. Korean J Gastroenterol 2013)¿¡¼ ÃÊÄ¡·á·Î 4Á¦ ¿ä¹ýÀ» »ç¿ëÇÒ ¼ö ÀÖ´Ù°í ¾ð±ÞÇÑ ºÎºÐµµ °í·ÁÇÑ °áÁ¤ÀÔ´Ï´Ù.
°ËÁø ±â°ü¿¡¼µµ ÀϹÝÀûÀΠȯÀÚÀÇ Áø´Ü°ú Ä¡·á´Â ÇÒ ¼ö ÀÖ¾î¾ß ÇÑ´Ù°í »ý°¢ÇÕ´Ï´Ù. ÁßÁõ Æä´Ï½Ç¸° ¾Ë·¯ÁöÀÇ °ú°Å·ÂÀÌ ÀÖ´Â °æ¿ì¶ó¸é ¸ð¸¦±î, ±×·¸Áö ¾ÊÀº °æ¿ì¿¡´Â ÀûÀýÈ÷ ÁÖÀÇÇϰí Àß ¼³¸íÇÑ ÈÄ Á÷Á¢ ó¹æÇϼŵµ ¹«¹æÇÏ´Ù°í º¾´Ï´Ù.
'°ËÁø ³»½Ã°æÀÌ ÁÖ¾÷¹«À̰í Á¶±Ý¸¸ ÀÌ»óÇÏ¸é »ó±Þ ±â°üÀ¸·Î ÀÇ·ÚÇÑ´Ù'´Â ÆíÇÑ »ý°¢º¸´Ù´Â ¿øÄ¢¿¡ µû¶ó Ã¥ÀÓÁö´Â ÀÚ¼¼·Î Á¤¹ÐÇÏ°Ô °Ë»çÇϰí ÀûÀýÇÏ°Ô Ä¡·áÇѴٴ ŵµ°¡ ÇÊ¿äÇÕ´Ï´Ù. ¹°·Ð Çö½ÇÀº ½±Áö ¾Ê°ÚÁö¸¸......
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´äº¯ °¨»çÇÕ´Ï´Ù ±³¼ö´Ô. ÀÌ·¸°Ô ½Ã°£ ³»Áּż ÀÇÇÐÀûÀÎ Áö½Ä¿¡ ´ëÇÑ ÀÚ¼¼ÇÑ ´äº¯À» ÇØÁֽô ºÐÀÌ °è½Ã´Ù´Â°ÍÀº ¾ÆÁ÷µµ ¸ð¸£´Â°ÍÀÌ ¸¹°í ¹è¿ï°ÍÀÌ »ê´õ¹Ì°°Àº ÀúÇÑÅ״ õ±º¸¸¸¶°°Àº ÈûÀÌ µË´Ï´Ù^^
º´¿ø¿¡ ÀÖÀ»¶§´Â ¹Ø¿¡¼ ¼ö·Ã¹Þ´Â ÀÔÀåÀ̶ó "´©±º°¡´Â ¾Ë°í °è½Ã°ÚÁö","¾î·Á¿î »óȲÀÌ¸é ´©±º°¡ µµ¿ÍÁֽðÚÁö"¶ó´Â »ý°¢¿¡ ³»½Ã°æÃ³¹æ°ú ³»½Ã°æ °Ë»ç ÀÚü¿¡ ´ëÇØ Å« °ÆÁ¤À» ÇÏÁö ¾Ê¾Ò´Âµ¥, ¸·»ó °È£¿¡ ³ª¿Í¼ ³»°¡ ¸ÃÀº ȯÀڵ鿡 ´ëÇÑ ¿ÂÀüÇÑ Ã¥ÀÓÀÌ Àú¿¡°Ô ÀְԵǴٺ¸´Ï... ÀÌÁ¦´Â ¼ö·ÃÀÇ ÀüÀÓÀÇ ½ÃÀý °í¹ÎÇÏÁö ¾Ê¾Ò´ø(¼ÖÁ÷È÷ ÇÒ Çʿ䰡 ¾ø¾ú´Ù°í Âø°¢ÇÑ....ÀÌ ´õ ¸ÂÀ»°Í °°½À´Ï´Ù ¤Ð¤Ð) ºÎºÐµé¿¡ ´ëÇÑ ÈÄȸ°¡ ¹Ð·Á¿É´Ï´Ù.
¹°·Ð ±×·¯´Ùº¸´Ï ¿äÁòÀº ¿ÀÈ÷·Á º´¿ø¿¡ ÀÖÀ»¶§º¸´Ù ´õ ¿½ÉÈ÷ °øºÎÇÏ°Ô µÇ´Â°Í °°½À´Ï´Ù. À̹ø¿¡ ´äº¯ÁֽŠºÎºÐÀº Á¦°¡ Áø·áº¸´Âµ¥ ¸¹Àº µµ¿òÀÌ µÉ°Í °°½À´Ï´Ù. ¾îÂ÷ÇÇ 2Â÷ Á¦±ÕÄ¡·á±îÁö´Â ÇÏ´Ï±î ¾ÕÀ¸·Î Æä´Ï½Ç¸° ¾Ë·¯Áö(¶Ç´Â ¾Ë·¯Áö°¡ ÀǽɵǴÂ) ȯÀÚ°¡ ¿Â´Ù¸é ¹Ù·Î ºñ½º¹«½º Á¦À縦 Æ÷ÇÔÇÏ´Â quadruple regimen ó¹æÀ» Çϵµ·Ï ÇϰڽÀ´Ï´Ù^^
[2016-8-10. ¾Öµ¶ÀÚ ÆíÁö]
Æä´Ï½Ç¸° ¾Ë·¯Áö ȯÀÚ¿¡ ´ëÇÑ Ç︮ÄÚ¹ÚÅÍ Á¦±Õ¿¡ ´ëÇÑ ¸ÞÀÏÀ» º¸³½Áö ¾ó¸¶µÇÁö ¾Ê¾Ò´Âµ¥ ŸÀֻ̹ó ±â°¡ ¸·È÷°Ôµµ Æä´Ï½Ç¸° ¾Ë·¯Áö°¡ ÀÖ´ø(ÀÌ ºÐÀº ampicillin-clavulanate Á¦Àç º¹¿ë ÈÄ ¿Â¸ö¿¡ rash°¡ ¹ß»ýÇß´Ù´ø ȯÀÚÀÔ´Ï´Ù) ºÐÀÌ ³»½Ã°æÀ» ¹Þ°í ½ÊÀÌÁöÀå¿¡ ±Ë¾ç ¹ÝÈçÀÌ °üÂûµÇ¾î CLO¸¦ ½ÃÇàÇߴµ¥ (+)ÀÌ ³ª¿Í¼ ±³¼ö´Ô²²¼ ÀÏ·¯ÁֽŴë·Î 2Â÷ Á¦±ÕÄ¡·á¾à(bismuth-based quadruple therapy)¸¦ ó¹æÇß½À´Ï´Ù. ¿ØÁö ¸ð¸£°Ô ±â»¼½À´Ï´Ù.^^ ´Ù½Ã ÇÑ ¹ø °¨»çµå¸³´Ï´Ù.
[2020-8-12. ¾Öµ¶ÀÚ Áú¹®] ¼¼ÆÈ·Î½ºÆ÷¸° Ç×»ýÁ¦ ¾Ë·¯Áö ȯÀÚÀÇ Ç︮ÄÚ¹ÚÅÍ±Õ Á¦±ÕÄ¡·á
ÀþÀº ¿©¼ººÐ °ËÁø¿¡¼ lymphofollicular gastritis, CLO positive ¼Ò°ß°üÂûµÇ¾ú½À´Ï´Ù. ȯÀÚ´Â ÀÌÀü¿¡ ¼¼ÆÈ·Î½ºÆ÷¸° (¼¼ÆÄÁ¦µ·) Ç×»ýÁ¦ ÁÖ»ç Åõ¾àÈÄ rash µî ¾Ë·¯Áö Áõ»óÀ» °æÇèÇß´Ù°í ÇÕ´Ï´Ù. 4Á¦ ¿ä¹ý (PPI + bismuth + tetracycline + metronidazole) À¸·Î ó¹æÇß°í ȯÀÚ´Â 3ÀÏ º¹¿ëÇÏ¸é¼ Á¡Á¡ ½ÉÇØÁö´Â µÎÅëÀ» °æÇèÇÑ´Ù°í ¹®Àǰ¡ ¿Í¼ ÀÏ´Ü º¹¾à ÁߴܽÃÄ״µ¥¿ä... ÀÌ·± °æ¿ì ÃßÈÄ Á¦±ÕÄ¡·á ¾øÀÌ f/u ¸¸ ÇØ¾ß µÇ´ÂÁö ¹®Àǵ帳´Ï´Ù.
[2020-8-12. ÀÌÁØÇà ´äº¯]
Lymphofollicular gastritisÀÇ °æ¿ì Á¦±ÕÄ¡·á¸¦ ²À ½ÃÇàÇϰí ÀÖ½À´Ï´Ù. ȯÀÚÀÇ Æä´Ï½Ç¸°/¼¼ÆÄ °è¿ ¾Ë·¯Áö º´·ÂÀÌ °ÆÁ¤ÀÎ »óȲÀÔ´Ï´Ù. ÀÌ °æ¿ì Á¤¸»·Î allergyÀÎ °æ¿ì´Â 10% Á¤µµ¶ó°í ÇÕ´Ï´Ù. µû¶ó¼ allergy·Î ÀÇ·ÚÇÏ¿© Ç×»ýÁ¦ ³»½Ã°æ¿¡ ´ëÇÑ Á¤¹Ð °Ë»ç¸¦ ¹Þµµ·Ï ±ÇÇÏ´Â °ÍÀÌ ¹Ù¶÷Á÷ÇÕ´Ï´Ù. ÁøÂ¥ Ç×»ýÁ¦ ³»¼ºÀÌ ¾Æ´Ï¸é 1Â÷ Ä¡·á¸¦ Æ÷±âÇÒ ÀÌÀ¯°¡ ¾ø±â ¶§¹®ÀÔ´Ï´Ù. 4Á¦ ¿ä¹ýµµ µå½ÃÁö ¸øÇÑ ºÐÀ̹ǷΠ´õ¿í ±×·¯ÇÕ´Ï´Ù. °ü·ÃÇÏ¿© °ú°Å ÀÚ·áµµ ¾Æ·¡¿¡ ºÙ¿©º¸¾ÒÀ¸´Ï Âü°íÇϽñ⠹ٶø´Ï´Ù.
2016-12-3 Ç︮ÄÚ¹ÚÅÍ ½ÉÆ÷Áö¾ö¿¡¼ ±è±¤ÇÏ ±³¼ö´Ô²²¼ Æä´Ï½Ç¸° ¾Ë·¯Áö°¡ Àִ ȯÀÚ¿¡¼ Ä¡·áÀü·«À» ¼Ò°³Çϼ̽À´Ï´Ù. ÀϺ»Àº Á¶±Ý ƯÀÌÇÑ ¾àÀ» ¾¹´Ï´Ù.
2020³â 7¿ù 17ÀÏ SI-HUG¿¡¼ Steven F. Moss ¹Ú»çÀÇ °ÀÇ Áß ÀϺÎÀÔ´Ï´Ù. Question "penicillin allergy," refer for allergy testing¶ó°í ¾ð±ÞÇϰí ÀÖ½À´Ï´Ù. ȯÀÚ ½º½º·Î penicillin allergy°¡ ÀÖ´Ù°í ¸»ÇÏ´Â »ç¶÷ Áß ½ÇÁ¦ allergy´Â ¸¹Áö ¾Ê´Ù´Â °ÍÀÔ´Ï´Ù.
7. Helicobacter Á¦±ÕÄ¡·á ÈÄ ¹ß»ýÇÒ ¼ö ÀÖ´Â ¹®Á¦µé
[allergy]
Helicobacter¿Í allergy¿ÍÀÇ °ü·Ã¼ºÀº ¸Å¿ì º¹ÀâÇÕ´Ï´Ù. ÇÑ ¸®ºä¸¦ ¼Ò°³ÇÕ´Ï´Ù.
Helicobacter pylori and allergy: Update of research (World J Methodol 2015;5:203).
Recently a lot of literature has been published about the possible preventive action of Helicobacter pylori against allergy. The present review summarizes research data about the association between H. pylori and allergic diseases, as well as discusses possible hypotheses about the preventive action of H. pylori against atopy. There is evidence from observational studies to support a weak inverse association between prevalence of H. pylori infection and allergy. However, confounders like some unidentified socioeconomic factors, antibiotic use and others could bias the association. Although data from cohort studies point to a possible association of H. pylori with some of the allergic diseases, no definite proof for causal relationship has been clearly demonstrated yet. A biological mechanism proposed to explain the preventive action of H. pylori to allergy is reduced exposure to a major stimulus for the generation of Treg cells in individuals without H. pylori infection. In addition, H. pylori could be an indicator for changes in gut microbiome, reflecting the complex interaction between microbes and immune system.
ÀüüÀûÀ¸·Î Hp°¡ atopy¸¦ Æ÷ÇÔÇÑ allergic disease¿¡ ´ëÇÑ preventive roleÀ» ÇÏ´Â °Í °°´Ù°í ±â¼úµÇ¾î ÀÖ½À´Ï´Ù. ±×·¯³ª Helicobacter Á¦±ÕÄ¡·á°¡ ¿ÀÈ÷·Á allergic disease¸¦ ÀÏÀ¸Å³ ¼ö ÀÖ´Ù´Â °¡´É¼ºµµ Á¦½ÃµÇ¾î ÀÖ½À´Ï´Ù. ÀÌ ¹®´Ü¿¡´Â °Ç±¹´ëÇб³ À̼±¿µ ±³¼ö´ÔÀÇ ³í¹®ÀÌ ÀοëµÇ¾î ÀÖ½À´Ï´Ù (Helicobacter 2015;20:49).
Hp Á¦±ÕÄ¡·á°¡ ³Î¸® ½ÃÇàµÇ´Â ÀϺ»¿¡¼´Â Á¦±ÕÄ¡·á ÈÄ ¹ß»ýÇÒ ¼ö ÀÖ´Â ¿©·¯ À̽´ Áß allergy°¡ ÈçÈ÷ ¾ð±ÞµÇ´Â °Í °°½À´Ï´Ù. ¾Õ¼ ¾ð±ÞÇÑ ¸®ºä(World J Methodol 2015)¿¡¼µµ Hp Á¦±ÕÄ¡·á¸¦ Çϸé microbiomeÀÇ diversity°¡ °¨¼ÒÇÒ ¼ö Àִµ¥ À̰ÍÀÌ allergy ¹ß»ý°ú °ü·ÃÀÖÁö ¾ÊÀ»±î ¾ð±ÞµÇ¾î ÀÖ½À´Ï´Ù.
¿äÄÁµ¥ Helicobacter´Â ÀÎüÀÇ ¿©·¯ system¿¡ ¸Å¿ì °·ÂÇÑ ¿µÇâÀ» ¹ÌÄ¡°í ÀÖ¾î¼ Á¦±ÕÄ¡·á ÈÄ ¿©±âÀú±â¼ ¿¹»óÄ¡ ¸øÇÑ °á°ú°¡ ³ª¿Ã ¼ö ÀÖ´Ù´Â Á¡À» ÀØÁö ¸»¾Æ¾ß ÇϰڽÀ´Ï´Ù. Allergy°¡ ±× Áß ÇϳªÀÏ ¼ö ÀÖ½À´Ï´Ù.
[hallucination/psychosis]
ÇÑ µ¿¹® ÈĹ踦 ¸¸³µ½À´Ï´Ù. Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á Ç×»ýÁ¦¿¡ ÀÇÇÑ hallucination ȯÀÚ¸¦ °æÇèÇÏ¿´´Ù°í ÇÕ´Ï´Ù. Ç︮ÄÚ¹ÚÅÍ 1Â÷ Á¦±ÕÄ¡·á¾àÀ» º¹¿ëÇÏ´Â Áß ÇÑ ¸ðÀÓ¿¡¼ ÀÌ»óÇÑ ¸»À» ÇÏ¿© ¹«Ã´ °ï¶õÇÑ ÀÏÀ» °Þ¾ú´Ù´Â ȯÀÚ¿´½À´Ï´Ù. Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á ¾à¿¡ ÀÇÇÑ hallucination/psychosisÀÔ´Ï´Ù.
ÇÑ Áõ·Ê º¸°íÀÇ abstract¸¦ ¿Å±é´Ï´Ù (Case Rep Gastroenterol. 2012).
Transient Psychotic Episode Induced by Helicobacter pylori Triple Therapy Treatment
The term ¡®antibiomania¡¯ refers to manic episodes that occur after a patient starts taking antibiotics. We report the case of a 49-year-old male who developed acute psychosis secondary to initiation of triple therapy for Helicobacter pylori eradication. Unlike with proton pump inhibitors, there have been several reported cases of central nervous system side effects and psychiatric consequences due to amoxicillin, however evidence points to clarithromycin as the likely culprit. On average onset of symptoms occurred within 1-5 days of initiating therapy. In all cases, symptoms resolved upon cessation of clarithromycin, mostly within 1-3 days. Unfortunately, the mechanism through which clarithromycin causes neurotoxicity remains unclear. Clinicians should be cognizant of psychiatric side effects secondary to clarithromycin, and discontinuation should be prompt for rapid recovery of mental status.
º»¹®¿¡ µû¸£¸é clarithromycin¿¡¼ ÈçÇÏ´Ù°í ÇÕ´Ï´Ù.
Antibiomania, a term used to describe antibiotic-induced manic episodes, is a rare but genuine side effect of some antimicrobials. Clarithromycin is among those more commonly associated with psychosis, with few reported cases involving amoxicillin. Onset of these symptoms typically occurs within 7 days of medication initiation and resolution of symptoms occurs 24-48 h after medication cessation.
[Symposium. 2015-8-22] Ä¡·á °¡À̵å¶óÀο¡ ¾ð±ÞµÈ 󹿹ý (°¡Å縯º´¿ø ¹ÚÀç¸í)
Á¦±Õ ½ÇÆÐ½Ã »ç¿ëÇÒ ¼ö ÀÖ´Â Ç×»ýÁ¦
(1) levofloxacin
(2) rifabutin - °áÇÙ À¯º´·ü¶§¹®¿¡ Á¶½ÉÇØ¾ß ÇÑ´Ù´Â ÀǰßÀÌ ÀÖÀ½.
