Gastritis (À§¿°)

The Root of Ambulatory Care
- Àú ÀÚ : ÀÌÁø¿ì
- Ãâ ÆÇ : ±ºÀÚÃâÆÇ»ç
- ÆäÀÌÁö¼ö: 543¸é
ÀÌÁø¿ì ¼±»ý´Ô, ±ºÀÚÃâÆÇ»ç¿Í Á¦ÈÞ¸¦ ÅëÇØ Ã¥ ³»¿ë ¹× ±×¸²À» Á¦°øÇÕ´Ï´Ù.
¹«´Ü º¹Á¦/¹èÆ÷ ±ÝÁö.
KEYWORDS:
..Acute gastritis
i. Acute H.pylori infection
ii. Other acute infectious gastritides (bacterial, viral, parasitic, fungal)
..Chronic atrophic gastritis
i. Type A: less common than type B
body-predominant, autoimmune (Ab to parietal cell and intrinsic factor)
ii. Type B: more common
Antral predominant, H.pylori-related, environmental
..Others-uncommon
i. Lymphocytic gastritis
ii. Eosinophilic gastritis
iii. Granulomatous gastritis : Crohn's disease, Sarcoidosis
1. Epigastric pain
..Acute gastritis symptomsÀº ¶§¶§·Î nausea, vomiting, flatulence, excess
salivation, headache, malaise¸¦ µ¿¹ÝÇÒ ¼ö ÀÖ´Ù.
..Chronic gastritis´Â Á¾Á¾ asymptomaticÇϸç, chronic epigastric pain, vague
dyspepsia, mild ulcer-like symptoms, nausea, anorexia, malodorous breath µî
À» ³ªÅ¸³¾ ¼öµµ ÀÖ´Ù.
1. Epigastric tenderness
..Chronic gastritis´Â Á¾Á¾ clinical findingÀÌ ¾ø´Ù.
Gastritis
Key symptoms
Key signs
1. Endoscopy : biopsy
149
The Root of ambulatory care
Key tests
¢º Erythematous/exudative gastritis
¢º Flat erosive gastritis
¢º Raised erosive gastritis
¢º Atrophic gastritis
¢º Hemorrhagic gastritis
Key treatments
Gastritis
1. Antacid & Adsorbents
..Mucosta.. 1T tid ¾ÆÄ§, Àú³á, Ãëħ Àü
..Ulcerlmin.. 1P tid, qid ½ÄÀü 1½Ã°£ ¹× Ãëħ Àü
..Albis.. 2T bid ¾ÆÄ§, Ãëħ Àü
2. Antagonist of gastric juice
..Cimetidine.. 200mg 1T qid ¾ÆÄ§, Á¡½É, Àú³á, Ãëħ Àü(2T)
..Curan.. 150mg 1T bid
..Albis.. 2T bid ¾ÆÄ§, Ãëħ Àü
3. Prokinetics
..Ganaton.. 50mg 1T tid ½ÄÀü
..Gasmotin.. 5mg 1T tid ½ÄÀü ȤÀº ½ÄÈÄ
4. Antispasmodics
- º¹ÅëÀÌ ½ÉÇÑ °æ¿ì
..Tiropa.. 1T tid
..Algiron.. 1T tid
5. Minor Tranquilizer
..Amitriptyline.. 10mg 1T, 1T-5T pohs
..Xanax.. 0.25mg 1T, 1/2-1T tid
..Buspar.. 5mg 1T, 1/2-1T tid
6. Digestants( & Simethicone)
..Festal-gold.. 1T tid
..Phazyme.. 1T tid
..Bearse.. 1T tid
..Mucosta.. - Rebamipide
..Ulcerlmin.. - Sucralfate
..Albis.. - Sucralfate, bismuth succinate, ranitidine HCL
..Gasmotin.. - Mosapride citrate
..Ganaton.. - Itopride hydrochloride
..Tiropa.. -Tiropamide
..Algiron.. - Cimetropium
..Xanax.. - Alprazolam
..Buspar.. - Buspirone
151
The Root of ambulatory care
..Minor tranquilizer ó¹æ½Ã addictive potential·Î ÀÎÇØ °¡´ÉÇϸé benzodiazepine
°è¿Àº ó¹æÇÏÁö ¾Ê´Â °ÍÀÌ ÁÁÀ¸¸ç, SSRI³ª other anxiolytic drugs(buspirone)
µîÀÌ ÁÁ´Ù.
