Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Functional Dyspepsia

기능성 소화불량증

  • Song, Kyung Ho (Department of Internal Medicine, Konyang University College of Medicine)
  • 송경호 (건양대학교 의과대학 소화기내과)
  • Received : 2016.04.20
  • Accepted : 2016.06.10
  • Published : 2016.06.30
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Abstract

Functional dyspepsia is one of the most common bowel disorders as prevalent of 7.7% Korean population. The cardinal manifestations include bothersome postprandial fullness, early satiation, epigastric burning or pain. These features are chronic and should be presented recurrently with no other compatible organic disease to explain the symptoms. Even though it is not life-shortening, functional dyspepsia usually make the health-related quality of life worse especially if other functional bowel disorder coexist. The coexistence of functional bowel disorders is called as 'overlap syndrome'. Anxiety, somatization and insomnia is more prevalent in overlap syndrome compared with sole functional bowel disorder. Therefore, it is worthwhile that physician interviews and elucidates whether the dyspeptic patient had other kinds of functional bowel disorders, and manages the underlying psychotic pathology. Placebo effect is large in functional dyspepsia, and there is only four kinds of prokinetics that is proven to be superior to placebo. Adverse events relating prolonged administration of prokinetics sometimes fatal or irreversible, physician willing to describe prokinetics should be familiar to the possible adverse effects and the relating risk factors. Pathologic acid reflux is not uncommon in functional dyspepsia, and acid-suppressant is equivalent to the prokientics in most of dyspeptic patients.

기능성 소화불량증은 우리나라 성인인구의 7.7%가 이환되어 있는 흔한 소화기 기능성질환이다. 주요 증상은 불편한 식후 충만감, 조기 포만감, 상복부 통증, 상복부 쓰림이다. 이런 증상들이 증상을 설명할 만한 기질적인 문제 없이 만성적으로 나타나는 질환이다. 기능성 소화불량증은 치명적이지는 않지만 대개 건강관련 삶의 질을 저하시키고 다른 소화기 기능성질환(위식도역류질환, 과민성 장증후군, 변비)과 공존할 때 더욱 불편함을 초래할 수 있다. 이러한 기능성 소화불량증과 다른 소화기 기능성질환과의 공존을 '중복 증후군'으로 칭한다. 중복 증후군 환자에서 불안, 신체화장애, 불면 등의 정신건강의학적인 문제가 보다 흔히 연관되어 있다. 그러므로 진료의는 소화불량을 호소하는 환자에게 다른 소화기 기능성질환이 공존하는지 여부를 파악하고, 기저 정신건강의학적 문제를 다루는 것이 필요하다. 기능성 소화불량증 환자에게 위약효과는 40% 안팎으로 매우 큰 편이며, 위약대비 효과가 증명된 위장관 운동촉진제는 네 가지이다. 간혹 이러한 위장관 운동 촉진제의 장기간 투약은 비가역적이거나 치명적인 부작용을 야기할 수 있으므로, 처방의사는 위장관 운동촉진제의 가능한 부작용과 연관된 위험인자를 숙지하고 있어야 한다. 병적 위산역류는 기능성 소화불량증 환자에게 드물지 않으며, 위산분비억제제는 많은 부분의 기능성 소화불량증 환자에게 위장관 운동촉진제 만큼 효과적이다.

Keywords

References

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