(3) furazolidone - ¿ì¸®³ª¶ó¿¡¼´Â ÀǾàǰÀ¸·Î Çã¿ëµÇÁö ¾ÊÀ½. Áß±¹¿¡¼´Â ´ß¿¡¼ »ç¿ëµÈ´Ù.
[Symposium. 2015-12-12] Best strategy of Hp eradication regimen (ÇѸ²´ëÇб³ ¹é±¤È£)
Sequential therapy 1-5ÀÏ: amoxicillin 1g + PPI (bid) 6-10ÀÏ: clarithromycin 500 mg + metronidazole 500 mg + PPI (bid) Concomitant therpay amoxicillin 1 g + clarithromycin 500 mg + metronidazole 500 mg (bid) 7ÀÏ
¹é±¤È£ ±³¼ö´ÔÀÇ Á¦¾È PCRÀ̳ª ¹è¾ç°Ë»ç°¡ ºÒ°¡´ÉÇÑ °æ¿ì »ïÁ¦¿ä¹ý 14ÀÏ PCR positiveÀÎ °æ¿ì 1) ClarithromycinÀ» metronidazole·Î º¯°æÇÑ »ïÁ¦¿ä¹ý
2) Quadruple therapy
3) Sequential therapy, Concomitant therapyCulture °Ë»ç°¡ °¡´ÉÇÑ °æ¿ì Tailered therapy
[Symposium. 2016-7-10] ¿¬¼¼´ëÇб³ ¼Òȱ⳻°ú ¿¬¼ö°Á (¿¬¼¼´ëÇб³ ÀÌ»ó±æ ±³¼ö´Ô)
ÀÌ»ó±æ ±³¼ö´ÔÀº '¿ì¸®³ª¶ó¿¡¼ ÀÇ»ç´Â È÷Æ÷Å©¶óÅ×½º ¼±¼¸¦ ÇßÀ½¿¡µµ ºÒ±¸ÇÏ°í ½ÉÆò¿ø ±âÁØÀ» µû¸£´Â °ø¹«¿øÃ³·³ »ì°í ÀÖ´Ù'¸ç Çö½ÇÀÇ ¾î·Á¿òÀ» À̾߱âÇϼ̽À´Ï´Ù.
´Ù¾çÇÑ Ä¡·á¹ý¿¡¼ ¾àÁ¦ »ç¿ëÀ» ÇϳªÀÇ Ç¥·Î Á¤¸®ÇØ Áּ̽À´Ï´Ù.
»õ·Î¿î À§»ê ºÐºñ ¾ïÁ¦ÀÎ VonoprazanÀÌ Æ¯È÷ clarithromycin ÀúÇ×¼ºÀÌ ÀÖ´Â °æ¿ì¿¡ µµ¿òÀÌ µÉ °ÍÀ̶ó´Â ÀڷḦ º¸¿©Áּ̽À´Ï´Ù.
Ä¡·á È¿°ú¸¦ ³ôÀ̱â À§ÇÑ Àü·«À» ¼Ò°³Çϼ̽À´Ï´Ù. ÀÌ»ó±æ ±³¼ö´ÔÀº '¼³¸íÀÌ Áß¿äÇÏ´Ù'´Â Á¡À» °Á¶Çϼ̽À´Ï´Ù. ¾àÀ» Àß ¸Ô´Â °Í°ú Á¦±Õ¼º°ø¿©ºÎ¸¦ È®ÀÎÇÏ´Â °ÍÀÌ ¾ó¸¶ Áß¿äÇÑÁö Àß ¼³¸íÇØ¾ß ÇÒ °Í °°½À´Ï´Ù.
Oral ¹é½Å¿¡ ´ëÇÑ Ã¹ Àӻ󿬱¸°¡ ¹ßÇ¥µÇ¾ú½À´Ï´Ù.
[Symposium. 2016-10-1] ³»½Ã°æÇÐȸ Á¦ÁÖÁöȸ ¿¬¼ö°Á (Á¦ÁÖ´ëÇб³ ³ª¼ö¿µ)
Á¦±ÕÄ¡·á¿¡¼ À§»ê ºÐºñ ¾ïÁ¦´Â ¸Å¿ì Áß¿äÇÕ´Ï´Ù.
Clarithromycin ³»¼º±ÕÁÖ¿¡¼ p-CABÀÌ À¯¸ÁÇÒ °Í °°½À´Ï´Ù.
* ÁÂÀå (Á¤ÈÆ¿ë ¼±»ý´Ô) comment: PPI-based triple therapyÀÇ È¿°ú°¡ ³·¾ÆÁö°í ÀÖ¾î¼ Á¶¸¸°£ ÀÏÂ÷¿ä¹ý¿¡¼ Á¦¿ÜµÉ °¡´É¼ºÀÌ ÀÖ½À´Ï´Ù. °ü·Ã ±¹Ã¥¿¬±¸°¡ ÁøÇà ÁßÀÔ´Ï´Ù.
[Symposium. 2018-4-15. ¼ÒȱâÇÐȸ Ãá°èÇмú´ëȸ] Helicobacter pylori (½Å¿î°Ç)
Ç︮ÄÚ¹ÚÅÍ °ü·ÃÇÑ ÇöÀçÀÇ ´ëÈ¥¶õ¿¡ ´ëÇÏ¿© ½Å¿î°Ç ±³¼ö´Ô²²¼ °ÀÇ·Ï °á·Ð¿¡ ¸í·áÇÏ°Ô Á¤¸®ÇØ Áּ̽À´Ï´Ù.
°á·Ð: 2018³â 1¿ù¿¡ º¯°æµÈ º¸°Çº¹ÁöºÎÀÇ Ç︮ÄÚ¹ÚÅÍ ÆÄÀϷθ® Á¦±Õ Ä¡·á¿¡ ´ëÇÑ ¿ä¾ç ±Þ¿© Á¶Á¤Àº ÇÕ¸®ÀûÀÎ °ÍÀ¸·Î ÆÇ´ÜÇÑ´Ù. ±×·¯³ª Áø´Ü °Ë»ç¹ý, Ä¡·á¹ý¿¡ ´ëÇÑ ³»¿ëÀÌ ºüÁ® ÀÖ°í, ȯÀÚ º»Àκδã·üÀÌ ´Ù¾çÇϸç, »ý°Ë °âÀÚÀÇ ±Þ¿© ¿©ºÎ±îÁöµµ °í·ÁÇØ¾ß ÇÏ´Â µî ³Ê¹« º¹ÀâÇÑ ÇüÅ·Πº¯°æµÇ¾î Áø·á¿¡ ÀûÁö ¾ÊÀº È¥¶õÀÌ ¿¹»óµÈ´Ù. µû¶ó¼ ºü¸¥ ½ÃÀÏ ³»¿¡ ´Ù½Ã ¼öÁ¤ÀÌ ÇÊ¿äÇÒ °ÍÀ¸·Î »ý°¢µÈ´Ù.
ÇöÀç Clarithromycin resistanceÀÇ insurance´Â ÀûÀÀÁõÀÌ Á¦ÇÑÀûÀÔ´Ï´Ù. ¿°±â¼¿ºÐ¼®Àº º»ÀÎ ºÎ´ã·ü 80%ÀÔ´Ï´Ù.
°Ë»ç ÀûÀÀÁõ¿¡ ´ëÇÏ¿© ½Å¿î°Ç ±³¼ö´ÔÀº "(1) ¹Ì¸® ¾Ë ¼ö ÀÖ´Â À§¾Ï °¡Á··ÂÀÌ ÀÖÀ¸¸é »çÀü¿¡ ¼³¸íÇÏ°í °Ë»ç ¹× Ä¡·á¸¦ Çϰí ÀÖ´Ù. (2) À§Ã༺ À§¿°Àº °Ë»ç Àü¿¡ ¿¹ÃøÀÌ ¾î·Æ°í ³»½Ã°æ Áø´ÜÀÌ Á¤È®ÇÏÁö ¾Ê±â ¶§¹®¿¡ ¾ÆÁ÷Àº ½ÃÇàÇÏÁö ¾Ê°í ÀÖ´Ù."°í ¸»¾¸Çϼ̽À´Ï´Ù.
Ä¡·á¿¡ ´ëÇÏ¿© ½Å¿î°Ç ±³¼ö´ÔÀÇ °á·Ð ½½¶óÀ̵åÀÇ ³»¿ëÀº "In present Korea, Bismuth based quadruple or concomitant therapy, 14 days."ÀÔ´Ï´Ù. ±×·¯³ª ÁÂÀå´Ô Áú¹®¿¡ ´ëÇØ¼´Â clarithromycin point mutation ¼öŹ°Ë»ç¸¦ ½ÃÇàÇÏ¿© clarithromycin ³»¼ºÀÌ ¾øÀ¸¸é clarithromycin ±â¹Ý 3Á¦ ¿ä¹ýÀ» »ç¿ëÇÒ ¼ö ÀÖ´Ù°í ´äº¯Çϼ̽À´Ï´Ù.
[ÀÌÁØÇà comment]
1. Àú´Â clarithromycin point mutation ¼öŹ°Ë»ç¸¦ ½ÃÇàÇÏÁö ¾Ê°í ÀÖ½À´Ï´Ù. (1) ³»½Ã°æ °Ë»ç ½Ã Á¶Á÷°Ë»ç³ª CLOtest¸¦ ½ÃÇàÇÏ¿© ¾ç¼ºÀ¸·Î ³ª¿Â °æ¿ì¿¡ 'clarithromycin point mutation ¼öŹ°Ë»ç'¸¦ ½ÃÇàÇÒ ¼ö ÀÖ½À´Ï´Ù. À̸¦ À§ÇÏ¿© ³»½Ã°æÀ» ´Ù½Ã ÇÒ ¼ö´Â ¾ø½À´Ï´Ù. (2) Point mutation¿¡ ÀÇÇÑ ÀúÇ×¼º ÆÇ´ÜÀÇ Á¤È®µµ°¡ 100%°¡ ¾Æ´Õ´Ï´Ù. (3) ÀÏ´Ü 1Â÷ Á¦±ÕÄ¡·á ÈÄ UBT ¾ç¼ºÀΠȯÀÚ¿¡¼ quadruple therapy¸¦ ½ÃÇàÇÑ ¹æ¹ý°ú, óÀ½ºÎÅÍ 'clarithromycin point mutation ¼öŹ°Ë»ç'¸¦ ½ÃÇàÇÏ¿© ±× °á°ú¿¡ µû¶ó ¾àÁ¦¸¦ ¼±ÅÃÇÑ ¹æ¹ý Áß ¾î´À ÂÊÀÌ ´õ ÁÁÀºÁö ºñ±³ ¿¬±¸°¡ ¾ø½À´Ï´Ù. (4) °Ë»ç ºñ¿ëÀÇ 80%¸¦ ȯÀÚ°¡ ºÎ´ãÇÑ´Ù´Â °Í ÀÚü¿¡ ¹Ý´ëÇϱ⠶§¹®ÀÔ´Ï´Ù. ÀÇ·á´Â ±âº»ÀûÀ¸·Î ´Ü¼øÇÑ ÇüŸ¦ À¯ÁöÇÏ°í ²À ÇÊ¿äÇÑ °æ¿ì¸¸ ¿¹¿Ü¸¦ µÎ¾î¾ß ÇÕ´Ï´Ù. Ç︮ÄÚ¹ÚÅÍÀÇ Áø´Ü°ú Ä¡·á¿¡ ´ëÇÏ¿© 5/100 (¾ÏȯÀÚ), 30-50/100 (º¸ÅëÀÇ Áø´Ü°ú Ä¡·á), 80/100 (clarithromycin point mutation ¼öŹ°Ë»ç), 90/100 (4°³ Ç¥ÁØ ÀûÀÀÁõ ÀÌ¿ÜÀÇ Ç︮ÄÚ¹ÚÅÍ °Ë»ç), 100/100 (4°³ Ç¥ÁØ ÀûÀÀÁõ ÀÌ¿ÜÀÇ Á¦±ÕÄ¡·á)°ú °°Àº º¹ÀâÇÑ Ã¼°è¸¦ À¯ÁöÇÏ´Â °ÍÀ» ¹Ý´ëÇÕ´Ï´Ù.
2. Àú´Â Ç×»ó clarithromycin ±â¹Ý 3Á¦ ¿ä¹ý (1ÁÖ)À¸·Î ½ÃÀÛÇÕ´Ï´Ù. 8ÁÖ ÈÄ UBT°¡ ¾ç¼ºÀ̸é quadruple therapy 1ÁÖ¸¦ Åõ¾àÇÕ´Ï´Ù. ´Ü¼øÇϰí È¿°úÀûÀ̶ó°í »ý°¢Çϰí ÀÖ½À´Ï´Ù. º¹ÀâÇÏ°í ´Ù¾çÇÑ Ã³¹æ patternÀ» Àû¿ëÇÏ¿© ÀǹÌÀÖ´Â À̵æÀÌ ÀÖ´Ù´Â È®½ÅÇÏÁö ¸øÇϱ⠶§¹®ÀÔ´Ï´Ù. »ý°¢À» ¹Ù²ã¾ß ÇÒ Á¤µµÀÇ ¸í¹éÇÑ ¿¬±¸ °á°ú¸¦ ¾ÆÁ÷ º¸Áö ¸øÇß½À´Ï´Ù. ¾Æ·¡´Â ÀúÀÇ Ç¥ÁØ Ã³¹æÀÔ´Ï´Ù.
[2019-9-9. ÀÌÁØÇà comment]
Á¤ÈÆ¿ë ±³¼ö´Ô²²¼ À¯·´ Ç︮ÄÚ¹ÚÅÍÇÐȸ¿¡¼ °¿¬À» ÇÏ½Ã°í ¸¶Áö¸· ½½¶óÀ̵带 Facebook¿¡ ¿Ã¸®¼Ì½À´Ï´Ù.
Referral hospital¿¡¼ culture-based treatment¸¦ ÃßõÇÑ´Ù´Â ¸»¾¸ÀÌ ²Þ¸¸ °°½À´Ï´Ù. Á¦ ¿Ü·¡¿¡¼´Â culture-based treatment¸¦ ÇÒ ¼ö ¾ø±â ¶§¹®ÀÔ´Ï´Ù. ¿ì¸®³ª¶ó¿¡¼ ÁøÁ¤ culture-based treatment¸¦ routineÀ¸·Î ÇÒ ¼ö ÀÖ´Â ±â°üÀÌ ÀÖÀ»±î¿ä? ÀÌ»ó°ú Çö½ÇÀÇ °£°ÝÀº ¸Ö±â¸¸ ÇÕ´Ï´Ù.
[Symposium. 2019-11-29. KDDW]
¿ì¸®³ª¶ó¿¡¼ Ç×»ýÁ¦ ³»¼º¿¡ µû¸¥ 4Â÷ Ä¡·á¿Í µ¿½Ã Ä¡·á ¼ºÀûÀÔ´Ï´Ù.
ÀϺ» third-line treatment ¼ºÀû ¿ä¾àÀÔ´Ï´Ù.
ÀϺ»ÀÇ P-CABÀÎ vonoprazanÀ» Ȱ¿ëÇÑ Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á ¼ºÀû¿¡ ´ëÇÑ °á·ÐÀÔ´Ï´Ù. Clarithromycin resistance¸¦ »ó´çºÎºÐ ±Øº¹ÇÒ ¼ö ÀÖ´Ù´Â ÁÖÀåÀ̾ú½À´Ï´Ù.
2020-7-17 ºÎÅÍ 7-18 SI-HUG 2020
À̼±¿µ ±³¼ö´Ô²²¼´Â 1,2,3Â÷ Ä¡·á¿¡ ¸ðµÎ bismuth¸¦ bid·Î ¾µ °ÍÀ» Á¦¾ÈÇϼ̽À´Ï´Ù.
Hamamatsu ´ëÇÐÀÇ Furuta ±³¼ö´Â PPI twice daily Æ÷ÇÔ 3Á¦ ¿ä¹ýÀÇ Á¦±ÕÀ²ÀÌ 75% ¼öÁØÀε¥ Vonoprazn Æ÷ÇÔ Á¦±Õ¿ä¹ýÀÇ Á¦±ÕÀ²Àº 90% ¼öÁØÀ̶ó°í ¹ßÇ¥ÇÏ¿´½À´Ï´Ù. PPI¸¦ 4ȸ Åõ¿©Çϸé CYP2C19 rapid metabolizer¿¡¼µµ ÃæºÐÇÑ Á¤µµÀÇ À§»ê ¾ïÁ¦¸¦ ÇÒ ¼ö ÀÖÀ¸¹Ç·Î vonoprazan allergic ȯÀÚ¿¡¼´Â PPI¸¦ 4ȸ »ç¿ëÇϴ ó¹æÀ» »ç¿ëÇÒ ¼ö ÀÖ´Ù°í ÇÕ´Ï´Ù.
±¹¸³´ë¸¸´ëÇÐÀÇ Liou ±³¼ö
Empirical therapy after two eradication failures |
- Avoid empirical reuse of clarithromycin, metronidazole, and levofloxacin.
- Empirical reuse of amoxicilin and tetracyclin is allowed. - Rifabutin may be used ad rescue therapy after third-line treatment - Sitafloxacin is preferred if available. |
Second-line therapy (Steven F. Moss)
Interchangeable use of PPIs based on relative potency | |
Drug at lowest available dosage | Omeprazole equivalent |
Pantoprazole 20 mg | 4.5 mg |
Lansoprazole 15 mg | 13.5 mg |
Omeprazole 20 mg | 20 mg |
Esomeprazole 20 mg | 32 mg |
Rabeprazole 20 mg | 36 mg |
Clin Gastroenterol Hepatol 2018 Interchangeable use of PPIs based on relative potency
Resistance testing and Hp therapy | |
Population | Antibiotic sensitivity real-time monitoring program Long-established in Europe Since 2013, Euro registry has > 30,000 patients from 23 countries |
Individual | Advised in Maastricht V guidelines after 2 failed therapies Evidence base weak, not clearly superior to empiric choice for most patients In US, probably not cost effective if EGD required Most endoscopy facilities do not have local culture option Send out → worse culture rates |
ÀϺ» Ç︮ÄÚ¹ÚÅÍÇÐȸ ȸÀåÀÎ Koto ¼±»ý´Ô: Only Japan keeps the triple therapy as the first-line eradication because VPZ can be used instead of PPI.
