과거 10년 동안 소화성 궤양 출혈의 예후는 개선되었는가? = Has Any Improvement been Made in the Clinical Outcome of Patients with Bleeding Peptic Ulcer in the Part 10 Years?

다국어 초록 (Multilingual Abstract)

Background/Aims: Bleeding still remains as one of the major medical problems in peptic ulcer diseases, despite of the advances in therapeutic options and endoscopic therapy. The aim of this study was to compare the clinical outcomes of bleeding peptic ulcer between two distinct periods in the past ten years. Methods: We divided the among 10 years, we selected the two distinct periods; the first (1993∼1995) and the second (2000∼2002). The clinical and endoscopic characteristics in patients with bleeding peptic ulcer were compared between the two periods. We also analyzed the changes in the clinical outcomes as well. Results: The age of patients during the second period was significantly older compare to the first period. In subgroup analysis, proportions of patients older than 60 years and of female patients were significantly higher in the second period. The percentage of the patients with co-morbid illness, such as diabetes mellitus, cardiovascular diseases, or users of non-steroidal anti- inflammatory drugs, was higher in the second period. Despite the decreasing the frequency of urgent surgery in the second period, there was no significant difference in the rate of re-bleeding and mortality between both periods. Conclusions: Despite the advances in therapeutic options in the second period, no significant difference was found in the prognosis of bleeding ulcer, compared to the first period. Old age, co-morbid illness, and increasing usage of NSAIDs has may contributed to this. Taken together, it might be more important to apply preventive measures to the patients who have risk factors for bleeding peptic ulcer.

국문 초록 (Abstract)

목적: 소화성 궤양 출혈은 최근의 약제 및 내시경적 치료의 발전에도 불구하고 고령 인구의 증가와 NSAIDs의 사용 증가 등으로 인해 여전히 중요한 의학적 문제로 남아있다. 본 연구는 이러한 원인적, 치료적 측면의 변화가 소화성 궤양의 예후에 어떠한 변화를 일으켰는지에 대해 알아보고자 하였다. 대상 및 방법: 1993년부터 1995년까지의 전반기와 2000년부터 2002년까지의 후반기로 나누어 상부 위장관 내시경검사를 통해 확진된 총 458명의 소화성 궤양 출혈 환자를 대상으로 하였다. 각 환자군에서의 임상적 특징, 과거 병력, 동반 질환 유무, H. pylori 유무, NSAIDs 복용 유무 등을 조사하였고, 각 군에서의 재출혈률, 수술률 및 사망률을 비교하였다. 결과: 전반기에 비해 후반기 환자들의 연령이 증가하였으며, 특히 60세 이상의 고령층이 유의하게 증가하였다. 여자의 비율이 증가하였고 당뇨병과 심혈관 질환을 동반한 환자의 비율이 통계적으로 유의하게 높았다. 후반기에 아스피린 및 NSAIDs의 사용이 증가하여 후반기 궤양 출혈의 주요원인이라고 판단된다. 궤양의 위치나 H. pylori 유병률은 양 군 간에 차이가 없었다. 후반기의 내시경적 치료의 발전과 proton pump inhibitor의 사용에도 불구하고, 전반기와 비교하여 수술률은 감소하였으나 재출혈률 및 사망률에 유의한 차이는 없었다. 결론: 과거 10년 동안 내과적 치료방법의 개선에도 불구하고 소화성 궤양 출혈의 예후는 개선되지 않았으며, 이것은 환자군의 연령증가, 심혈관계 질환 같은 동반 질환의 증가 및 NSAIDs 사용 증가에 기인하는 것으로 생각한다. 따라서 이러한 고위험군에서 적극적인 예방 및 조기치료가 출혈성 궤양의 예후를 개선시키는데 중요하리라 생각한다.

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