우리나라 1차 의료기관의 위식도역류질환 진단 및 치료 실태 = Diagnosis and Treatment of GastroEsophageal Reflux Disease at the Primary Health Care Clinics in Korea

다국어 초록 (Multilingual Abstract)

Background/Aims: The prevalence of GERD and treatment costs are continuously rising in Korea, and the importance of primary health care clinics where the most treatment of actual patients is conducted is increasing. In this study, the diagnosis of GERD, selection of therapeutic drugs, and treatment methods in primary health care clininics were investigated through a large-scale multi-dimensional surveys.
Methods: From January 2015 to December 2018, the study data of 18,010 patients with GERD were retrospectively investigated based on eletronic medical record at 542 primary health care clinics in Korea.
Results: Among all GERD patients, endoscopy was used for diagnosis in 16.11% of cases, and the most frequently performed in gastroenterology department (28.85%). The average BMI and the proportion of patients in stages 1 to 3 of obesity were highest in the ERD group, and the majority of the severity of ERD group was mild. Symptoms of the patients with GERD were mainly heartburn, gastric acid reflux, and chest pain. Drug treatment was performed in most of the patients with GERD, and PPI was the main drug, and Esomeprazol was prescribed the most among the main ingredients, and the ratio of PPI alone was high. The rate of symptom improvement after GERD treatment was slightly higher in the ERD group (75.91%) and the NERD group (74.36%) than in the GERD diagnosed without endoscopy group (63.89%).
Conclusions: In domestic primary health care clinics, the majority were diagnosed with GERD without endoscopy on the basis of symptoms. The most preferred treatment for GERD was PPI, which was prescribed alone in the majority.

참고문헌 (Reference)