[Ç︮ÄÚ¹ÚÅÍ Ä¡·á ¾àÁ¦ ¼±Åà °¡À̵å¶óÀÎ]
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1Â÷ Á¦±ÕÄ¡·á optionÀ» multiple·Î parellelÇÏ°Ô Á¦½ÃÇÏ´Â °ÍÀÌ È¥¶õÀ» ºÎÃßų °¡´É¼ºÀº ¾ø´Â°¡?
[2015-9-8. Webseminar Áú¹®]
1Â÷ Ä¡·á½Ã PPI Áß À¯ÀÏÇÏ°Ô lansoprazoleÀ» 2ÁÖ »ç¿ëÇÒ ¼ö ÀÖ½À´Ï´Ù.
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PPI¸¶´Ù Çã°¡µÈ ¿ë¹ý¿ë·®ÀÌ ´Ù¸¨´Ï´Ù. »ç½Ç ¸»µµ ¾È µÇ´Â ÀÏÀÌÁö¸¸...
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2Â÷ Ä¡·á±îÁöµµ ÇØµµ Á¦±Õ½ÇÆÐ½Ã ¾î¶»°Ô ÇϽóª¿ä?
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3Â÷, 4Â÷, 5Â÷±îÁö Åõ¾àÇÏ´Â ¼±»ý´Ôµµ °è½ÃÁö¸¸ Àú´Â º¸Åë 2Â÷±îÁö ¾È µÇ¸é Æ÷±âÇϰí ÀÖ½À´Ï´Ù. ÁÁÀº 3Â÷ Ä¡·á°¡ ¾ø±â ¶§¹®ÀÔ´Ï´Ù. Á¦±ÕµÇ´Â µí Çß´Ù°¡ À̳» ´Ù½Ã ³ªÅ¸³ª´Â °æ¿ì°¡ ¸¹½À´Ï´Ù.
[2015-9-8. Webseminar Áú¹®]
¸¸¼º ½ÅÁúȯ (CRF, azotemia, ½ÅºÎÀü) ȯÀÚ¿¡¼ÀÇ dose´Â renal dose·Î ¸ÂÃß¾î¾ß ÇÏ´ÂÁö¿ä?
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GRF¿¡ µû¶ó Á¤È®È÷ ¾àÀ» ³ª´©¾î ÁÙ ¼ö ¾ø´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. ±×·² ¶§¿¡´Â ÇÏ·ç µÎ¹ø 1ÁÖÀÏ µå¸®´Â ¾àÀ» ÇÏ·ç Çѹø 1ÁÖÀÏ µå½Ãµµ·Ï, Áï ÀüüÀûÀÎ ¿ë·®À» Àý¹ÝÀ¸·Î ÁÙÀÌ¸é ÆíÇÕ´Ï´Ù. ¾ÆÁÖ Á¤È®ÇÑ ¿ë·®Àº ¾Æ´ÏÁö¸¸ Çö½ÇÀûÀÎ ¹æ¹ýÀ̶ó°í ÇÒ ¼ö ÀÖ½À´Ï´Ù.
[2015-9-8. Webseminar Áú¹®]
¾îÁ¦ ³Ø½Ã¿ò ¾àÀüÀ» º¸´Ù°¡ ÇØ¿Ü¾àÀüÀ» º¸´Ï Á¦±ÕÄ¡·á½Ã 40mg qd·Î ¾´´Ù µÇ¾î ÀÖ´øµ¥ ¿ì¸® °¡À̵å¶óÀÎÀº Ç¥Áؿ뷮 PPI bid »ç¿ëÇϴµ¥ 40mg bid·Î ¾²´Â°Ô ¸Â´ÂÁö¿ä º¸ÇèÀº 20mg bidÀΰɷΠ¾Æ´Âµ¥ ÀÌ°Ç half dose bidÀεíÇѵ¥¿ä.
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PPI Ç¥Áؿ뷮 bid°¡ ¿ì¸®³ª¶óÀÇ Ç¥ÁØÀÔ´Ï´Ù. NexiumÀº 40 mgÀÌ Ç¥Áؿ뷮ÀÔ´Ï´Ù (À¯·´¿¡¼´Â 20 mgÀ» Ç¥ÁØÀ¸·Î »ý°¢Çϱ⵵ ÇÏÁö¸¸...).
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±³¼ö´ÔÀº Á¦±Õ ÃÊÄ¡·á ±â°£À¸·Î 2ÁÖ¸¦ ¼±ÅÃÇÏ´Â °æ¿ì´Â ¾øÀ¸½Ã³ª¿ä?
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MALToma¿¡¼´Â 2ÁÖ, ±Ë¾çÀ̳ª À§¾Ï ³»½Ã°æ Ä¡·á ÈÄ¿¡´Â 1ÁÖ¸¦ ó¹æÇϰí ÀÖ½À´Ï´Ù.
[2015-9-8. Webseminar Áú¹®]
À§Ã༺ À§¿°°ú Àå»óÇÇÈÈ»ýÀÇ Á¾·ù¿¡ µû¶ó Á¦±ÕÄ¡·áÀÇ È¿°ú°¡ ´Ù¸¥ º¸°í°¡ ÀÖ´Â °ÍÀ¸·Î ¾Ë°í Àִµ¥ ¾î¶»°Ô »ý°¢ÇÏ´ÂÁö¿ä?
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º° Â÷ÀÌ ¾ø´Ù°í »ý°¢ÇÕ´Ï´Ù. ¹«½ÃÇÒ Á¤µµÀÇ Â÷ÀÌÀÏ °ÍÀÔ´Ï´Ù. ¾î¶² ¹®ÇåÀÎÁö Àú´Â Àß ¸ð¸£°Ú½À´Ï´Ù¸¸... ¾Ë·ÁÁÖ½Ã¸é °¨»çÇϰڽÀ´Ï´Ù.
[2015-9-8. Webseminar Áú¹®]
Ç︮ÄÚ¹ÚÅÍ ±Õ Áø´Ü½Ã 2°¡Áö °Ë»çÀÇ °á°ú°¡ ´Ù¸£°Ô ³ª¿ÔÀ» ¶§ ±Õ¾ç¼ºÀ¸·Î ³ª¿Â °á°ú¸¦ ¹Ï¾î¾ß Çϳª¿ä?
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Çϳª¶óµµ ¾ç¼ºÀÌ¸é ¾ç¼ºÀ¸·Î ÆÇ´ÜÇÕ´Ï´Ù.
[2015-9-8. Webseminar Áú¹®]
Á¦±Õ ÈÄ 2ÁÖ ÈÄ UBT ÇÏ·¯ ¿À¶ó°í Çϴµ¥¿ä, Áï ¾àÁÖ°í 1´Þ µÚ¿¡ ¿À¶ó°í Çϴµ¥¿ä, À̰͵µ ¹®Á¦¾øÀ»±î¿ä?
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2ÁÖ ÈÄ´Â ³Ê¹« ºü¸¥µ¥¿ä... Á¦±ÕÄ¡·á Á¾·á 4ÁÖ Èİ¡ ÁÁ½À´Ï´Ù. 2013³â °¡À̵å¶óÀÎÀÇ ÇØ´ç ºÎºÐÀ» ¿Å±é´Ï´Ù.
[2015-10-27. ¾Öµ¶ÀÚ Áú¹®]
PPI + clarithromycin + amoxicillinÀ¸·Î 1Â÷ Á¦±Õ Ä¡·á Áß È¯ÀÚºÐÀÌ ¿©·¯ side effect·Î ¸î ÀÏ º¹¿ëÇÏ´Ù°¡ Áß´ÜÇßÀ» °æ¿ì ±³¼ö´Ô²²¼´Â ¾î¶»°Ô ÇϽôÂÁö ±Ã±ÝÇÕ´Ï´Ù. ÀÌÈÄ Ãß°¡ Åõ¿© ¾øÀÌ f/u °Ë»ç¸¦ ÇϽôÂÁö ¾Æ´Ï¸é 2Â÷ ¾àÁ¦¸¦ Åõ¿©ÇϽôÂÁö¿ä?
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A. 2Â÷ ¾àÁ¦¸¦ Åõ¿©Çϰí ÀÖ½À´Ï´Ù. ¾àÁ¦°¡ °ãÄ¡Áö ¾Ê°í ºÎÀÛ¿ë profileµµ »ó´çÈ÷ ´Þ¶ó¼ Ç¥ÁØ 3Á¦¿ä¹ýÀÌ Èûµé¾ú´ø ȯÀÚµµ 2Â÷ 4Á¦¿ä¹ýÀº Àß µå½Ã´Â ºÐÀÌ ¸¹Àº °Í °°½À´Ï´Ù.
[2015-10-27. ¾Öµ¶ÀÚ Áú¹®]
¸¸¾à¿¡ 1Â÷ ¾àÁ¦ ½ÇÆÐ, 2Â÷ ¾àÁ¦ ½ÇÆÐÀÇ °æ¿ì ±³¼ö´Ô²²¼´Â 3Â÷ ¾àÁ¦·Î rifabutin base regimen or levofloxacin base regimenÀ» »ç¿ëÇϽôÂÁö ¾Æ´Ï¸é ´Ù¸¥ ¹æ¹ýÀ» ¼±ÅÃÇϽôÂÁö ±Ã±ÝÇÕ´Ï´Ù. ±×¸®°í ¸¸¾à 3Â÷ ¾àÁ¦±îÁö ½ÇÆÐÇÑ °æ¿ì¿¡´Â ¾î¶»°Ô f/u ÇϽôÂÁö ±Ã±ÝÇÕ´Ï´Ù.
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LevofloxacinÀ» Çѵιø ½á º» ±â¾ïÀÌ ³³´Ï´Ù (PPI + levofloxacin 250mg + amoxicillin 500mg, bid). 3Â÷ ¾àÁ¦±îÁö ½ÇÆÐµÇ¾î ÀÇ·ÚµÈ È¯ÀÚÀÇ ´ëºÎºÐÀº óÀ½ºÎÅÍ Á¦±ÕÄ¡·áÀÇ ¶Ñ·ÇÇÑ ÀûÀÀÁõÀÌ ¾Æ´Ï¾ú´ø °æ¿ì°¡ ¸¹¾Ò½À´Ï´Ù. ±×³É µ¹·Á º¸³Â½À´Ï´Ù. ¼Òȼº±Ë¾çÀÇ °æ¿ì 2Â÷ Á¦±ÕÄ¡·á°¡ ½ÇÆÐÇÑ »óȲ¿¡¼ ÀÚ²Ù Àç¹ßÇϸé Â÷¶ó¸® Àå±â À§»êºÐºñ¾ïÁ¦Á¦ Åõ¿©¸¦ ¼±ÅÃÇϰí ÀÖ½À´Ï´Ù. Half dose PPI¸¦ ÀÏÁÖÀÏ¿¡ 2¹ø ȤÀº 3¹ø °è¼Ó º¹¿ëÄÉ ÇÏ´Â ¹æ¹ýÀÔ´Ï´Ù.
[2016-8-8. ¾Öµ¶ÀÚ Áú¹®]
H. pylori 4Á¦ ¿ä¹ý ¿ë·® ¹®Àǵ帳´Ï´Ù. Çѱ¹ÀÎ Ç︮ÄÚ¹ÚÅÍ ÆÄÀϷθ® °¨¿°ÀÇ Áø´Ü°ú Ä¡·á ÀÓ»ó Áø·áÁöħ °³Á¤¾È 2013¿¡ ÀÇÇϸé 'PPI Ç¥Áؿ뷮 ÇÏ·ç 2ȸ, metronidazole 500mg tid, tetracycline 500mg qid, bismuth 120mg qid, 7~14ÀÏ'·Î µÇ¾î ÀÖ½À´Ï´Ù.
Metronidazole 500mg tid → ¾¾Á¦ÀÌÈĶó½Ã´Ò (1t = 250mg) 2 tab tid, tetracycline 500mg qid → Åׯ®¶ó½ÎÀÌŬ¸°Ä°¼¿ (1cap = 250mg) 2 cap qid¸¦ ¾²¸é °¡´ÉÇÒ °ÍÀ¸·Î ÆÇ´ÜµË´Ï´Ù.
(¹®ÀÇ1) bismuth ÀÇ °æ¿ì¿¡´Â µ¥Á¹Á¤ 1tab = 300mg ÀÔ´Ï´Ù. 120mg qid ·Î ¾î¶»°Ô ó¹æÀ» ³»¸é µÇ´ÂÁö¿ä?
(¹®ÀÇ2) 4Á¦ ¿ä¹ýÀº 7~14ÀÏÀ̶ó°í °¡À̵å¶óÀο¡ µÇ¾îÀִµ¥, ½ÉÆò¿ø ±âÁØÀº ¸çÄ¥·Î ó¹æÇØ¾ß ÇÏ´ÂÁö¿ä?
(¹®ÀÇ3) µå·¯±×ÀÎÆ÷¿¡ bisthmus ´Â "tetracycline ÀÇ Èí¼ö¸¦ ÀúÇØÇÒ ¼ö ÀÖÀ¸¹Ç·Î º´¿ëÅõ¿©ÇÏÁö ¾Ê´Â´Ù", "2½Ã°£ÀÌ»óÀÇ °£°ÝÀ» µÎ°í Åõ¿©ÇÑ´Ù" ¶ó°í µÇ¾î ÀÖ½À´Ï´Ù. bisthmus ´Â qid, tetracyclineµµ qid Àε¥, 4Á¦¿ä¹ý °¢°¢ÀÇ ¾à º¹¾à ½Ã°£À» ¾î¶»°Ô ½ÃÄÑ¾ß ÇÏ´ÂÁö¿ä?
[2016-8-16. ÀÌÁØÇà ´äº¯]
Á¶±Ý º¹ÀâÇÕ´Ï´Ù. Åõ¾à ±â°£Àº 7ÀϱîÁö¸¸ °¡´ÉÇÕ´Ï´Ù. ´ëÇѹα¹ ½ÉÆò¿ø ¹ýÀÔ´Ï´Ù. ³»±Ô¸¦ ¹ýó·³ »ç¿ëÇÏ´Â ÀÌ»óÇÑ Á¶Á÷À̱â´Â ÇÕ´Ï´Ù.
¸ðµç º¹¾à ±ÔÁ¤À» ´Ù Áö۸é ȯÀÚ°¡ ¾àÀ» ¸ÔÀ» ¼ö ¾ø½À´Ï´Ù. ±×·¡¼ Àú´Â ¾Æ·¡¿Í °°ÀÌ ´Ü¼øÇÑ Ã³¹æÀ» ÀÌ¿ëÇϰí ÀÖ½À´Ï´Ù.
[2015-9-8. Webseminar Áú¹®]
Àú´Â µÇµµ·Ï °¡À̵å¶óÀο¡ µû¶ó ±Ë¾ç¿¡¼¸¸ Ç︮ÄÚ¹ÚÅÍ °Ë»ç¸¦ Çϰí Àִµ¥ CLOtest°¡ ¾Æ´Ñ H. pylori PCR °Ë»ç¸¦ Çϰí ÀÖ½À´Ï´Ù. °Ë»ç¸¦ ÇÏ´Ï clarithromycin ÀÇ ³»¼º ¿©ºÎ°¡ ¹Ù·Î ³ª¿À´õ¶ó±¸¿ä. À̶§ ³»¼ºÀÌ ÀÖ´Â ºÐ¿¡°Ô´Â 4Á¦ ¿ä¹ýÀ» ¹Ù·Î Àû¿ëÇÏ´Â °ÍÀÌ ¸Â´Â °ÍÀÎÁö, º¸Çè»óÀ¸·Îµµ »ó°ü¾ø´ÂÁö ±Ã±ÝÇÕ´Ï´Ù. ó¹æÀ» ÇÏ·Á´Ï ¿äÁò tetracyclineÀÌ ´ÜÁ¾µÇ¾ú´Ù°í ÇÏ´øµ¥ ¾î¶»°Ô ó¹æÀ» ÇØ¾ßÇÏ´Â °ÍÀÎÁö¿ä?
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°¡À̵å¶óÀο¡ µû¶ó °Ë»ç ÀûÀÀÁõÀ» Á¤ÇÏ½Å´Ù´Ï °¨»çÇÕ´Ï´Ù. '¾Ç¹ýÀÌ¶óµµ °¡±ÞÀû ÁöŲ´Ù'´Â ŵµ¸¦ °¡Á®¾ß ÇâÈÄ °³¼±ÀÇ Àü¸ÁÀ» ¼¼¿ï ¼ö ÀÖ´Ù°í »ý°¢ÇÕ´Ï´Ù. ±ÔÁ¤À» ¹«½ÃÇÏ¸é ³ª»Û ±ÔÁ¤ÀÌ °íÃÄÁöÁö ¾Ê½À´Ï´Ù. ¸ðµÎ°¡ ¹üÁËÀÚ°¡ µÇ´Â ±æÀÔ´Ï´Ù.
Ç︮ÄÚ¹ÚÅÍ PCR °Ë»ç´Â H.pylori-ClaR ACE Detection kit (Seegene) µîÀÌ ÀÖ½À´Ï´Ù. ¾ÆÁ÷ CLOtest¿Í °°Àº Ç¥ÁØ rapid urease test¸¦ ´ëüÇÒ ¼ö ÀÖ´Ù°í È®¸³µÇ¾î ÀÖÁö ¾ÊÁö¸¸ marketingÀÇ ÈûÀÌ Å« °Í °°½À´Ï´Ù. ¸¹Àº ¼±»ý´ÔµéÀÌ »ç¿ëÇÏ°í °è½Ê´Ï´Ù. Àú´Â ¾Æ´ÏÁö¸¸... ¾Æ·¡ Seegene »ç ȨÆäÀÌÁö ±×¸²¿¡¼ ¼³¸íµÇ´Â ¹Ù¿Í °°ÀÌ multiplex PCRÀ» ÅëÇÏ¿© Ç︮ÄÚ¹ÚÅÍ À¯¹«¿Í ÇÔ²² clarithromycin ÀúÇ×¼º À¯ÀüÀÚ ÀÌ»óµµ µ¿½Ã¿¡ È®ÀÎÇÒ ¼ö ÀÖ½À´Ï´Ù.
