위식도 역류질환의 초 치료 및 유지치료에 관한 온라인 설문조사: 전국 2, 3차 의료기관 소화기내과 전문의를 대상으로 = Clinical Practice Patterns of Gastroenterologists for Initial and Maintenance Therapy in Gastroesophageal Reflux Disease: A Nationwide Online Survey in Korea

국문 초록 (Abstract)

목적: 2003년 아시아-태평양 지역에서 실시한 FAST survey에서 위식도 역류질환(GERD)에 대한 치료 양상을 보고하였으나 우리나라의 실정이 잘 반영되지 않았다. 이번 연구는 한국에서 GERD의 초 치료 및 유지치료에 대한 최근의 인식과 실제 임상에서의 적용 양상을 알아보고자 하였다. 대상 및 방법: 우리나라 전역의 2, 3차 의료기관 소화기내과 전문의를 대상으로 2007년 12월 5일부터 2008년 1월 9일까지 온라인 설문조사를 시행하였다. 설문은 GERD 유지치료와 관련된 15개의 문항으로 구성되었다. 결과: 총 366명(응답률 366/475명=77%)이 설문에 참여하였으며 응답자의 지역별 분포는 조사대상자의 지역별 분포와 유의한 차이를 보이지 않았다. GERD 심한 정도의 기준은 응답자의 54%가 증상이었고, 46%가 내시경소견이었다. 응답자 거의 모두에서 일부 또는 모든 위식도 역류질환을 대상으로 프로톤펌프 억제제(PPI)를 근간으로 하는 유지치료를 시행하였는데, 경증인 경우 저용량 PPI (66%), 중증인 경우 표준용량 PPI (50%)를 선호하였다. 역류성 식도염은 지속 유지요법을 (66%), 비미란성 GERD의 경우 on-demand 유지요법을(68%) 주로 시행하였고, 유지치료 기간은 경증 7.7±5.1주, 중증 15.0±9.4주로 나타났다. 치료기간을 결정하는 데 영향을 주는 요인으로는 증상의 중증도, 증상의 빈도, 내시경에서 병변의 중증도 순이었다. 결론: 대부분의 2, 3차 의료기관 소화기내과 전문의들은 GERD 치료 시 PPI 제제를 근간으로 하는 약물요법의 중요성을 인지하고 있으나, 유지치료 시 적절한 용법 및 투여 기간에 대해서는 더 많은 논의가 필요할 것으로 생각한다.

다국어 초록 (Multilingual Abstract)

Background/Aims: Gastroesophageal reflux disease (GERD) is a chronic condition and accompanied by frequent relapses. We aimed to evaluate the clinical practice patterns of gastroenterologists for initial and maintenance therapy of GERD in Korea. Methods: We administered a nationwide, multi-center, and questionnaire-based online survey between December 2007 and January 2008. The questionnaire consisted of 15 questions about prescribing patterns of initial and maintenance therapy for GERD. Results: A total of 371 gastroenterologists participated in the survey with the response rate of 77%. For mild cases of GERD, the most common choice of initial therapy was full dose proton-pump inhibitors (PPIs) (59%), followed by half dose PPIs (20%), and H2 receptor antagonists (4%). For severe cases, full dose PPIs were prescribed in 99%. Almost all gastroenterologists agreed to the need for maintenance therapy. For both mild (95%) and severe (99%) cases of GERD, gastroenterologists preferred the use of PPI-based maintenance regimen. The preferred maintenance strategy for GERD was continuous therapy in erosive esophagitis (67%), and on-demand therapy in non-erosive reflux disease (68%). The overall duration of the therapy (initial＋maintenance) was 7.7±5.1 wk in mild cases and 15.0±9.4 wk in severe cases. The duration of maintenance therapy was affected by symptom severity, followed by symptom frequency and endoscopic finding. Conclusions: In this study, a majority of the gastroenterologists is aware of importance on PPI-based pharmacological treatment for GERD. Further studies are needed to clarify the appropriate strategy and duration of maintenance therapy. (Korean J Gastroenterol 2009;54:364-370)

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