• 1 김병창 ; 윤영훈 ; 정현수 ; 정재복 ; 전재윤 ; 이상인 ; 이용찬, "위식도역류질환의 임상 특징과 Helicobacter pylori 감염과의 상관관계" 대한소화기학회 47 (47): 363-369, 2006
• 2 윤형란 ; 정훈용 ; 박효진 ; 배상철, "역류성 식도염 치료에 대한 양자펌프억제제와 ranitidine 사용의 비용-효과 분석" 대한내과학회 62 (62): 3-512, 2002
• 3 황진기 ; 김주형 ; 정성주 ; 주문경 ; 이범재 ; 박종재 ; 김재선 ; 박영태 ; 홍승권, "국내 2-3차 의료기관에서 관찰된 미란 식도염의 유병률 및 증상 분포" 대한소화기학회 53 (53): 283-291, 2009
• 4 유승석 ; 이원현 ; 하종 ; 최순필 ; 김현진 ; 김태효 ; 이옥재, "건강진단검사 수진자에서 식도질환의 유병률" 대한소화기학회 50 (50): 306-312, 2007
• 5 김현영 ; 김나영 ; 김선미 ; 서지현 ; 박영수 ; 황진혁 ; 김진욱 ; 정숙향 ; 이동호, "건강 검진자에서의 미란성 및 비미란성 위식도역류질환의 임상적 특성 및 위험인자" 대한내과학회 71 (71): 491-500, 2006
• 6 Singh M, "Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: a prospective intervention trial" 21 : 284-290, 2013
• 7 Kim N, "The prevalence of and risk factors for erosive oesophagitis and non-erosive reflux disease : a nationwide multicentre prospective study in Korea" 27 : 173-185, 2008
• 8 Jeon SG, "The prevalence and risk factors of reflux esophagitis in routine check-up subjects" 32 : 701-708, 1998
• 9 El-Serag H, "The association between obesity and GERD : a review of the epidemiological evidence" 53 : 2307-2312, 2008
• 10 Friedenberg FK, "The association between gastroesophageal reflux disease and obesity" 103 : 2111-2122, 2008
• 11 Vakil N, "The Montreal definition and classification of gastroesophageal reflux disease : a global evidence-based consensus" 101 : 1900-1920, 2006
• 12 Castell DO, "Review article : the pathophysiology of gastro-oesophageal reflux disease-oesophageal manifestations" 20 (20): 14-25, 2004
• 13 Birbara C, "Rabeprazole for the prevention of recurrent erosive or ulcerative gastro-oesophageal reflux disease. Rabeprazole Study Group" 12 : 889-897, 2000
• 14 Harris RA, "Proton pump inhibitors or histamine-2 receptor antagonists for the prevention of recurrences of erosive reflux esophagitis : a cost-effectiveness analysis" 92 : 2179-2187, 1997
• 15 Harris RA, "Prevention of recurrences of erosive reflux esophagitis : a cost-effectiveness analysis of maintenance proton pump inhibition" 102 : 78-88, 1997
• 16 민양원 ; 임성우 ; 이준행 ; 이항락 ; 이오영 ; 박재명 ; 최명규 ; 이풍렬, "Prevalence of Extraesophageal Symptoms in Patients With Gastroesophageal Reflux Disease: A Multicenter Questionnaire-based Study in Korea" 대한소화기 기능성질환∙운동학회 20 (20): 87-93, 2014
• 17 Tack J, "Pathophysiology of gastroesophageal reflux disease" 154 : 277-288, 2018
• 18 Dent J, "Omeprazole v ranitidine for prevention of relapse in reflux oesophagitis. A controlled double blind trial of their efficacy and safety" 35 : 590-598, 1994
• 19 El-Serag HB, "Obesity is an independent risk factor for GERD symptoms and erosive esophagitis" 100 : 1243-1250, 2005
• 20 Lagergren J, "No relation between body mass and gastro-oesophageal reflux symptoms in a Swedish population based study" 47 : 26-29, 2000
• 21 Nilsson M, "Lifestyle related risk factors in the aetiology of gastro-oesophageal reflux" 53 : 1730-1735, 2004
• 22 Nocon M, "Lifestyle factors and symptoms of gastro-oesophageal reflux--a population-based study" 23 : 169-174, 2006
• 23 "Healthcare Bigdata Hub" Health Insurance Review & Assessment Service
• 24 Korean Medical Association, "Guideline for using gastrointestinal drugs"
• 25 Eusebi LH, "Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms : a meta-analysis" 67 : 430-440, 2018
• 26 Lundell LR, "Endoscopic assessment of oesophagitis : clinical and functional correlates and further validation of the Los Angeles classification" 45 : 172-180, 1999
• 27 Lundell L, "Does massive obesity promote abnormal gastroesophageal reflux?" 40 : 1632-1635, 1995
• 28 "Diagnosis and evaluation of obesity" Korean Society for the Study of Obesity
• 29 Shim KN, "Clinical spectrum of reflux esophagitis among 25, 536 Koreans who underwent a health check-up : a nationwide multicenter prospective, endoscopy-based study" 43 : 632-638, 2009
• 30 Jacobson BC, "Body-mass index and symptoms of gastroesophageal reflux in women" 354 : 2340-2348, 2006
• 31 Fock KM, "Asia-Pacific consensus on the management of gastroesophageal reflux disease : update" 23 : 8-22, 2008
• 32 Pan J, "Alcohol consumption and the risk of gastroesophageal reflux disease : A systematic review and meta-analysis" 54 : 62-69, 2019
• 33 Hye-Kyung Jung ; Chung Hyun Tae ; Kyung Ho Song ; Seung Joo Kang ; Jong Kyu Park ; Eun Jeong Gong ; Jeong Eun Shin ; Hyun Chul Lim ; Sang Kil Lee ; Da Hyun Jung ; Yoon Jin Choi ; 서승인 ; Joon Sung Kim ; Jung Min Lee ; Beom Jin Kim ; Sun Hyung Kang ; Chan Hyuk Park ; Suck Chei Choi ; Joong Goo Kwon ; Kyung Sik Park ; Moo In Park ; Tae Hee Lee ; Seung Young Kim ; Young Sin Cho ; Han Hong Lee ; Kee Wook Jung ; Do Hoon Kim ; Hee Seok Moon ; Hirota Miwa ; Chien-Lin Chen ; Sutep Gonlachanvit ; Uday C Ghoshal ; Justin C Y Wu ; Kewin T H Siah ; Xiaohua Hou ; Tadayuki Oshima ; Miyoung Choi ; Kwang Jae Lee, "2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease" 대한소화기 기능성질환∙운동학회 27 (27): 453-481, 2021