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PCR °Ë»ç¿¡¼ clarithromycin ÀúÇ×¼ºÀÌ È®ÀεǸé clarithromycinÀ» »ç¿ëÇÏÁö ¾Ê´Â ó¹æÀ¸·Î ½ÃÀÛÇÑ´Ù´Â Àü·«Àº ³í¸®ÀûÀ¸·Î Ÿ´çÇÕ´Ï´Ù. ¿ì¸®³ª¶óó·³ clarithromycin ÀúÇ×ÀÌ ÈçÇÑ Áö¿ª¿¡¼´Â ºñ·Ï °Ë»ç°¡ ¾ø´õ¶óµµ óÀ½ºÎÅÍ clarithromycinÀ» Æ÷ÇÔÇÏÁö ¾Ê´Â ó¹æÀ» ÇÒ ¼ö ÀÖ´Ù´Â °ÍÀÌ ±¹³» °¡À̵å¶óÀÎÀÇ ÀÔÀåÀ̱⵵ ÇÕ´Ï´Ù.
½ÉÆò¿ø Æò°¡±âÁØÀº ¸ð¸£°Ú½À´Ï´Ù. ½º½º·ÎÀÇ ¿øÄ¢À» ¸íÈ®È÷ ¹àÈ÷Áö ¾Ê°í ºñ¹Ð½º·´°Ô ÀÏÇÏ´Â Á¶Á÷ÀÎÁö¶ó...
Tetracyclin °ø±Þ¿¡ ´ëÇÏ¿© ¾àÁ¦ºÎ¿¡ ¹®ÀÇÇÏ¿´½À´Ï´Ù. ÀúÈñ º´¿ø¿¡¼´Â Tetracyclin 250mg(Á¾±Ù´ç) Á¦Ç°À» »ç¿ëÇϰí Àִµ¥ Á¦¾à»ç¿¡ ¹®ÀÇÇÑ ¹Ù ÇöÀç ¼ö±Þ¿¡ ¹®Á¦ ¾ø´Ù´Â ´äº¯À» ¹Þ¾Ò´Ù°í ÇÕ´Ï´Ù.
[¿ÜºÎ Àü¹®°¡ ´äº¯] PCR »ç¿ë½Ã¿¡´Â Giemsa µî Hp °Ë»çÀÇ À§¾ç¼ºÀÇ ¿øÀÎÀÎ Campylobacter µî ´Ù¸¥ ±ÕÁÖ¸¦ Ä¡·áÇÏÁö ¾Ê°í ³Ñ¾î°¥ ¼ö ÀÖ´Ù´Â ´ÜÁ¡ÀÌ ÀÖ½À´Ï´Ù. Hpº¸´Ù À§Ã༺ º¯È¸¦ ´ú ÀÏÀ¸Å°Áö¸¸ ºñ°¨¿°ÀÚº¸´Ù´Â À§¾ÏÈ °úÁ¤ÀÇ À§Ç輺ÀÌ ¿ùµîÈ÷ Áõ°¡Çϴµ¥, À̵éÀ» ±×³É °£°úÇØµµ µÉ±î¿ä? ¼¾ç¿¡¼´Â µðÇÁÅ׸®¾Æ À§Àå°ü¿°¸¸ ½ÉÇÏ°Ô ¾Î¾Æµµ ÈÄÀ¯ÁõÀ¸·Î À§Ã༺ À§¿°ÀÌ »ý±â¹Ç·Î Á¶½ÉÇØ¾ß ÇÑ´Ù°íµé ÇÕ´Ï´Ù.
[2017-7-9. ¾Öµ¶ÀÚ Áú¹®]
5³â Àü °ËÁø ³»½Ã°æ¿¡¼ ½ÊÀÌÁöÀå ±Ë¾ç ¹ÝÈçÀÌ ¹ß°ßµÇ¾î 1Â÷ Á¦±ÕÄ¡·á¸¦ ¹Þ¾ÒÀ¸³ª Á¦±Õ ¼º°ø ¿©ºÎ´Â È®ÀεÇÁö ¾Ê¾Ò½À´Ï´Ù. 4³â Àü ´Ù½Ã °ËÁø ³»½Ã°æ ÈÄ 1Â÷ Á¦±ÕÄ¡·á¸¦ ¹Þ¾Ò°í 2°³¿ù ÈÄ UBT¿¡¼ ¾ç¼ºÀ» ³ª¿Í 4Á¦¿ä¹ýÀ¸·Î 2Â÷ Á¦±ÕÄ¡·á¸¦ ¹Þ¾Ò´Âµ¥ ÃßÀû UBT´Â ½ÃÇàµÇÁö ¾Ê¾Ò½À´Ï´Ù. ±Ý¹ø °ËÁø¿¡¼ ´Ù½Ã Hp (+) ½ÊÀÌÁöÀå ±Ë¾ç ¹ÝÈçÀÌ ³ª¿Ô½À´Ï´Ù. ¾î¶»°Ô ÇÏ´Â °ÍÀÌ ÁÁÀ»±î¿ä? 3Â÷ Á¦±ÕÄ¡·á·Î PPI + levofloxacin 250mg + amoxicillin 500mg bid¸¦ ½áº¼ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù¸¸...
±×¸®°í EndoTODAY¿¡ 4Á¦¿ä¹ýÀÇ ¿ë·®ÀÌ ¾Æ·¡¿Í °°ÀÌ ¼Ò°³µÇ¾î ÀÖ¾ú½À´Ï´Ù.
Áï metronidazoleÀÌ 250mg 1T qid·Î µÇ¾î Àִµ¥, 500mg tid°¡ quadruple therapyÀÇ Ç¥ÁØÀÎ °Í °°¾Æ ¹®Àǵ帳´Ï´Ù. 500mg tid ¿Í 250mg qid¿¡ Â÷À̰¡ ¾ø°í tetracyclineµµ qid¶ó¼ º¹¿ëÆíÀǸ¦ À§ÇÑ °ÍÀϱî¿ä?
[2017-7-10. ÀÌÁØÇà ´äº¯]
1. °ú°ÅºÎÅÍ ºÎ½ÇÇÑ Ä¡·á¸¦ ¹ÞÀº ȯÀÚÀÔ´Ï´Ù. Á¦±ÕÄ¡·á¸¦ ÇÏ¸é ²À È®ÀÎÀ» ÇØ¾ß Çϴµ¥ À̸¦ ¹«½ÃÇÏ´Â ºÐµéÀÌ ¸¹½À´Ï´Ù. Ä¡·á °èȹÀ» Á¤È®È÷ ÀâÀ» ¼ö ¾ø½À´Ï´Ù.
2. ¿À·¡ Àü Á¦±ÕÄ¡·á¸¦ ¹Þ°í ±ÕÀÌ ¾È ¾ø¾îÁ³°Å³ª, È®ÀεÇÁö ¾ÊÀº »óÅ¿¡¼ À̹ø¿¡ ´Ù½Ã ±ÕÀÌ ³ª¿À´Â ȯÀÚ´Â... ±×³É óÀ½À̶ó°í »ý°¢Çϰí 1Â÷ Á¦±Õ¿ä¹ýÀ» Çϰí ÀÖ½À´Ï´Ù. ÀÌÀ¯´Â ¾Ë ¼ö ¾øÀ¸³ª °ú°Å¿¡ ½ÇÆÐÇÑ È¯ÀÚ°¡ À̹ø¿¡´Â ¼º°øÇÏ´Â °æ¿ìµµ ÀûÁö ¾ÊÀº °Í °°½À´Ï´Ù (°³ÀÎÀû °æÇè).
3. 4Á¦ ¿ä¹ýÀÇ ¿ë·®Àº Ç¥ÁØÈµÇ¾îÀÖÁö ¾Ê½À´Ï´Ù. 1998³â °¡À̵å¶óÀΰú 2013³â °¡À̵å¶óÀÎÀÇ 4Á¦¿ä¹ý ºÎºÐÀ» º¸¸é ¿ë·®ÀÌ Á¶±Ý ´Ù¸¨´Ï´Ù. 2¹ø ¸Ô´Â ¾à, 3¹ø ¸Ô´Â ¾à, 4¹ø ¸Ô´Â ¾àÀ» ÇѲ¨¹ø¿¡ ÁÖ¸é Çò°¥·Á¼ °ï¶õÇÕ´Ï´Ù. ±×·¡¼ 2¹ø ¸Ô´Â ¾à 2°¡Áö, 3¹ø ¸Ô´Â ¾à 2°¡Áö ÀÌ·¸°Ô ó¹æÇϰí ÀÖ½À´Ï´Ù. ÀúÀÇ Ã³¹æÀº metronidazoleÀÌ ´Ù¼Ò ¿ë·®ÀÌ ÀûÀºµ¥¿ä... ¾ÆÁ÷±îÁö Å« ¹®Á¦´Â ¾ø¾î¼°í ¾Æ¸¶µµ º° Â÷ÀÌ´Â ¾øÀ» °ÍÀÔ´Ï´Ù. ÀúÀÇ Ã³¹æ¿¡¼ÀÇ °í¹ÎÀº DeNolÀÌ ³Ê¹« ¸¹Àº ¾ç ¾Æ´Ñ°¡ ÇÏ´Â Á¡Àä... 1¾Ë·Î ¹Ù²ÜÁö ¸»Áö ¾ÆÁ÷µµ °í¹ÎÁßÀÔ´Ï´Ù.
[2017-7-19. ¾Öµ¶ÀÚ Áú¹®]
Ç︮ÄÚ¹ÚÅÍ 2Â÷ Ä¡·á¸¦ ±³¼ö´Ô²²¼ 1ÁÖ ÇÏ½Å´Ù°í ¸»¾¸Çϼ̴ø °ÍÀ¸·Î ±â¾ïÇÕ´Ï´Ù. ¾î¶² ·ÎÄ® ¼±»ý´Ôµé²²¼´Â 2Â÷ Á¦±ÕÄ¡·á¸¦ 2ÁÖ ÇÏ½Å´Ù°í µé¾ú½À´Ï´Ù. 2Â÷ Á¦±ÕÀ» 2ÁÖ ÇØµµ ¾ÆÁ÷Àº »è°¨ÀÌ ¾ø¾ú´Ù°í ÇÕ´Ï´Ù.È®½ÇÇÑ º¸Çè±âÁØÀº ¸ð¸£°Ú´Ù°í ÇϽʴϴÙ. °¡À̵å¶óÀο¡ º¸´Ï 1Â÷Á¦±Õµµ 7~14ÀÏ, 2Â÷Á¦±Õµµ 7~14ÀÏ À̶ó°í µÇ¾îÀÖ´øµ¥¿ä.
¿ì¸®³ª¶ó º¸Çè ±âÁØÀº 1Â÷µµ, 2Â÷µµ 1ÁÖ¸¸ ÀÎÁ¤ÀÌ µÇ´ÂÁö¿ä? ¾Æ´Ï¸é, 2Â÷´Â 2ÁÖµµ ÀÎÁ¤ÇÏ´ÂÁö¿ä?
[2017-7-19. ÀÌÁØÇà ´äº¯]
½ÉÆò¿ø ±ÔÁ¤Àº ¸ðµÎ 1ÁÖÀÏÀÔ´Ï´Ù. ¿äÁòÀº 2ÁÖ¸¦ ó¹æÇصµ »è°¨Àº Àß ¾ÈÇÏ´Â °Í °°½À´Ï´Ù.
Àü¹®°¡ ±×·ìÀÌ °¡À̵å¶óÀÎÀ» ÅëÇÏ¿© ÁÖÀåÇÏ´Â Ä¡·á ±â°£À» Á¤ºÎ¿¡¼ ¹Þ¾ÆµéÀÌÁö ¾Ê°í ÀÖ´Â Çü±¹ÀÔ´Ï´Ù. Çö »óȲÀ̶ó¸é °¡À̵å¶óÀÎÀº ¸¸µå³ª¸¶³ªÀÔ´Ï´Ù. È¥¶õ¸¸ Ä¿Áý´Ï´Ù. µµ¹«Áö Á¤ºÎ°¡ ²Þ½µµ ¾È ÇϹǷÎ... ÀÌÁ¦ ±ÇÀ§ÁÖÀÇ Á¤ºÎµµ ¹°·¯³µÀ¸´Ï, ¾ÕÀ¸·Î´Â Àü¹®°¡ ±×·ìÀÇ ÁøÁ¤¼º ÀÖ´Â °ÇÀǸ¦ ¹Þ¾ÆµéÀÌ´Â »õ Á¤ºÎÀÇ »õ·Î¿î ¸ð½ÀÀ» ±â´ëÇØº¾´Ï´Ù. ±¹¹Î °Ç°Àº ¸Å¿ì Áß¿äÇϴϱî¿ä.
[2017-7-20. ¾Öµ¶ÀÚ Áú¹®]
Ç︮ÄÚ¹ÚÅÍ Á¦±Õ Ä¡·á conventional 3Á¦ ¿ä¹ý ½ÇÆÐ, 4Á¦ ¿ä¹ý ½ÇÆÐÇÑ °æ¿ì ÇöÀç ¸íÈ®ÇÑ strategy°¡ ¾ø´Â °ÍÀ¸·Î ¾Ë°í ÀÖ½À´Ï´Ù. (1) ¾î¿ ¼ö ¾øÀÌ ¼³¸í ÈÄ observationÇØ¾ß ÇÏ´Â °ÍÀÎÁö, (2) EGD ¹× biopsy/culture ÁøÇàÇÏ¿© resistance µîÀ» ÆÇ´ÜÇØ º¸°Ô µÇ´ÂÁö, (3) ºÐ´ç¼¿ï´ëº´¿ø ³í¹®¿¡¼ »ç¿ëµÇ¾ú´ø moxifloxacin Æ÷ÇÔ ¿ä¹ý µîÀ» ½ÃµµÇØ º¸´Â °ÍÀÌ ÁÁÀ»Áö ±Ã±ÝÇÕ´Ï´Ù.
[2017-7-21. ÀÌÁØÇà ´äº¯]
Ç¥ÁØ 1Â÷ Ä¡·á ¹× 2Â÷ Ä¡·á¿¡ ½ÇÆÐÇÑ È¯ÀÚÀÇ rescue therapy´Â ¾ÆÁ÷ Ç¥ÁØÀÌ ¾ø½À´Ï´Ù. °ú°Å¿¡´Â ±×³É Æ÷±âÇß¾ú´Âµ¥¿ä, ÃÖ±Ù¿¡´Â Àû¾îµµ 3Â÷ Ä¡·á±îÁö ½ÃµµÇغ¸´Â °ÍÀÌ ÀϹÝÀûÀÔ´Ï´Ù. PPI + levofloxacin 250mg + amoxicillin 500mgÀ» ÇÏ·ç 2¹ø, 1ÁÖÀÏ Åõ¾àÇϰí ÀÖ½À´Ï´Ù. ¹è¾ç °Ë»ç ÈÄ Ç×»ýÁ¦ °¨¼ö¼ºÀ» È®ÀÎÇÏ¿© Ä¡·áÇÏ¸é ´õ ÁÁ°ÚÁö¸¸, ÇöÀç ÀÏ»óÀûÀÎ °Ë»ç°¡ ºÒ°¡´ÉÇÏ¿© reserach setting¿¡¼¸¸ ÇÒ ¼ö ÀÖ´Â ±â°üÀÌ ´ëºÎºÐÀÎÁö¶ó ±ÇÇϱâ´Â ¾î·Æ½À´Ï´Ù. °ú°Å ¾àÁ¦¸¦ Àß »ìÆìº¸°í »ç¿ëÇÏÁö ¾Ê¾Ò´ø Ç×»ýÁ¦¸¦ °ñ¶ó¼ »ç¿ëÇÏ´Â °ÍÀÌ Çö½ÇÀûÀÎ ´ë¾ÈÀÔ´Ï´Ù. 1Â÷ ¹× 2Â÷ Ä¡·á¾àÁ¦ÀÇ Åõ¾à±â°£ÀÌ 1ÁÖÀÏÀ̾ú´ø °æ¿ì °°Àº ¾àÀ» ´Ù½Ã Àå±â°£ »ç¿ëÇÏ´Â ÃʽÄÀ» °í·ÁÇÏ´Â ¼±»ý´Ôµéµµ °è½ÃÁö¸¸ Áõ°Å´Â ¹Ì¾àÇÑ ÆíÀ̶ó Àú´Â »ç¿ëÇÏÁö ¾Ê°í ÀÖ½À´Ï´Ù.
[2017-9-3. ÀÌÁØÇà Áú¹®]
Á¤¼º¿ì ±³¼ö´Ô. ¾È³çÇϽʴϱî.
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[2017-9-4. °í·Á´ëÇб³ Á¤¼º¿ì ±³¼ö´Ô ´äº¯]
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ÇöÀç »ç¿ëµÇ¾îÁö´Â ³ì½ÊÀÚ µ¥³îÁ¤Àº ¾àǰÁ¤º¸¿¡ ºñ½º¹«Æ®½ÃÆ®¸£»ê¿°Ä®·ý(tripotassium dicitrato bismuthate) 300mg 1Á¤À¸·Î ±âÀçµÇ¾î ÀÖ½À´Ï´Ù. ±×·¯³ª ½ÄǰÀǾàǰ¾ÈÁ¤Ã³ ÀÚ·á¿¡ µû¸£¸é ½ÇÁ¦ 1Á¤ÀÇ ÃÑ·®Àº 440mgÀ̰í ÀÌÁß ºñ½º¹«Æ®½ÃÆ®¸£»ê¿°Ä®·ý·®ÀÌ 300mgÀÔ´Ï´Ù. ÀÌÁß È°¼º¹°Áú¿ë·®ÀÌ »êȺñ½º¹«Æ®·Î½á 120mg°ú Ä®·ý 36mgÀÔ´Ï´Ù. ±×·¯¹Ç·Î 1Á¤¿¡ µé¾îÀÖ´Â elemental bismuth´Â 120mgÀÔ´Ï´Ù. Á¦±ÕÄ¡·á½Ã¿¡´Â 2Á¤¾¿ 2ȸ º¹¿ëÇϱ⠶§¹®¿¡ 1ȸ º¹¿ëµÇ´Â Ȱ¼º bismuth´Â 240mgÀ̰í ÃÑ 480mgÀ» º¹¿ëÇÏ°Ô µË´Ï´Ù. ÃÖ±Ù PAM-B, PAC-B Á¦±ÕÄ¡·á·Î ÁÁÀº °á°ú¸¦ º¸¿© ÁÖ¾ú´ø ¿¬±¸(Zhang W, et al. Gut 2015)¿¡¼´Â elemental bismuth 220mgÀ» ÇÏ·ç 2ȸ (ÃÑ 440mg)·Î ºñ½ÁÇÑ ¿ë·®À» »ç¿ëÇÏ¿´½À´Ï´Ù.