¸¸ÀÏ benzodiazepine °è¿ÀÇ ¾à¹°À» ó¹æÇß´Ù¸é 1°³¿ù ÀÌ»ó ó¹æÇÏÁö ¾Ê´Â
°ÍÀÌ ÁÁÀ¸¸ç ²÷À» ¶§´Â taperingÀÌ ÇÊ¿äÇÏ´Ù.
..Bloating SxÀÌ Àִ ȯÀÚ¿¡°Õ ƯÈ÷ Simethicone ¼ººÐÀÌ ÀÖ´Â ¼ÒÈÁ¦ ó¹æÀÌ ÁÁ´Ù.
..Menetrier¡¯s disease
- ÁÖ·Î À§ üºÎ¿Í ±âÀúºÎ¿¡ ½ÉÇÑ ¼Ò¿Í¼¼Æ÷ °úÁõ½Ä(foveolar hyperplasia)À¸·Î À§º® ÁÖ¸§ÀÌ ºñÈÄ
µÇ´Â ÁúȯÀ¸·Î ¿øÀÎÀ» ¾Ë ¼ö ¾øÀ¸¸ç TGF-¥á°°Àº ¼ºÀåÀÎÀÚ°¡ °ú¹ßÇöµÇ¾î ÀÖ´Ù. »óº¹ºÎ ÅëÁõ,
üÁß°¨¼Ò, ¿À½É, ±¸Åä µîÀÇ Áõ»óÀÌ ÀÖÀ¸¸ç ´Ü¹éÁú ¼Õ½Ç¼º À§º´ÁõÀ» º¸À̱⵵ ÇÑ´Ù. ³»½Ã°æÀû
¼Ò°ß°ú Á¶Á÷°Ë»ç¸¦ ÅëÇÏ¿© Áø´ÜÇϸç Ä¡·á´Â Ç×Äݸ°¼º ¾àÁ¦, ÇÁ·Î½ºÅ¸±Û¶õµò Á¦Á¦, À§»êºÐºñ
¾ïÁ¦Á¦, ÇÁ·¹µå´Ï¼Õ µîÀ» »ç¿ëÇϸç À§ÀüÀýÁ¦¼úÀ̳ª À§ºÎºÐÀýÁ¦¼úÀÌ ÇÊ¿äÇÑ °æ¿ìµµ ÀÖ´Ù. °¨
º°ÁúȯÀ¸·Î Á¹¸°°Å-¿¤¸®½¼ ÁõÈıº, Á¾¾ç(À§¾Ï, ¸²ÇÁ¾Ï), °¨¿°(°Å´ë¼¼Æ÷¹ÙÀÌ·¯½º, È÷½ºÅäÇöóÁî
¸¶Áõ, ¸Åµ¶), ħÀ±¼º Áúȯ(À¯À°Á¾Áõ, ¾Æ¹Ð·ÎÀ̵åÁõ) µîÀÌ ÀÖ´Ù.
Helicobacter pylori
¢º G(-) microaerophilic rod, S-shaped
¢º Commonly found in the deeper portions of the mucous gel coating the gastric mucosa
or between the mucous layer and the gastric epithelium
¢º Initially H.pylori resides in the antrum and then migrates toward the more proximal
segments
¢º À§³»ÀÇ PH°¡ Áõ°¡ÇÏ´Â »óȲ¿¡¼ ¼ö°¡ °¨¼ÒÇϴµ¥ ÀÌ´Â ´Ù¸¥ ¼¼±ÕµéÀÌ À§³»¿¡ Áõ½ÄÇϱâ
¶§¹®ÀÌ´Ù.
