臨牀消化器内科 Vol.15 No.1(1)


特集名 消化器疾患とQOL
題名 逆流性食道炎とQOL
発刊年月 2000年 01月
著者 黒澤 進 帝京大学医学部第三内科
【 要旨 】 医療の分野では,治癒に至る急性疾患は減少しており,慢性疾患が増え,疾患とともに生きて生活することの中身,すなわちQOLが重要になってきた.近年,QOLを定量的に測定できるSF-36,PGWB,GSRSなどの評価方法が一般的になり,QOLを病状,治療効果の指標として応用する試みが盛んになってきた.消化器疾患のなかでも,GERDは慢性に経過し,QOLを損なう疾患であることが指摘されている.しかし,QOLが低いのはGERDの患者だけでなく,内視鏡検査を受ける前の患者のQOLも低く,軽度の心不全,手術予定の狭心症患者より低かった.また,SF-36を用いた検討では高血圧,糖尿病,うつ状態の患者と比べて,GERDのQOLは,体の痛み,役割機能(精神),社会機能の制限で低いという特徴があった.とくに内視鏡を指標に使えない内視鏡陰性GERDでQOLでの評価は重要であり,病状の重症度とQOLは密接に相関していた.さらにいくつかの研究で,内視鏡陰性GERDにプロトンポンプ阻害薬などの投与で,コントロールに比べQOLの有意の改善がみられた.このように,QOLはGERDの病状や,治療効果を評価する重要な指標となってきた.
Theme Quality of Life in Gastroenterological Disorders
Title Quality of Life in Reflux Esophagitis
Author Susumu Kurosawa Third Department of Internal Medicine, Teikyo University School of Medicine, Ichihara Hospital
[ Summary ] Recent studies of the characteristics of diseases show that the number of acute diseases is decreasing, whereas, the number of chronic diseases is increasing. This means that health related QOL, which is the style of life while living with diseases, has become very important. Recently, QOL has been measured quantiatively by several methods, such as PGWB, SF-36 or GSRS and has been applied to the assessment of the severity of diseases or drug efficacy. Decrease in GERD has been said to be the factor which most severely impairs QOL.However, GERD not only impairs QOL but patients who are going to undergo endoscopy have low QOL scores, as well. Their QOL is lower than that of patients with mild heart failure or angina, before surgery. Compared to patients with hypertension, diabetes mellitus or depression, GERD patients have lower QOL in relation to bodily pain, role limitation-physical and social functioning, as seen by using SF-36. QOL assessment is especially important in endoscopically negative GERD patients, who cannot utilize endoscopic evaluation. The severity of symptoms correlated with the QOL score. Some studies disclosing use of proton pump inhibitors showed significant QOL improvements, compared to control groups. Thus, QOL measurements have become very important methods to assess GERD patients.
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