[2017-9-9. ÀÌÁØÇà ´äº¯]
Á¤¼º¿ì ±³¼ö´Ô. °¨»çÇÕ´Ï´Ù. Á¦°¡ ´Ù½Ã Çѹø Á¤¸®ÇØ º¸¾Ò½À´Ï´Ù.
±×°£ Ç︮ÄÚ¹ÚÅÍ 2Â÷ Á¦±ÕÄ¡·á(quadruple treatment)ÀÇ bismuth ¿ë·®¿¡ ´ëÇÑ È¥¼±ÀÌ ÀÖ¾ú½À´Ï´Ù. ÀÏÀüÀÇ ÇÑ ¾Öµ¶ÀÚ°¡ "bismuth ÀÇ °æ¿ì¿¡´Â µ¥Á¹Á¤ 1tab = 300mg ÀÔ´Ï´Ù. 120mg qid ·Î ¾î¶»°Ô ó¹æÀ» ³»¸é µÇ´ÂÁö¿ä?"¶ó°í Áú¹®ÇÑ °Íµµ È¥¼±ÀÇ ÇÑ ¸ð½ÀÀ̾ú½À´Ï´Ù (2016-8-8. ¾Öµ¶ÀÚ Áú¹®). ÀÏÂ÷ÀûÀÎ ¿øÀÎÀº 1998³â Helicobacter °¡À̵å¶óÀο¡¼ bismuth ¿ë·®°ú DeNol ¿ë·®ÀÌ Æ²¸®°Ô Á¦½ÃµÇ¾ú±â ¶§¹®ÀÔ´Ï´Ù. ¾Æ·¡ Ç¥¿Í °°ÀÌ BIS¿¡ ÇØ´çÇÏ´Â ºÎºÐÀÌ DeNol 120mgÀ¸·Î µÇ¾î ÀÖ½À´Ï´Ù. ¾Æ¸¶µµ elemental bismuth 120mg (DeNol·Î´Â 300mg)À» ÇÏ·ç µÎ¹ø ÁÖÀÚ´Â Àǵµ°¡ DeNol 120mgÀ¸·Î À߸øµÇ¾ú´ø °Í °°½À´Ï´Ù. Elemental bismuth 120mgÀº DeNol·Î´Â 300mgÀÔ´Ï´Ù. µû¶ó¼ 1998³â °¡À̵å¶óÀÎÀÇ DeNol 120mgÀº bismuth 120mg (=DeNol 300mg)À¸·Î ¼öÁ¤µÇ¾î¾ß ÇÕ´Ï´Ù.
1998³â Helicobacter °¡À̵å¶óÀÎ
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2013³â Helicobacter °¡À̵å¶óÀÎ
Á¦°¡ ¸î ºÐ ±³¼ö´Ô²² ¹®ÀÇÇÏ¿´´Âµ¥ ´ëºÎºÐ 2013³â °¡À̵å¶óÀÎÀÇ ¿ë·®À» »ç¿ëÇÏ°í °è¼Ì½À´Ï´Ù. ¿¹¸¦ µé¾î »ï¼º¼¿ïº´¿ø ÀÌÇõ ±³¼ö´ÔÀÇ Ã³¹æÀº "PPI bid + Metronidazole 500mg tid + Denol 300mg qid + Tetracycline 500mg qid"·Î 2013³â °¡À̵å¶óÀΰú Á¤È®È÷ ÀÏÄ¡ÇÏ¿´½À´Ï´Ù. ÀúÀÇ °æ¿ì´Â 2017³â »ó¹Ý±â±îÁö´Â ȯÀÚ ÆíÀǸ¦ »ý°¢ÇÑ´Ù´Â ÀÌÀ¯·Î ¾Æ·¡¿Í °°ÀÌ ´Ù¼Ò º¯°æµÈ ¿ë·®À» »ç¿ëÇÏ¿´´Ù°¡ 2017³â ÇϹݱâºÎÅÍ 2013³â °¡À̵å¶óÀÎÀ» 100% Áö۰í ÀÖ½À´Ï´Ù. ÇÏ·ç 2¹ø ¾àÀÌ ÀÖ°í, ÇÏ·ç 3¹ø ¾àÀÌ ÀÖ°í, ÇÏ·ç 4¹ø ¾àÀÌ ÀÖ¾î¼ ¹«Ã´ º¹ÀâÇÏÁö¸¸ ±×³É °¡À̵å¶óÀÎÀ» Áö۰í ÀÖ½À´Ï´Ù.
2017 »ó¹Ý±â±îÁö »ç¿ëÇÏ¿´´ø ó¹æ. ÀÌÈÄ 2013³â °¡À̵å¶óÀÎÀ» 100% ÁöŰ´Â ¹æÇâÀ¸·Î º¯°æÇÔ.
[2017-9-15. °³¾÷°¡ Áú¹®]
Àç¹ßÀÇ ÈçÇÑ ¿øÀÎÀº ¹«¾ùÀԴϱî?
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¼ºÀο¡¼´Â ÀÌ¹Ì À§Ã༺ º¯È°¡ ÁøÇàµÇ¾î ±ÕÁÖÀÇ Á¢ÂøÀÌ ½±Áö ¾Ê¾Æ¼ Àç¹ßÀÌ 1-2%·Î µå¹°´Ù°í ÇÏÁö¸¸, ¿ì¸®³ª¶ó¿¡¼´Â ÀǿܷΠ¸¹À» ¼ö ÀÖ½À´Ï´Ù. ¿Ü±¹¹®Çå¿¡¼´Â Ä¡°ú ½Ã¼ú±â±¸ÀÇ Àç»ç¿ë, À§³»½Ã°æ Á¶Á÷°Ë»ç°âÀÚÀÇ Àç»ç¿ëÀÌ ÈçÇÑ ¿øÀÎÀ̶ó°í ÇÕ´Ï´Ù. °³ÀÎÀûÀÎ °æÇèÀ¸·Î´Â (1) ±¸°³» À§»ý»óŰ¡ ÁÁÁö ¾Ê¾Ò´ø °æ¿ì, (2) µ¿°ÅÇÏ´Â °¡Á· Áß¿¡ Ȱµ¿¼º °¨¿°ÀÚ°¡ ÀÖ´Â °æ¿ì, (3) ¼úÀÜÀ» µ¹·Á°¡¸ç ¸¶½Ã´Â À½ÁÖ°¡ ÀæÀº °æ¿ì¿¡ Àç¹ß·üÀÌ ³ô¾Ò½À´Ï´Ù.
[2017-9-15. °³¾÷°¡ Áú¹®]
Àç¹ßÀ» ¸·±âÀ§ÇÑ °ËÁõµÈ ¹æ¹ýÀº ¹«¾ùÀԴϱî?
[2017-9-15. ÇÑ Àü¹®°¡ÀÇ ´äº¯]
¹®Çå»óÀ¸·Î´Â ÀÇ·á½Ã¼ú±â±âÀÇ Ã¶ÀúÇÑ ¸ê±Õ¼Òµ¶, µ¿°ÅÇÏ´Â °¡Á·µéÀÇ Á¦±Õ Ä¡·á°¡ °ËÁõµÈ ¹æ¹ýÀÔ´Ï´Ù. Ä¡¼® ³» Ç︮ÄÚ¹ÚÅͰ¡ Á¦´ë·Î Á×Áö ¾Ê¾Æ, Á¦±Õ Ä¡·áµÈ À§·Î ´Ù½Ã Èê·¯µé¾î°¡¼ °¨¿°µÇ´Â °æ¿ìµµ ÀÖ´Ù°í ÇÕ´Ï´Ù. Ä¡¼®Àº microaerobic conditionÀ¸·Î Hp Áõ½Ä¿¡ À¯¸®Çϰí 1-2ÁÖ Ä¡·á·Îµµ Àß Á×Áö ¾Ê±â¿¡, Ä¡¼®ÀÌ ¸¹Àº ȯÀÚ³ª Àç¹ßµÈ ȯÀÚ¿¡°Ô´Â Á¦±Õ Ä¡·á ½Ã ½ºÄÉÀϸµÀ» ÇÔ²² ¹Þµµ·Ï ±ÇÇϰí ÀÖ½À´Ï´Ù.
[2017-9-18. °³¾÷°¡ Áú¹®]
1Â÷ Ä¡·á( Amox + clarithromycin+ PPI) & 2Â÷ Ä¡·á(bismuth + TC + MET + ppi) ¿¡ ½ÇÆÐÇßÀ» ¶§´Â ¾î¶»°Ô ÇØ¾ßµÇ´ÂÁö¿ä? 2Â÷Ä¡·áÈÄ¿¡ Ä¡·á¹æ¹ýÀ» ¸ô¶ó¼ Àú´Â Áö±Ý Ä¡·á¾øÀÌ 1³â¸¶´Ù ³»½Ã°æ °üÂû¸¸ ÇÏÀÚ°í ÇÏ´Â ½ÇÁ¤ÀÔ´Ï´Ù.
[2017-9-18. ÇÑ Àü¹®°¡ÀÇ ´äº¯]
ȯÀÚ¸¶´Ù Ä¡·á½ÇÆÐ ¿øÀÎÀÌ ´Ù¸£°í, 3Â÷ Á¦±Õ Ä¡·áÁ¦¿¡ ´ëÇØ¼´Â ´Ù¾çÇÑ ÀǰߵéÀÌ ¸¹¾Æ¼ ¾ÆÁ÷µµ Á¤´äÀº ¾ø´Â °Í °°½À´Ï´Ù. °³ÀÎÀûÀ¸·Î´Â ÇØ´ç ȯÀÚÀÇ ½ÇÆÐ ¿øÀÎÀ» ¸ÕÀú ã¾Æº¸°í(¾Æ·¡ Ç¥¿¡ Çѱ¹Àο¡¼ÀÇ ½ÇÆÐ ¿øÀεéÀ» ¿ä¾àÇß½À´Ï´Ù), ³¡±îÁö ãÁö ¸øÇϸé quinolone + amoxicillin + PPI bid·Î 3Â÷ Ä¡·á¸¦ ÇÕ´Ï´Ù.
Èï¹Ì·Ó°Ôµµ ´ëºÎºÐ ¿øÀÎÀ» ¾Æ·¡ Ç¥ÀÇ ¿øÀÎÀ̳ª Ä¡¼®(¼Òµ¶¸éºÀÀ¸·Î Ä¡¼®À» ±Ü¾î¼ CLO ŰƮ¿¡ ³ÖÀ¸¸é »¡°£»öÀ¸·Î º¯ÇÔ)¿¡¼ ãÀ» ¼ö ÀÖ¾úÀ¸¸ç, ±×¿¡ ¸ÂÃç¼ ´Ù½Ã 1Â÷³ª 2Â÷ Ä¡·á¸¦ Á¦´ë·Î Ä¡·áÇß´õ´Ï ´ëºÎºÐ ¼º°øÇß¾ú½À´Ï´Ù.
Graham & Lee. Gastroenterol Clin North Am. 2015
Áõ·Ê¼ö°¡ Àû¾î¼ ¿øÀú¸¦ ÀÛ¼ºÇÒ ¼ö ¾ø¾ú±â¿¡ Ä¡¼®À̳ª Ç×¹ÙÀÌ·¯½ºÁ¦ Ä¡·á ȯÀÚ¿¡¼ÀÇ ³ôÀº ½ÇÆÐÀ²¿¡ ´ëÇØ¼´Â Ç¥6¿¡ ¹Ìó ³ÖÁö ¸øÇßÀ¸³ª, °£¿°À¸·Î ÀÎÇØ Ç×¹ÙÀÌ·¯½ºÁ¦ Ä¡·á ÁßÀΠȯÀÚ¿¡¼ÀÇ Á¦±Õ Ä¡·á ½ÇÆÐÀ²Àº °ÅÀÇ 100%À̹ǷÎ, Ç×¹ÙÀÌ·¯½ºÁ¦ Ä¡·á¸¦ ¸¶Ä¥ ¶§±îÁö Á¦±Õ Ä¡·á¸¦ º¸·ùÇÕ´Ï´Ù. ³î¶ø°Ôµµ ±× ÀÌÈÄ¿¡ Á¦±Õ Ä¡·áÇß´õ´Ï, ¸ðµÎ ÇÑ ¹ø¿¡ ¼º°øÇß½À´Ï´Ù.
¹Ý¸é¿¡ ¿°Áõ¼º ÀåÁúȯ ȯÀÚµéÀº ±Þ¼º±â³ª Àå¿ÜÁõ»óÀÌ ¿À±â Àü¿¡ ¹Ì¸® Á¦±Õ Ä¡·áÇϰí ÀÖÀ¸¸ç, 100¿¹ ³Ñ°Ô Ä¡·áÇßÁö¸¸ ÀÌ·Î ÀÎÇØ ¿°Áõ¼º ÀåÁúȯÀÌ ¾ÇÈµÈ °æ¿ì¿¡´Â ¾ø¾î¼ ¾È½ÉÇϰí ÇÑ»ìÀÌ¶óµµ ¾î¸± ¶§ Á¦±Õ Ä¡·á¸¦ ±ÇÇϰí ÀÖ½À´Ï´Ù.
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ÀϺ»¿¡¼ 2013³âºÎÅÍ Hp °¨¿°µÈ Àü±¹¹ÎÀ» ´ë»óÀ¸·Î ½ÃÇàÇÏ´Â Hp ¹Ú¸êÄ¡·á ±¹°¡»ç¾÷ÀÌ °è¼Ó ÁøÇàµÇ°í ÀÖ´ÂÁö ±Ã±ÝÇÕ´Ï´Ù.
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³×, Àû±ØÀûÀ¸·Î ÁøÇàµÇ°í ÀÖ½À´Ï´Ù. Á¡Â÷ Ä¡·á´ë»óÀÇ ³ªÀ̵µ ¾î·ÁÁö°í Àִµ¥, ¼Ò¾Æ´Â ¿ö³« Àç°¨¿°À²ÀÌ ³ô¾Æ¼ 15¼¼ºÎÅÍ Ä¡·áÇÏÀÚ´Â ÀǰßÀÌ ¸¹´Ù°í ÇÕ´Ï´Ù. ¸¸¾à ¼Ò¾Æ¸¦ Ä¡·áÇÑ´Ù¸é ÇÔ²² °ÅÁÖÇÏ´Â ¼ºÀÎ °¡Á·µéºÎÅÍ ¸ÕÀú Ä¡·áÇÏ°í ¼Ò¾Æ Ä¡·á¸¦ ÇÑ´Ù°í ÇÕ´Ï´Ù. ÇöÀç´Â Àǹ«±³À°ÀÌ ³¡³ª´Â Áß3 ¶§ ´Üü·Î ¹«·á ¼Òº¯Ç×ü°Ë»ç·Î °¨¿°ÀÚ¸¦ ¼±º°Çؼ, °¡Á·°ú ÇÔ²² Á¦±ÕÄ¡·áÇÑ´Ù°í µé¾ú½À´Ï´Ù. »çȸ¿¡ ³ª°¡¼ Æó¸¦ ³¢Ä¡Áö ¸»¶ó´Â(³²¿¡°Ô Hp¸¦ Àü¿°½ÃŰ°í ´Ù´ÏÁö ¸»¶ó´Â) ±¹¹ÎÁ¤¼°¡ ¿³º¸ÀÌ´Â ´ë¸ñÀÔ´Ï´Ù.
[2017-9-19. È¿äÀú³ÎŬ·´ ³íÀÇ ³»¿ë]
À̹ø¿¡ ÀϺ» Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á ÇöȲÀ» °ËÅäÇÏ¸é¼ ÀϺ»¿¡¼ °¡Àå ¸¹ÀÌ »ç¿ëµÇ°í Àִ ó¹æÀ» ¾Ë°Ô µÇ¾ú½À´Ï´Ù. ÀÌ ¾à Àú ¾à µû·Î ó¹æÇÏÁö ¾Ê°í set·Î µÇ¾î ÀÖ´Â ¾à(treatment pack formulation)À» »ç¿ëÇÑ´Ù°í ÇÕ´Ï´Ù. »óǰ¸íÀ¸·Î Lansap°ú Rabecure¶ó°í ÇÕ´Ï´Ù.
[2018-2-5. ¾Öµ¶ÀÚ Áú¹®]
¼Òȼº ±Ë¾ç µîÀÇ º¸Çè¿¡ ÇØ´çµÇ´Â ¿µ¿ªÀÌ ¾Æ´Ï°í... #1. single erosion ºÎÀ§ biopsy °á°ú¿¡¼ H.pylori ¼Ò°ßÀÌ °üÂûµÇ°Å³ª ȤÀº #2. diffuse mucosal redness at high body, fundus º¸À϶§¿¡ HP associated gastritis ·Î Á¶Á÷°Ë»ç 1-2Á¡ °¡·® ½ÃÇàÇϰí HP infection ÀÇ ¼Ò°ßÀÌ °üÂûµÇ¸é ȯÀںв² ¼³¸íµå¸®°í Àû±ØÀûÀ¸·Î HP eradication Ä¡·á ±Ç°í¸¦ Çϰí Àִµ¥¿ä. (100/100 À¸·Î º¯°æµÇ°í Á»´õ ¶¸¶¸ÇϰÔ....) ÀÌ·± ¹æ¹ýÀÌ °úÀ×Ä¡·á´Â ¾Æ´ÑÁö Á¶±Ý °ÆÁ¤µË´Ï´Ù. ±³¼ö´Ô ÀǰßÀº ¾î¶°ÇϽŰ¡¿ä??