¢º H.pylori
Gastritis
¢º 1998³â ¿ªÇבּ¸¿¡ ÀÇÇÏ¸é ¿ì¸®³ª¶ó 16¼¼ÀÌ»ó ¼ºÀÎÀÇ 66.9%¿¡¼ H.pylori ab(+)¿´À¸¸ç, 15
¼¼ ÀÌÇÏÀÇ ¼Ò¾Æ¿¡¼´Â 17.2%¿´À¸³ª, º¸Åë À¯³â½ÃÀý oral to oral, fecal to oral route¸¦ ÅëÇØ
°¨¿°µÇ´Â °É·Î ¾Ë·ÁÁ® ÀÖ´Ù. ¶ÇÇÑ ¿À¿°µÈ ³»½Ã°æÀ» ÅëÇØ¼µµ ÀüÆÄ°¡ °¡´ÉÇÏ´Ù.
¢º H.pylori¿¡ ÀÇÇØ À¯¹ßµÇ´Â Áúȯ
- ¸¸¼º Ç¥À缺 À§¿°, ¸¸¼º À§Ã༺ À§¿°
- À§½ÊÀÌÁöÀå ±Ë¾ç
- À§¼±¾Ï
- ˤ MALT lymphoma
¢º Risk factors for H.pylori infection
..Birth or residence in a developing country
..Low socioeconomic status
..Domestic crowding
..Unsanitary living conditions
..Unclean food or water
..Exposure to gastric contents of infected individual
..¿ì¸®³ª¶ó¿¡¼± endoscopy with biopsy¸¦ ÅëÇÑ rapid urease test°¡ Áø´Ü ¸ñÀûÀ¸·Î Ãßõ
µÈ´Ù.
Âü°í ¹®Çå
John B. Pope : Gastritis, in Saunders Manual of Medical Practice, 2nd ed, Robert E. Rakel(ed). Philadelphia,
Saunders, 2000, P 425-427
Á¶Á¤Áø : À§¿°, in °¡Á¤ÀÇÇÐ ÀÓ»óÆí. ¼¿ï, °èÃø¹®È»ç, 2002, P 943-948
Sripathi R. Kethu, M.D., Steven F. Moss, M.D. : Gastritis and Peptic Ulcer Disease, in Conn's Current
Therapy 2004, Robert E. Rakel(ed), Edward T. Bope(ed_). Philadelphia, Saunders, 2004, P 542-549
°¡Å縯Àǰú´ëÇÐ ³»°úÇб³½Ç : À§¿°. in Current Principles and Clinical Practice of Internal Medicine. ¼¿ï,
±ºÀÚÃâÆÇ»ç, 2005, P 401-410
¿Àâ¼®(ed) : À§¿°, in Complete Guide To Practical Based Prescription Medicine. ¼¿ï, Çѿ츮, 2005, P
65-66
¼º±Õ°ü´ëÇб³Àǰú´ëÇÐ »ï¼º¼¿ïº´¿ø³»°ú : Gastropathy and gastritis. in Handbook of Internal Medicine,
2nd ed. ¼¿ï, ±ºÀÚÃâÆÇ»ç, 2004, P 7-14
¹Î¿µÀÏ ¿Ü : »óºÎÀ§Àå°ü ³»½Ã°æ. ¼¿ï, ±ºÀÚÃâÆÇ»ç, 2001, P 174~176
¹ÚÀμ ¿ª : À§»êÁúȯ¿¬°üÀÇ º´ÅÂ¿Í Ä¡·á. ¼¿ï, ±ºÀÚÃâÆÇ»ç, 2005, P 550