내시경 지혈술을 시행받은 소화성궤양 환자에서 재출혈 예방에 대한 고용량 프로톤 펌프 억제제(PPI)의 경구 및 정맥투여의 효과 비교 = A Comparison of the Effect of High-dose Oral and Intravenous Proton Pump Inhibitor on the Prevention of Rebleeding after Endoscopic Treatment of Bleeding Peptic Ulcers

다국어 초록 (Multilingual Abstract)

Background/Aims: The use of proton pump inhibitor (PPI) prevents rebleeding by elevating the intragastric pH in patients with bleeding peptic ulcers after hemostasis has been achieved. We assessed if high-dose oral pantoprazole is as effective as high-dose intravenous pantoprazole for their ability to prevent rebleeding after having achieved initial hemostasis in patients with active bleeding or nonbleeding visible vessels. Methods: Thirty eight patients with bleeding peptic ulcers who had achieved initial hemostasis were enrolled in this randomized controlled trial. In the high-dose oral pantoprazole group (n=19), 40 mg of pantoprazole was given orally twice daily for 5 days. In the high-dose intravenous pantoprazole group (n=19), an 80 mg intravenous bolus of pantoprazole was given; this was followed by 8 mg/hour of continuous infusion daily for 3 days. Thereafter, 40 mg of pantoprazole was given orally once daily for 8 weeks. Results: The two groups were similar with respect to all the background variables. Rebleeding occurred in 2 patients (10.5%) in the intravenous group and in 1 patient in the oral group (5.3%) by day 30 after enrollment (p=1.000). There was no significant difference in terms of the number of therapeutic endoscopic sessions (1 vs. 1.13 0.52), the surgery (0% vs. 0%), the bleeding related mortality (0% vs. 0%), and the mean number of units of transfused blood. Conclusions: The high-dose oral pantoprazole is as effective as an intravenous administration in reducing rebleeding episodes in patients with bleeding peptic ulcers after successful endoscopic therapy. (Korean J Gastrointest Endosc 2006;33:6-11)

국문 초록 (Abstract)

목적: 프로톤 펌프 억제제(proton pump inhibitor, PPI)는 위산 분비를 강력히 억제하고 출혈부위의 피덩이를 안정화시켜 궤양성 출혈환자에 있어 재출혈의 빈도를 낮춘다. 고용량 프로톤 펌프 억제제 정맥투여는 위 내 pH를 중성에 가깝게 유지하지만 고용량 프로톤 펌프 억제제 경구투여에 대한 효과는 불분명한 실정이다. 이에 전향적 무작위 임상연구로 궤양 출혈환자에게 내시경 치료 후 고용량 프로톤 펌프 억제제 경구투여가 정맥투여와 동일한 지혈효과가 있는지를 알아보고자 비교연구를 계획하였다. 대상 및 방법: 2004년 8월부터 2005년 5월까지 상부위장관 출혈로 경희의료원 소화기내과에 입원하였던 환자 중 고위험군의 궤양 출혈환자 38명을 대상으로 하였다. 내시경 치료로 에피네프린 주사법과 아르곤 플라스마 응고법(argon plasma coagulation, APC) 병합요법을 시행한 후, 무작위로 고용량 판토프라졸 경구투여군과 정맥투여군으로 나누어 연구를 진행하였다. 고용량 판토프라졸 경구투여군(n=19)은 판토프라졸 40 mg을 하루 2회, 5일간 투여하였으며, 고용량 판토프라졸 정맥투여군(n=19)은 초기 80 mg을 정맥주사하고 그 이후 유지요법으로 3일간 시간당 8 mg의 속도로 정맥주입하였다. 두 군 간에 7일째와 30일째의 재출혈률을 비교하였다. 결과: 고용량 판토프라졸 경구투여군과 정맥투여군 사이에는 연령, 성, 궤양의 위치, 궤양의 출혈징후, 크기, 내원 당시 쇼크 상태, 헤모글로빈, 동반질환, 헬리코박터 감염 유무, 과거의 궤양 또는 출혈성 궤양의 기왕력, 비스테로이드성 소염제(non-steroidal anti-inflammatory drugs, NSAIDs) 복용 기왕력, 흡연력 등에서 차이를 보이지 않았다. 7일과 30일째의 재출혈률은 정맥투여군에서 각각 10.5%였고 경구투여군은 각각 0%, 5.3%였으나 두 군 간에 유의한 차이는 없었다(7일째 재출혈률, p=0.486; 30일째 재출혈률, p=1.000). 경구투여군과 정맥투여군 사이에 수술률, 사망률, 치료내시경 횟수, 수혈량에서 차이를 보이지 않았다. 결론: 고위험군의 궤양 출혈환자에서 내시경 지혈술 후에 고용량 PPI 경구투여는 정맥투여와 대등하게 재출혈률을 감소시켰고, 비용-효과적인 측면에서도 절감의 효과가 있는 것으로 생각한다.

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