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Hp Ä¡·á ÀûÀÀÁõ (½ÉÆò¿ø) 2017³â±îÁö 2018³âºÎÅÍ ¼Òȼº±Ë¾ç, MALT ¸²ÇÁÁ¾ ±Þ¿© ±Þ¿© Á¶±âÀ§¾Ï ³»½Ã°æÄ¡·á ÈÄ Àü¾×º»Àκδã (100/100 ±Þ¿© =ÇÕ¹ý) ±Þ¿© ITP ÀÓÀÇ ºñ±Þ¿© (=ºÒ¹ý) ±Þ¿© ±âŸ ¸ðµç °æ¿ì ÀÓÀÇ ºñ±Þ¿© (=ºÒ¹ý) Àü¾×º»Àκδã (100/100 ±Þ¿© =ÇÕ¹ý) Àú´Â 2018³â ¹ßÇ¥µÈ Á¤ºÎÀÇ ¹æÄ§¿¡ Âù¼ºÇÕ´Ï´Ù (100/100 ºÎºÐ¸¸ »©°í). Ç︮ÄÚ¹ÚÅÍ °¨¿°ÀÌ È®ÀÎµÈ ¸ðµç ȯÀڴ Ưº°ÇÑ contraindicationÀÌ ¾ø´Â ÇÑ Á¦±ÕÄ¡·á¸¦ ¹Þ´Â °ÍÀÌ ÁÁÀ» °ÍÀ¸·Î »ý°¢ÇÕ´Ï´Ù. ÀþÀº »ç¶÷¿¡¼´Â À§¾Ï ¿¹¹æ È¿°ú¸¦ ±â´ëÇÒ ¼ö ÀÖ°í, Á߳⿡¼´Â À§¿°ÀÌ ÁÙ¾î À§¾Ï °ËÁø ³»½Ã°æÀÇ È¿°ú°¡ ÁÁ¾ÆÁú ¼ö ÀÖ°í, °í·É¿¡¼´Â ´ÙÀ½ ¼¼´ë·ÎÀÇ ÀüÆÄ¸¦ ¸·À» ¼ö ÀÖ´Ù´Â Á¡À» ¸ðµÎ °í·ÁÇÑ ÆÇ´ÜÀÔ´Ï´Ù.
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2Â÷ Á¦±ÕÄ¡·á ¾àÁ¦ÀÇ Åõ¾à ½ÃÁ¡Àº ¾î¶»°Ô ÇÏ°í °è½Ê´Ï±î?
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½ÄÈÄ 30ºÐ¿¡ 3¹ø, ±×¸®°í Àú³á¿¡ 1¹ø µå½Ã´Â °ÍÀ¸·Î ÅëÀÏÇϰí ÀÖ½À´Ï´Ù.
[2018-4-21. ¼øÃµ¸¸³»½Ã°æ¼¼¹Ì³ª 2018 Áú¹®]
2Â÷ Á¦±ÕÄ¡·á±îÁö ½ÃÇàÇÑ ÈÄ Ç︮ÄÚ¹ÚÅÍ À½¼ºÀ¸·Î ³ª¿Ô´ø ȯÀÚ°¡ 5-6³â ÈÄ ´Ù½Ã ¾ç¼ºÀ¸·Î ³ª¿Â °æ¿ì´Â ¾î¶»°Ô Åõ¾àÇÏ°í °è½Ê´Ï±î?
[2018-4-21. ÀÌÁØÇà ´äº¯]
óÀ½À̶ó°í °¡Á¤Çϰí ÀÏ¹Ý PPI-based triple therapy·Î Ä¡·áÇϰí ÀÖ½À´Ï´Ù. °ú°Å 1Â÷ ¾àÁ¦·Î Ä¡·áµÇÁö ¾Ê´ø ȯÀÚ¿¡¼ ¸î ³â ÈÄ¿¡´Â Ä¡·á°¡ µÇ´Â °æ¿ìµµ ÀÖ½À´Ï´Ù.
[2018-7-1. ¾Öµ¶ÀÚ Áú¹®]
Ȥ½Ã Åõ¼® ȯÀÚ¿¡¼ HP Á¦±ÕÄ¡·á dose ¸¦ Á¤ÇØ ³õÀ¸½Å°Ô ÀÖ´ÂÁö¿ä? ã¾Æº¸´Ï PPI ´Â dose adjustment ÇÒ Çʿ䰡 ¾ø°í, amoxicillin ÀÇ °æ¿ì 250-500mg q24h, clarithromycin Àº Åõ¼® ÈÄ Åõ¾à À̶ó°í¸¸ lexicomp renal dosing ¿¡ ½á Àִµ¥ Ȥ½Ã Á¤ÇØÁø standard dose °¡ ÀÖ´ÂÁö ±Ã±ÝÇÏ¿© ¸ÞÀÏÀ» µå¸³´Ï´Ù. ´ÙÀ½ÁÖ¿¡ Åõ¼® ȯÀÚ Áß¿¡ erosion ¿¡¼ HP+ ÀÌ ³ª¿Â ºÐÀÌ Àִµ¥ Á¦±Õ Ä¡·á ¼³¸íÀ» µå¸®·Á±¸¿ä~
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ÀϹÝÀûÀ¸·Î ¸¸¼º ½ÅÁúȯ ȯÀÚ¿¡¼µµ GFRÀÌ Á¤»óÀ̸é Á¤»ó ¿ë·®, GRFÀÌ °¨¼ÒÇÏ¿´À¸¸é ±×¿¡ ¸ÂÃç ó¹æÇÏ¸é µË´Ï´Ù. Ç÷¾× Åõ¼® ÁßÀΠȯÀÚ¿¡¼´Â ´ç¿¬È÷ ¿ë·®À» ÁÙ¿©¾ß°ÚÁö¿ä. Àú´ÂÇ¥ÁØ Ã³¹æ¿¡¼ amoxicillin°ú clarithromycinÀ» 'ÇÏ·ç 1ȸ ¾ÆÄ§ ½ÄÈÄ (M) Åõ¾à'À¸·Î Á¶Á¤Çϰí ÀÖ½À´Ï´Ù.
[2018-7-8. SMC ¼Òȱ⺴½ÉÆ÷Áö¾ö Áú¹®]
Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á Áß È¥µ·À̳ª ȯ°¢ °°Àº ½Å°æ°è ºÎÀÛ¿ëÀ» 3¹ø °æÇèÇÏ¿´½À´Ï´Ù. ¼±»ý´ÔÀº À¯»çÇÑ °æÇèÀ» ÇϽŠÀûÀº ¾øÀ¸½Ê´Ï±î?
[2018-7-8. ÀÌÁØÇà ´äº¯]
°³ÀÎÀûÀ¸·Î È¥µ·À̳ª ȯ°¢ °°Àº ½Å°æ°è ºÎÀÛ¿ëÀ» °æÇèÇÑ ÀûÀº ¾ø½À´Ï´Ù. ´Ù¸¸ 2Â÷ ¾àÀ» ÀÚÁÖ »ç¿ëÇÏ´Â metronidazoleÀº ´Ù¾çÇÑ ºÎÀÛ¿ëÀÌ °¡´ÉÇѵ¥ ±× Áß ½Å°æ°è ºÎÀÛ¿ëÀÌ ÀÖ½À´Ï´Ù.
ÀÏÀü¿¡ IV metronidazole Åõ¿© ÈÄ encephalopathy°¡ ¿Ô´ø Å©·Ðº´ ȯÀÚ Áõ·Ê º¸°í°¡ ÀÖ¾ú½À´Ï´Ù (Kim JH. Intest Res 2017). ƯÀÌÇÑ Á¡Àº metronidazoleÀ» °æ±¸ Åõ¿©ÇßÀ» ¶§¿¡´Â ¹®Á¦°¡ ¾ø¾ú´Âµ¥ IV Åõ¿© ÈÄ encephalopathy°¡ ÀÖ¾ú´Ù´Â Á¡ÀÔ´Ï´Ù.
Brain MRI findings. Fluid-attenuated inversion recovery MRI shows high-intensity lesions in the bilateral medial thalamus (A), midbrain tegmentum (B), pontine tegmentum (C), fourth ventricle and dentate nucleus (D), and subcortical white matter (E) (arrows).
[2018-7-12. ¾Öµ¶ÀÚ Áú¹®]
Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á ½Ã ºÎÀÛ¿ëÀÌ ÀÖÀ» °æ¿ì, ¼³»ç ȤÀº À§Àå°ü Áõ»ó ºÎÀÛ¿ë ½Ã Áõ»óÀ» Á¶ÀýÇÏ¸é¼ ³¡±îÁö ¾àÀ» ¸ÔÀ» °ÍÀ» ±ÇÇÏ´Â ÆíÀä... ¹ßÁø°°Àº ÇǺκ´º¯ÀÌ ³ªÅ¸³ª´Â °æ¿ì¿¡´Â ¾î¶»°Ô ÇØ¾ßÇÒ±î¿ä? ¿ì¼± ¾àÀ» stop Çϰí Á¦±ÕÄ¡·á¸¦ ¾ÈÇϰí ÀÖ½À´Ï´Ù.
Ȥ½Ã ´Ù¸¥ ¹æ¹ýÀ¸·Î ¾àÀ» ¸ÔÀ» ¼ö ÀÖ´Â ¹æ¹ýÀÌ ÀÖÀ»Áö ȤÀº Á¦±ÕÄ¡·á¸¦ Æ÷±âÇÏ´Â °ÍÀÌ ÁÁÀ»Áö¿¡ ´ëÇØ¼ °í°ß ¿©Âã´Ï´Ù.
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¾î·Á¿î Áú¹®ÀÔ´Ï´Ù. ¹ßÁøµµ ¹ßÁø ³ª¸§À̰ÚÁö¿ä. ÀϹÝÀûÀ¸·Î ¸»ÇÏÀÚ¸é Àú´Â ¹ßÁø Áß ÀϺδ Áß¿ä ºÎÀÛ¿ëÀÇ Áõ»óÀÏ ¼ö ÀÖ´Ù°í »ý°¢ÇÏ°í ¾àÀ» ²÷µµ·Ï ±ÇÇϰí ÀÖ½À´Ï´Ù. 1Â÷ ¾àÀ» ¸Ô´Â Áß ¹ßÁøÀÌ »ý±â¸é Àá½Ã ½¬¾ú´Ù°¡ 2Â÷ ¾àÀ» µå½Ãµµ·Ï ó¹æÇÏ¸é ¾î¶³±î¿ä?
[2018-10-6. ¾Öµ¶ÀÚ Áú¹®]
ÀÌÁØÇà ±³¼ö´Ô²². ±³¼ö´ÔÀÇ ¿£µµ Åõµ¥ÀÌ¿¡¼ ¸¹Àº µµ¿òÀ» ¹Þ°í ÀÖ´Â °ËÁø¼¾ÅÍ¿¡¼ ÀÏÇÏ¸é¼ À§³»½Ã°æÀ» Çϰí ÀÖ´Â °¡Á¤ÀÇÇаú ÀÇ»çÀÔ´Ï´Ù.
±Ë¾ç µî º´º¯ÀÌ Àְųª À§Ã༺ À§¿°ÀÌ ÀÖÀ¸¸é¼ Ç︮ÄÚ¹ÚÅÍ±Õ °Ë»ç ¿øÇϽô ºÐ µî¿¡°Ô CLOtest¸¦ ½ÃÇàÇÏ¿© ¾ç¼ºÀ¸·Î ³ª¿Â ºÐµé¿¡°Ô Á¦±ÕÄ¡·á¸¦ ½Ç½ÃÇϰí ÀÖ½À´Ï´Ù. °£È¤ ¼ºÀÎ ¿©¼º Áß 35kg~42kg Á¤µµ·Î ¾ÆÁÖ ¸¶¸¥ ºÐµéÀÌ ÀÖ½À´Ï´Ù. º¸ÅëÀÇ ¿ë·®ÀÌ 40kgµµ ¾È µÇ´Â ºÐµé¿¡°Ô´Â °úÇÏÁö ¾Ê³ª °í¹ÎÀÔ´Ï´Ù. Ȥ½Ã üÁß¿¡ µû¸¥ ¿ë·® Á¶Àý¿¡ ´ëÇØ¼ ÇÐȸ¿¡¼ ³íÀÇµÈ ¹Ù°¡ ÀÖ´ÂÁö, ±×¸®°í ±³¼ö´ÔÀº ÀϰýÀûÀ¸·Î ±×´ë·Î ¾àÀ» ÁֽôÂÁö ±Ã±ÝÇÕ´Ï´Ù. (°áÇÙ¾àÀº 50kg ±âÁØÀ¸·Î ´Ù¸£°Ô ¾àÀ» Åõ¿©Çϴϱî¿ä.)
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¼Ò¾ÆÀÇ ¿ë·®À» Âü°íÇϸé ÁÁÀ» °Í °°½À´Ï´Ù. ¼Ò¾ÆÃ»¼Ò³â°ú¿¡¼ »ç¿ëÇÏ´Â amoxicillin ¿ë·®Àº 50mg/kg/day·Î¼ 40kgÀÌ¸é ¼ºÀÎÀÇ Åë»ó ¿ë·® 2g/day°¡ µË´Ï´Ù. ¼Ò¾ÆÃ»¼Ò³â°ú¿¡¼ »ç¿ëÇÏ´Â clarithromycin ¿ë·®Àº 15mg/kg/day·Î 67kgÀÌ¸é ¼ºÀÎÀÇ Åë»ó ¿ë·® 1g/day°¡ µË´Ï´Ù.
¾à 40kgÀÇ ¼ºÀÎÀ̶ó¸é amoxicillinÀº ¼ºÀÎ ¿ë·®À» ±×´ë·Î ¾²¸é µÇ°í, clarithromycinÀº ¾à°£ °ú¿ë·®ÀÌ µÇ´Â ¼ÀÀÔ´Ï´Ù. Àú´Â 40kgÀÇ ¼ºÀÎÀ̸é Åë»ó ¿ë·®°ú µ¿ÀÏÇÏ°Ô Ã³¹æÇϰí ÀÖ½À´Ï´Ù. ¿µ ¸¶À½¿¡ °É¸®½Ã¸é clarithromycin 250mg bid¸¦ ¾²¼Åµµ ¹«¹æÇÒ °Í °°½À´Ï´Ù. ÀÌ °æ¿ì´Â 15mg/kg/day¿¡ ¾à°£ ¸ðÀÚ¶ø´Ï´Ù. ±×·¯³ª ÀϺ»À» Âü°íÇÏ¸é ¿ë·®ÀÌ ÀûÀº °Íµµ ¾Æ´Õ´Ï´Ù. ÀϺ»Àº ¿ì¸®³ª¶óÀÇ 500mg bid°¡ ¾Æ´Ï¶ó 200mg bid¸¦ ¾²±âµµ Çϱ⠶§¹®ÀÔ´Ï´Ù.
Âü°í·Î ÀϺ»¿¡¼´Â ¿ì¸®³ª¶óº¸´Ù Ç×»ýÁ¦¸¦ Á¶±Ý ¾àÇÏ°Ô »ç¿ëÇÕ´Ï´Ù. 1Â÷ Á¦±ÕÄ¡·á ¾àÁ¦·Î´Â Amoxacillin 750 mg+Clarithromycin 200 mg (or 400mg)+protop pump inhibitor (PPI) ¼¼°¡Áö ¾àÁ¦°¡ ÇÏ·ç µÎ¹ø¾¿ 7Àϰ£ º¸ÇèÀû¿ëÀÌ µË´Ï´Ù.
¿äÄÁµ¥ 40kgÀÇ ¼ºÀο¡¼ PPI¿Í amoxicillinÀº Åë»ó¿ë·®À» ½áµµ ÁÁ°í clarithromycinÀº Åë»ó¿ë·® ȤÀº Àý¹Ý ¿ë·®À» Åõ¿©ÇÏ¸é µÇ°Ú½À´Ï´Ù. Àú´Â ±×³É ¸ðµç ¾àÀ» Åë»ó ¿ë·®À¸·Î ó¹æÇϰí ÀÖ½À´Ï´Ù.
[2018-10-28. ³»°úÇÐȸ Áú¹®]
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Ç¥ÁØÀûÀÎ Ç×»ýÁ¦¸¦ ¸î Â÷·Ê »ç¿ëÇÏ¿´À¸³ª Á¦±ÕµÇÁö ¾Ê´Â ºÐµé¿¡¼ µÚ´Ê°Ô Ç×»ýÁ¦ ³»¼º °Ë»ç¸¦ ÇÏ¿© ÀǹÌÀÖ´Â µµ¿òÀ» ¹Þ±â´Â ¾î·Á¿ï °Í °°½À´Ï´Ù. Ç×»ýÁ¦ ³»½Ã°æ °Ë»ç °á°ú ¿©ºÎ¿Í ¹«°üÇÏ°Ô ¾àÀ» ÁÖ¾ú´Âµ¥ ±ÕÀÌ ¾ø¾îÁöÁö ¾ÊÀ¸¸é ¾îÂ¥ÇÇ ¾î¶»°Ô ÇØ º¼ µµ¸®°¡ ¾ø±â ¶§¹®ÀÔ´Ï´Ù. Çö½ÇÀûÀÎ ÀÌÀ¯·Î Ç×»ýÁ¦ ³»¼º °Ë»ç¸¦ Çϱ⵵ ¾î·Æ½À´Ï´Ù. ÀÏ»ó °Ë»ç·Î´Â ºÒ°¡´ÉÇϰí ÀÓ»ó ¿¬±¸ setting¿¡¼ ½ÃÇàÇÒ ¼ö ÀÖÀ» »ÓÀÔ´Ï´Ù. °¡´ÉÇÑ °÷ÀÌ º°·Î ¾ø½À´Ï´Ù. Á¦ ¿Ü·¡¿¡¼µµ ºÒ°¡´ÉÇÕ´Ï´Ù. ´ÜÁö clarithromycin resistance¸¦ genetics·Î °£Á¢ÀûÀ¸·Î È®ÀÎÇÏ´Â °ÍÀÌ ÀüºÎÀÔ´Ï´Ù. ³»¼º °Ë»ç¸¦ ÇÑ´Ù¸é ÃÊÄ¡·á Àü ȤÀº ÃÖ¼ÒÇÑ 1Â÷ Á¦±ÕÄ¡·á ½ÇÆÐ ÈÄ ½ÃÇàÇÒ ¼ö ÀÖ½À´Ï´Ù. ±×·¯³ª Çö½ÇÀûÀ¸·Î´Â µÎ °æ¿ì ¸ðµÎ ¸Å¿ì ¾î·Æ½À´Ï´Ù. ¿ì¸®³ª¶ó¿¡¼´Â ¾î·Æ°Ô ÀÓ»ó ¿¬±¸·Î °Ë»ç¸¦ ÇÏ°í ±× °á°ú¸¦ È®ÀÎÇÏ¿© Ä¡·áÇÏ´Â °Íº¸´Ù ÀÏ´Ü Ç¥ÁØ ¾àÁ¦¸¦ Åõ¿©Çϰí UBT·Î È®ÀÎÇÏ´Â °ÍÀÌ È¯ÀÚ¿¡°Ô³ª Àǻ翡°Ô³ª ´õ ÆíÇÑ Ãø¸éµµ ÀÖ½À´Ï´Ù. Àú´Â Ç︮ÄÚ¹ÚÅÍ ³»¼º°Ë»ç ¾øÀÌ È¯ÀÚ¸¦ Áø·áÇϰí Àִµ¥ Å« ¾î·Á¿òÀº ¾ø¾ú½À´Ï´Ù.
[2018-10-28. ³»°úÇÐȸ Áú¹®]
ÀϺ»¿¡¼ Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á°¡ ¸¹¾ÆÁø ÈÄ À§¾Ï ¹ß»ý·üÀÌ ÁÙ°í ÀÖ½À´Ï±î? µ¥ÀÌŸ°¡ ÀÖ½À´Ï±î?
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¾ÆÁ÷ 5³â¹Û¿¡ µÇÁö ¾Ê¾ÒÀ¸¹Ç·Î Á¤Ã¥º¯È·Î ÀÎÇÏ¿© À§¾ÏÀÌ ÁÙ¾ú´Ù´Â Á÷Á¢ÀûÀÎ µ¥ÀÌŸ´Â ¾ÆÁ÷ º¸Áö ¸øÇß½À´Ï´Ù. ¹Ý´ë·Î ÃÖ±Ù ÀϺ»¿¡¼ °ËÁø ³»½Ã°æÀ» µµÀÔÇÏ¸é¼ Á¶±âÀ§¾ÏÀÌ °ú°Åº¸´Ù ´õ ¸¹ÀÌ Áø´ÜµÇ´Â prefecture°¡ ÀÖ´Ù°í ¾Ë°í ÀÖ½À´Ï´Ù.
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2019³â 5¿ù 4ÀÏ ÇÑ ½ÉÆ÷Áö¾ö¿¡¼ °í·Á´ë ±Ýº¸¶ó ¼±»ý´ÔÀÇ 'Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á' °ÀǸ¦ Àß µé¾ú½À´Ï´Ù. Àß Á¤¸®µÈ ½½¶óÀ̵带 º¸¿©Áּż »çÁø ÇÑ Àå Âï¾ú½À´Ï´Ù.
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¿ì¸®³ª¶ó¿¡ bismuth 120mgÀÌ ÀÖ½À´Ï±î? 300mg ¹Û¿¡ ¾ø´Â °Í ¾Æ´Ñ°¡¿ä?
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¿ì¸®³ª¶ó¿¡¼ ÈçÈ÷ »ç¿ëµÇ´Â bismuth´Â DeNol (bismuth subcitrate)ÀÔ´Ï´Ù. Elemental bismuth 120mgÀº DeNol·Î´Â 300mgÀÔ´Ï´Ù. µû¶ó¼ °¡À̵å¶óÀο¡ bismuth 120mgÀ¸·Î µÇ¾î ÀÖ´Â °ÍÀº DeNol 300mgÀ¸·Î ó¹æÇÏ¸é µË´Ï´Ù. °¡À̵å¶óÀε¥ »óǰ¸íÀ» ¾µ ¼ö ¾ø¾î¼ ±×¸® µÈ °Í °°½À´Ï´Ù. Á¤¸®Çϸé "bismuth 120mg = DeNol 300mg"ÀÔ´Ï´Ù.
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¿ÃÇØ °Ë»ç´Â ¾ø´Âµ¥ ÀÛ³â °Ë»ç °á°ú ÀǰŠÇ︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á¸¦ ÇÒ ¼ö ÀÖ½À´Ï±î?
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º¸Çè±ÔÁ¤Àº Á¤È®È÷ ¸ð¸£°Ú½À´Ï´Ù. ÀÇÇÐÀûÀ¸·Î´Â °¡´ÉÇÒ °Í °°½À´Ï´Ù. Ç︮ÄÚ¹ÚÅÍ °¨¿°Àº Á¤±Ô Á¦±ÕÄ¡·á¸¦ ÇÏÁö ¾Ê´Â ÇÑ ÀúÀý·Î ¾ø¾îÁö´Â °æ¿ì´Â °ÅÀÇ ¾ø½À´Ï´Ù. ÃßÀû°Ë»ç¿¡¼ À½¼ºÀ¸·Î ³ª¿Íµµ false negative°¡ ¸¹À» °ÍÀÔ´Ï´Ù.
¼ö °³¿ù Àü ±×¿Í ºñ½ÁÇÑ È¯ÀÚ°¡ ÀǷڵǾú±â¿¡ ¾Æ·¡¿Í °°ÀÌ ¼³¸íÇÏ°í ¾àÀ» ó¹æÇÑ °æÇèÀÌ ÀÖ½À´Ï´Ù. 100/100 ¼±º°±Þ¿©·Î ó¹æÇߴµ¥¿ä, »è°¨µÇ¾ú´ÂÁö ¾Æ´ÑÁö´Â ¾Ë ¼ö ¾ø½À´Ï´Ù.
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Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á¸¦ À§ÇÏ¿© ÀǷڵǼ̽À´Ï´Ù. ±Ý¹ø ³»½Ã°æ¿¡¼´Â Ç︮ÄÚ¹ÚÅÍ Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¾Ê¾ÒÁö¸¸ (¼Òȼº±Ë¾ç, Á¶±âÀ§¾Ï, MALT ¸²ÇÁÁ¾, Ç÷¼ÒÆÇ °¨¼ÒÁõ¿¡¼¸¸ °Ë»ç¸¦ Çϰí ÀÖ°í ±âŸ´Â ¿ì¿¬È÷ ³ª¿À´Â °æ¿ìÀÔ´Ï´Ù) °ú°Å °Ë»ç¿¡¼ ¾ç¼ºÀ̾ú´ø ±â·ÏÀÌ ÀÖ¾ú½À´Ï´Ù.
¹«Áõ»ó ¼ºÀÎÀÇ Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·áÀÇ µæ½Ç¿¡ ´ëÇØ¼´Â ¾ÆÁ÷±îÁöµµ ³í¶õÀÌ ÀÖ½À´Ï´Ù. µû¶ó¼ ¾ÆÁ÷±îÁö Á¤ºÎ¿¡¼´Â Àü±¹¹Î ´ë»ó Á¦±ÕÄ¡·á¸¦ ±ÇÇÏÁö ¾Ê°í ÀÖ½À´Ï´Ù. À§¿¡´Â ¾à°£ µµ¿òÀÌ µÇÁö¸¸ Ÿ Àå±â¿¡´Â ¾î¶² ¿µÇâÀ» ¹ÌÄ¡´ÂÁö°¡ ºÒ¸íÈ®ÇÏ¿© ¾ÆÁ÷±îÁö´Â ÀüüÀûÀ¸·Î µæ½ÇÀÌ ¸íÈ®ÇÏÁö ¾Ê´Ù´Â ÀÚ·á°¡ ¸¹±â ¶§¹®ÀÔ´Ï´Ù. ±×·¡¼ 2017³â ¸»±îÁö´Â ¼Òȼº ±Ë¾çÀ̳ª À§¾Ï ȯÀÚ¿¡¼¸¸ Ç︮ÄÚ¹ÚÅÍ Ä¡·á°¡ °¡´ÉÇß½À´Ï´Ù. ±âŸ °æ¿ì´Â ±ÇÇÏÁö ¾Ê°Ô µÇ¾î ÀÖ¾ú½À´Ï´Ù (ÀûÀÀÁõ ¾Æ´Ô).
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µÎ Á¾·ùÀÇ Ç×»ýÁ¦¿Í ÇÑ Á¾·ùÀÇ À§»êºÐºñ¾ïÁ¦Á¦¸¦ 1ÁÖ Åõ¾àÇÕ´Ï´Ù. ÁÖ·Î Ç×»ýÁ¦ ¶§¹®¿¡ ¼³»ç µî À§ÀåÀå¾Ö³ª ¾Ë·¯Áö¿Í °°Àº ºÎÀÛ¿ëÀÌ °¡´ÉÇÕ´Ï´Ù¸¸ °³ÀÎÂ÷´Â Å®´Ï´Ù. Á¦±Õ ¼º°ø·üÀº 80% ÀüÈÄÀÔ´Ï´Ù. Ä¡·á°¡ Àß µÇ¾ú´ÂÁö È®ÀÎÇϱâ À§ÇÏ¿© ¾à 8 ÁÖ ÈÄ È£±â°Ë»ç¸¦ ÇÕ´Ï´Ù.
°èȹ: Á¦±ÕÄ¡·á (100/100) + 8ÁÖ ÈÄ È£±â°Ë»ç
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Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á¿¡ À¯»ê±Õ À½·á°¡ µµ¿òÀÌ µË´Ï±î?
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Hp eradication 2Â÷ ¾àÁ¦·Î Ä¡·á¹ÞÀº ºÐÀÔ´Ï´Ù. ¾Æ¿ï·¯ ¼Ó¾²¸² Áõ»óÀÌ ÀÖ¾î PPI¸¦ µå½Ã°í ÀÖ½À´Ï´Ù. PPI Åõ¿©Áß È£±â°Ë»ç¸¦ Çϸé false negative °¡´É¼ºÀÌ ³ôÀº °ÍÀ¸·Î ¾Ë°í ÀÖ½À´Ï´Ù. ±Ë¾çÀ̳ª ¾ÏÀÌ ÀÖ´ø ȯÀÚ´Â ¾Æ´Ï¹Ç·Î 100/100À¸·Î Hp ó¹æÇß´ø ȯÀÚºÐÀε¥... ÀÌ·± °æ¿ìµµ ²À UBT °Ë»ç¸¦ ÇØ¾ß ÇÏ´ÂÁö¿ä? PPI¸¦ µå½Ã°í °è¼Å¼ °í¹ÎÀÔ´Ï´Ù. ÀÏ´ÜÀº Á¦±ÕÄ¡·á ¼º°øÀ» °¡Á¤ÇÏ°í °æ°ú°üÂûÀ» ÇÒ °ÍÀÎÁö, PPI¸¦ Áß´ÜÇϰí UBT¸¦ ÇÒ °ÍÀÎÁö °í¹ÎÀÔ´Ï´Ù.
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Á¦±ÕÄ¡·á¸¦ ÇÒ °ÍÀÎÁö ¸» °ÍÀ» °í¹ÎÇÏ´Â °ÍÀÌ ¿ì¼±À̶ó°í »ý°¢ÇÕ´Ï´Ù. ÀÏ´Ü Á¦±ÕÄ¡·á ¾àÀ» Åõ¿©ÇÑ ÈÄ¿¡´Â ¹Ýµå½Ã È®ÀÎÇÒ °ÍÀ» ±ÇÇÕ´Ï´Ù. ¾Æ·¡ YouTube °ÀǸ¦ Âü°íÇϽʽÿÀ.
PPI´Â 2ÁÖ ²÷°í, H2RA´Â 1ÁÖ ²÷°í UBT °Ë»ç¸¦ ÇÏ´Â °ÍÀÌ ÀϹÝÀûÀÔ´Ï´Ù. »ê¿ª·ù Áõ»óÀÌ ½ÉÇϸé PPI¸¦ 1ÁÖ¸¸ ²÷±âµµ ÇÕ´Ï´Ù. Çʿ伺À» Àß ¼³¸íÇϸé 1ÁÖÀÏ Á¤µµ PPI¸¦ ²÷À» ¼ö ¾ø´Â GERD ȯÀÚ´Â º°·Î ¾ø½À´Ï´Ù.
* Âü°í: EndoTODAY Á¦±ÕÄ¡·á ÈÄ °á°ú È®ÀÎÀ» ¾È ÇßÀ» ¶§ÀÇ ¹®Á¦Á¡
°íÇ÷¾Ð°ú °íÁöÇ÷ÁõÀÌ Àִ ȯÀÚ¿¡¼ Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á¸¦ ó¹æÇϸé clarithromycin°ú statin°è ¾à¹°ÀÇ »óÈ£ÀÛ¿ë¿¡ ´ëÇÑ pop-up °æ°íâÀÌ ¶ß´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. ÃÖ±Ù¿¡´Â µàÄ«·ÎÁ¤À» º¹¿ë ÁßÀΠȯÀÚ¿¡¼ Á¦±ÕÄ¡·á¸¦ ÇØ¾ß ÇÏ´Â °æ¿ì°¡ ÀÖ¾î °í¹ÎÇÑ ÀûÀÌ ÀÖ½À´Ï´Ù. ±³¼ö´ÔÀº ¾î¶»°Ô ÇÏ°í °è½Ã´ÂÁö¿ä?
[2020-6-7. ÀÌÁØÇà ´äº¯]
Macrolide°è ¾à¹°ÀÎ clarithromycin¿¡ ÀÇÇØ statin°è ¾à¹° Áß CYP3A4 ´ë»ç¿¡ ¿µÇâÀ» ¸¹ÀÌ ¹Þ´Â simvastatin, lovastatin µîÀÇ Ç÷Áß³óµµ°¡ Áõ°¡ÇÏ¿© ±ÙÀ°º´ÁõÀÇ À§Ç輺ÀÌ Áõ°¡µÉ ¼ö Àֱ⠶§¹®¿¡ °æ°íâÀÌ ¶ß´Â °Í °°½À´Ï´Ù. Àú´Â 1Â÷ Á¦±ÕÄ¡·á ¾à µå½Ã´Â 1ÁÖÀÏ µ¿¾È statin°è ¾à¹°À» Àá½Ã Áß´ÜÇϵµ·Ï Çϰí ÀÖ½À´Ï´Ù.
»ç½Ç statin ¾àÁ¦°¡ CYP3A4¿¡ ÀÇÇØ ´ë»çµÇ´Â Á¤µµ ´Ù¸£±â ¶§¹®¿¡ ¸ðµç statin¿¡ ´ëÇÏ¿© µ¿ÀÏÇÏ°Ô Áß´ÜÀ» ±ÇÇØ¾ß ÇÏ´ÂÁö´Â °í¹ÎÀÔ´Ï´Ù. Prescriber Update 2014;35:12¿¡´Â ¾Æ·¡¿Í °°ÀÌ µÇ¾î ÀÖ¾ú½À´Ï´Ù.
- Simvastatin and to a lesser extent atorvastatin are metabolised by the hepatic isoenzyme CYP3A4.
- CYP3A4 inhibitors may increase the plasma concentration of these statins, increasing the risk of adverse reactions such myopathy and/or rhabdomyolysis.
- If a potent CYP3A4 inhibitor such as erythromycin must be used, then simvastatin or atorvastatin therapy should be stopped for the duration of therapy.
- Fluvastatin, pravastatin and rosuvastatin are not significantly metabolised by CYP3A4 and are less susceptible to CYP interactions.
- CYP3A4 inducers may reduce the effectiveness of some statins; therefore, lipid profiles should be monitored if co-prescribed.
¹®Á¦´Â °íÇ÷¾Ð¾à°ú statinÀÇ º¹ÇÕÁ¦¸¦ µå½Ã´Â ºÐÀÌ ¸¹À¸¹Ç·Î statin°è ¾à¹°¸¸ Áß´ÜÇÏ±â ¾î·Æ´Ù´Â °ÍÀÔ´Ï´Ù. µàÄ«·ÎÁ¤Àº angiotensin ll receptor blocker ÇǸ¶»ç¸£Åº°ú calcium channel blocker ¾Ï·ÎµðÇÉ, ±×¸®°í ·Î¼ö¹Ù½ºÅ¸Æ¾À» °áÇÕÇÑ °íÁ¤¿ë·® 3Á¦º¹ÇÕÁ¦ÀÔ´Ï´Ù. RosuvastatinÀº CYP3A4¿¡ ÀÇÇØ ÁÖ·Î ´ë»çµÇ´Â Á¾·ù´Â ¾Æ´Ï¹Ç·Î ¾àÀ» ²÷¾î¾ß ÇÏ´ÂÁö °í¹ÎÀ̾úÁö¸¸... Àú´Â 1ÁÖÀÏ µ¿¾È µàÄ«·ÎÁ¤À» Áß´ÜÇÏ°í ´ë½Å amlodipine 5mgÀ» º¹¿ëÇÏ¸é¼ Ç÷¾ÐÀ» ¸î ¹ø ÃøÁ¤ÇØ º¸½Ç °ÍÀ» ±ÇÇÏ¿´½À´Ï´Ù. °íÇ÷¾Ð ¾à µÎ °¡Áö Áß ÇÑ °¡Áö¸¦ ¸çÄ¥ ²÷´Â´Ù°í Å« ¹®Á¦°¡ ¹ß»ýÇÒ °Í °°±â ¾Ê¾Ò±â ¶§¹®ÀÔ´Ï´Ù. FimasartanÀº ó¹æÇØ º» ÀûÀÌ ¾ø¾î¼ amlodipineÀ» °ñ¶ú½À´Ï´Ù.
[2020-10-5] °¡Á·µµ Ä¡·áÇØ¾ß Çմϱî? ¾ÆÁ÷Àº ?
[2020-10-5] ÀÛ³â ÀÚ·á·Î ¿ÃÇØ Ä¡·áÇÒ ¼ö ÀÖ½À´Ï±î? ¾ÆÁ÷Àº ?
[2020-10-22. ÀÌÁØÇà µ¶¹é]
Ç︮ÄÚ¹ÚÅÍ ³»¼º°Ë»ç ±â¹ÝÀ¸·Î Á¦±ÕÄ¡·á ¾àÁ¦¸¦ ¼±ÅÃÇÏ¸é ¸·´Ù¸¥ °ñ¸ñÀ¸·Î ¸ô¸®´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. 1Â÷ ó¹æ ¹× 2Â÷ ó¹æ µÎ °¡Áö°¡ °¡´ÉÇÑ »óȲ¿¡¼ 100% Á¤È®ÇÏÁöµµ ¾ÊÀº ³»¼º °Ë»ç¿¡ ÀǰÅÇÏ¿© 1Â÷¸¦ skipÇϰí 2Â÷ ¾àÁ¦ ó¹æÀ» ÇÏ¿´´Âµ¥ Á¦±Õ ½ÇÆÐ·Î ³ª¿À¸é ÂüÀ¸·Î ³°¨ÇÕ´Ï´Ù.
±×·¡¼ Àú´Â ³»¼º°Ë»ç ±â¹ÝÀÇ Ä¡·á´Â ¾ÆÁ÷ ½Ã±â»óÁ¶¶ó°í »ý°¢ÇÕ´Ï´Ù. Àú´Â ³»¼º°Ë»ç ó¹æÀ» ÇÏÁö ¾Ê½À´Ï´Ù.
[2020-12-7. ¾Öµ¶ÀÚ Áú¹®]
ȯÀÚ°¡ 2009, 2012³â Bx¿¡¼´Â Hp ¾ç¼ºÀ̾ú°í Á¦±ÕÄ¡·á ÇÑ ÀûÀÌ ¾ø´Âµ¥ 2015³â, 2016³â Á¶Á÷°Ë»ç ¶§´Â Hp È®ÀεÇÁö ¾Ê¾Ò°í ÀÌÈÄ¿¡´Â EGD½Ã CAG¸¸ È®ÀÎµÇ¾î µû·Î Á¶Á÷°Ë»ç´Â ÁøÇàÇÏÁö ¾Ê¾Ò½À´Ï´Ù. Epigastric soreness°¡ Áö¼ÓµÇ¾î ȯÀÚ°¡ Hp eradicationÀ» ¿øÇÏ¿© °ÇÁø¿¡¼ UBT °Ë»ç ÁøÇàÇߴµ¥ negative ¿´½À´Ï´Ù. ÀÌ·¸°Ô ÃÖ±Ù °á°ú¿¡¼ Hp infectionÀ» ½Ã»çÇÏ´Â ¼Ò°ßÀÌ ¾ø´Â °æ¿ì¿¡µµ Hp Á¦±ÕÄ¡·á ÇϽôÂÁö ±Ã±ÝÇÏ¿© ¸ÞÀϵ帳´Ï´Ù.
Àú´Â UBTµµ negative¶ó¼ Á¦±ÕÄ¡·á ÈÄ Á¦±Õ¿©ºÎ¸¦ È®ÀÎÇÒ ¼ö ÀÖ´Â ±Ù°Åµµ ¸íÈ®ÇÏÁö ¾Ê°í ÃÖ±Ù¿¡ Hp infection ½Ã»çÇÏ´Â ¼Ò°ßµéÀº ¾ø¾î¼ Hp Á¦±ÕÄ¡·á ½ÃÇàÇÒ ±Ù°Å°¡ ¾ø´Ù°í º¸°í ÀÖ±â´Â ÇÕ´Ï´Ù...
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ÀÀ¿ë ´äº¯: ºñ·Ï ÃÖ±Ù °Ë»ç°¡ À½¼ºÀ̾ú¾îµµ °ú°Å °Ë»ç¿¡¼ ¾ç¼º(positive)ÀÌ ¶Ñ·ÇÇϰí Ä¡·á·ÂÀÌ ¾øÀ¸¸é Ä¡·áÇØ º¼ ¼ö ÀÖÀ½ (ÀÌ ºÎºÐ¿¡ ´ëÇØ¼´Â ³í¶õÀÇ ¿©Áö°¡ ÀÖÀ½)
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¾È³çÇϽʴϱî, ±³¼ö´Ô. Àú´Â (Ÿº´¿ø) Æç·Î¿ì ¶§ºÎÅÍ ±³¼ö´Ô ¿£µµÅõµ¥ÀÌ ¹× ºí·Î±×¸¦ ÅëÇØ ¸Ö¸®¼³ª¸¶ ¸¹Àº Áö½ÄÀ» ¹è¿ì°í ÀÖ´Â ¼Òȱ⳻°ú ºÀÁ÷ÀÇÀÔ´Ï´Ù. Ç×»ó ³ë·ÂÇϽðí, ¹ßÀüÇϽô ¸ð½ÀÀÌ ³Ê¹« Á¸°æ½º·´°í Å« µµÀüÀÌ µË´Ï´Ù. ¿©Â庼 ³»¿ëÀº Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á¿¡ ´ëÇØ¼ÀÔ´Ï´Ù.
ù¹øÂ°´Â 1Â÷ Á¦±ÕÄ¡·á¸¦ 7 → 10ÀÏ·Î º¹¿ë³¯Â¥¸¦ Áõ°¡ÇÏ¿´À¸³ª, UBT À½¼ºÀÌ 70% ÀÌÇÏ·Î ³ª¿À°í ÀÖ½À´Ï´Ù. "Çѱ¹ÀÎ Ç︮ÄÚ¹ÚÅÍ ÆÄÀϷθ® °¨¿° Ä¡·á ±Ù°Å ±â¹Ý ÀÓ»óÁø·áÁöħ °³Á¤¾È 2020" ¿¡ µû¶ó¼ ÃÖ±Ù¿¡´Â 14ÀÏ Ã³¹æÀ» Çϰí ÀÖÀ¸¸ç, µ¿½ÃÄ¡·á¸¦ Çϰųª Ŭ·¡¸® ³»¼º°Ë»ç¸¦ ½Ç½ÃÇØ¾ßÇÒÁö °í¹Î Áß¿¡ ÀÖ½À´Ï´Ù. 2Â÷ Á¦±ÕÄ¡·áµµ 2ÁÖ¸¦ Çϰí Àִµ¥. 100/100 À¸·Î ó¹æÇϴ ȯÀÚµéÀÌ ¸¹¾Æ¼ ±Ý¾×ÀûÀ¸·Îµµ ºÎ´ãÀ» ÁÖ´Â °Í°°¾Æ ¸¾ÀÌ ºÒÆíÇÕ´Ï´Ù. ±³¼ö´Ô²²¼´Â 1Â÷, 2Â÷ Á¦±ÕÄ¡·á ¸ðµÎ 7ÀÏ Ã³¹æÇϽô °É·Î ¾Ë°í ÀÖ½À´Ï´Ù. ¾î¶»°Ô Á¢±ÙÇÏ´Â °Ô ÁÁÀ» Áö °¡¸£Ä§À» ÁÖ½Ã±æ ¹Ù¶ó°í ¶ÇÇÑ °¨»çµå¸³´Ï´Ù.
µÎ¹øÂ°´Â 1Â÷ Á¦±ÕÄ¡·á ÈÄ UBT ¾ç¼º ³ª¿Â À§Ã༺ À§¿° ¿©ÀÚ È¯ÀÚºÐÀÔ´Ï´Ù. ³²Æí ºÐ Áø·áÇÏ´Â Áß¿¡ ¾Æ³»°¡ UBT ¾ç¼º ³ª¿Ô´Âµ¥, Åׯ®¶ó»çÀÌŬ¸° Ç×»ýÁ¦ ¾Ë·¹¸£±â°¡ ÀÖ´Ù°í À̾߱âÇß½À´Ï´Ù. ÀÏ´Ü ÀÌ·± °æ¿ì´Â óÀ½ Á¢Çغ» °Å¶ó À쫆 ̣¾Æº¸°Ú´Ù°í À̾߱âÇÏ°í º¸³Â½À´Ï´Ù. Ȥ½Ã ÀÌ·± ÄÉÀ̽º¸¦ º¸½Å ÀûÀÌ ÀÖÀ¸½Å°¡¿ä? Åׯ®¶ó»çÀÌŬ¸°À» »« 2Â÷ Á¦±ÕÄ¡·á¸¦ ÇØ¾ßÇϴ°ÇÁö, ¾Æ´Ï¸é 3Â÷ Á¦±ÕÄ¡·á¸¦ ÇØ¾ßÇÏ´Â °ÇÁö °í¹ÎÀÔ´Ï´Ù. ´Ü¼øÇÑ À§Ã༺ À§¿°¶§¹®¿¡ 3Â÷ Á¦±ÕÄ¡·á±îÁö ÇÏ´Â °Ô ¸Â´ÂÁöµµ °í¹ÎÀÔ´Ï´Ù.
Äڷγª·Î ÀÎÇØ¼ ¾î¼ö¼±ÇÑ ºÐÀ§±â ¼Ó¿¡¼ °Ç° Á¶½ÉÇÏ½Ã±æ ±âµµÇÕ´Ï´Ù. ±ÍÁßÇÑ °¡¸£Ä§ Ç×»ó °¨»çµå¸³´Ï´Ù. ±ä ±Û ÀоîÁּż °¨»çÇÕ´Ï´Ù.
[2020-12-19. ÀÌÁØÇà ´äº¯]
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Ç¥ÁØ 1Â÷ Á¦±ÕÄ¡·á 7-10ÀÏ ÈÄ UBT 70%ÀÌÇÏ´Â ¿ì¸®³ª¶ó¿¡¼´Â ÈçÇÑ ÀÏÀÔ´Ï´Ù. 14ÀÏ·Î ´Ã¸®¸é ¸î %Á¤µµ UBT À½¼ºÀÌ ³»·Á°©´Ï´Ù. ¸»¾¸ÁֽŠ¹Ù¿Í °°ÀÌ 2020 °¡À̵å¶óÀο¡¼ 14ÀÏÀÌ ±ÇÀ¯µÇ¾ú½À´Ï´Ù.
±×·¯³ª, (1) ¿ì¸®³ª¶ó Á¤ºÎÁöħÀº ¿©ÀüÈ÷ 7ÀÏÀ̸ç, (2) Èûµç ¾àÀ» 7ÀÏ ´õ ¸Ô¾î¼ 7-8% Á¤µµ Á¦±ÕÀ²À» ³ôÀÌ´Â °ÍÀÌ Àå±âÀûÀ¸·Î ±àÀûÀûÀÎ °á°ú¸¦ °¡Á®¿À´ÂÁö ¸íÈ®ÇÏÁö ¾ÊÀ¸¸ç, (3) 1Â÷ 7ÀÏ ÈÄ UBT ¾ç¼ºÀÏ ¶§ 2Â÷ 7ÀÏÀ» Ãß°¡ Ä¡·áÇÏ´Â ÀüÅëÀûÀÎ Àü·«ÀÌ 1Â÷¾àÀ» 14ÀÏ Åõ¾àÇÏ´Â °Íº¸´Ù ´õ ³ôÀº Á¦±Õ ¼º°ø·üÀÌ ³ª¿Â´Ù´Â Á¡¿¡¼ Àú´Â 1Â÷¿Í 2Â÷¸¦ ¸ðµÎ 7ÀÏ Ã³¹æÇÏ´Â ¹æÄ§À» 30³â° Çϰí ÀÖ½À´Ï´Ù. ¾ÆÁ÷±îÁö ÇÑ ¹øµµ ¹®Á¦µÈ ÀûÀÌ ¾ø¾ú½À´Ï´Ù. »ç½Ç Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÀÌ ¾î¶² ÁúȯÀÇ Ä¡·á¿¡ ¾ÆÁÖ °áÁ¤ÀûÀÎ °ÍÀº ¾Æ´Ï±â ¶§¹®ÀÔ´Ï´Ù. ÇÐȸ °¡À̵å¶óÀÎÀÌ ¹Ù²î¾ú°í, Á¤ºÎ¿¡¼µµ ±ÔÁ¤Àº 7ÀÏÀÌÁö¸¸ 14ÀÏÀ» »è°¨ÇÏÁö ¾Ê°í ÀÖ´Ù´Â °ÍÀº Àß ¾Ë°í ÀÖÀ¸³ª ÀúÀÇ Áø·á½Ç¿¡¼ 30³â µ¿¾È °è¼ÓµÈ ó¹æ ÆÐÅÏÀÌ ÀüÇô ¹®Á¦¸¦ ÀÏÀ¸Å°Áö ¾Ê°í ÀÖ´Ù´Â Á¡À» °í·ÁÇÏ¿© Àú´Â ÇöÀçÀÇ Ä¡·á ¹æÄ§À» º¯°æÇÒ °èȹÀº ¾ø½À´Ï´Ù.
µ¿½ÃÄ¡·á³ª clarithromycin ÀúÇ×¼º °Ë»çµµ ¸¶Âù°¡Áö ÀÔÀåÀÔ´Ï´Ù. º¹ÀâÇÏ°í »õ·Î¿î ó¹æÀ» ÇÏ´õ¶óµµ 1Â÷ 7ÀÏ ÈÄ UBT ¾ç¼ºÀÏ ¶§ 2Â÷ 7ÀÏÀ» Ãß°¡ Ä¡·áÇÏ´Â °Íº¸´Ù ´õ ÁÁÀº °á°ú¸¦ º¸ÀÎ °ÍÀº ¾ø½À´Ï´Ù.
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¿ª½Ã Å« Ʋ¿¡¼ ¹«¾ùÀÌ Áß¿äÇÑÁö¸¦ »ìÇÇ´Â °ÍÀÌ ÁÁÀ» °Í °°½À´Ï´Ù. ÇöÀç ¿ì¸®³ª¶ó À§¾Ï °ü¸®ÀÇ ÇÙ½ÉÀº Á¶±â Áø´ÜÀÔ´Ï´Ù. À̸¦ À§ÇÏ¿© °ËÁø ³»½Ã°æÀÇ ÁúÀ» ³ôÀÌ´Â °ÍÀÌ °¡Àå Áß¿äÇѵ¥, ¿ì¸®³ª¶ó ÀÇ·áÇöÀå¿¡¼´Â °ËÁø ³»½Ã°æÀÇ Áú°ü¸®´Â °ÅÀÇ ¹«½ÃµÇ°í ¾û¶×ÇϰԵµ Ç︮ÄÚ¹ÚÅÍ¿¡ °ü½ÉÀ» ÁýÁßÇÏ´Â ¸ð½ÀÀ» ÀÚÁÖ º¸°í ÀÖ½À´Ï´Ù. ³»½Ã°æÀÇ Ç°ÁúÀº Á÷Á¢ÀûÀÎ °á°ú¸¦ °¡Á®¿À´Âµ¥ ºñÇÏ¿© Ç︮ÄÚ¹ÚÅÍ Ä¡·áÀÇ È¿°ú´Â ¾ÆÁ÷±îÁö ¸íÈ®ÇÏÁö ¾Ê½À´Ï´Ù. Ç︮ÄÚ¹ÚÅ͸¦ Á¦±ÕÇϸé À§¾ÏÀº ¾à°£ ÁÙÁö¸¸ overall survivalÀÌ Áõ°¡µÇ´ÂÁö´Â ºÒ¸íÈ®ÇÕ´Ï´Ù. ¿ÀÈ÷·Á overall survivalÀÌ ³ªºüÁø´Ù´Â ÀÚ·á°¡ ´õ ¸¹½À´Ï´Ù. ÀÌ Á¡Àº ±³¼ö³ª ¿¬±¸ÀÚµéÀÌ ÀÌ·± ºÒ¸®ÇÑ Á¡Àº Àß ¸»ÇÏÁö ¾Ê±â ¶§¹®¿¡ ¸ð¸£½Ã´Â ºÐµµ ¸¹½À´Ï´Ù. Á¦ YouTube¿¡ ¼Ò°³ÇØ ³õÀº ºÎºÐÀÌ ¾Æ¸¶µµ °¡Àå ÀÚ¼¼ÇÑ ¼³¸íÀÏ °ÍÀÔ´Ï´Ù (ÀÌÁØÇà YouTube ÇØ´ç ºÎÀ§ link). Àúµµ ¸Å¿ì ÀÚ¼¼È÷ °ÀÇÇÏÁö´Â ¸øÇß½À´Ï´Ù. ÀÌ·± Á¡À» °Á¶ÇÏ¸é ½È¾îÇÏ´Â »ç¶÷ÀÌ ³Ê¹« ¸¹¾Æ¼......
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2) 2018-10-28 ³»°úÇÐȸ °ÀÇ - Helicobacter pylori Á¦±ÕÄ¡·áÀÇ ÃֽŠÀ̽´
3) EndoTODAY Helicobacter Á¦±ÕÄ¡·á ½Ã Åõ¾à ½ÃÁ¡
4) [2016-9-20. Çѱ¹ÀϺ¸] ¡°Ç︮ÄÚ¹ÚÅͱÕÀ» °ú¿¬ ¾ø¾Ö¾ß Çϳª?¡± Á¦±Õ ³í¶õ
5) [2017-9-20. »óºÎÀ§Àå°üÇ︮ÄÚ¹ÚÅÍÇÐȸ ±³À°ÀÚ·á] Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á·Î È£ÀüµÈ Ư¹ß¼º Ç÷¼ÒÆÇ °¨¼Ò¼º ÀÚ¹ÝÁõ
6) Ç︮ÄÚ¹ÚÅÍ ÆÄÀϷθ® Áø´Ü°ú Ä¡·á °ÀÇ VOD ½Å¿î°Ç ±³¼ø´Ô (2018³â ¼Òȱâ PG course)
7) Helicobacter¿Í PPI¿¡ ´ëÇÑ on-line °ÀÇ (2020³â 5¿ù 7ÀÏ) ÈÄ feedbackÀ» Á¤¸®ÇÑ ³»¿ëÀÔ´Ï´Ù. ¿ì¸®³ª¶ó ÀÇ·áÇöÀåÀÇ ¸ð½ÀÀ» Àß ¾Ë ¼ö ÀÖ½À´Ï´Ù.
© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng