一例Barrett食管患者的循證治療_《中國循證醫學雜志》

作者：

林丹丹 ,  董衛國 , 呂曉光 , 劉啟勝 , 田珍 , 施華秀

武漢大學人民醫院消化內科（武漢 430060）;

關鍵詞：

Barrett食管循證治療隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20120075

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　借助循證醫學方法為1例成年男性Barrett食管患者確定治療方案。
方法　在充分評估患者情況后，提出臨床問題，從Cochrane圖書館（2009年第3期）、PubMed（1995～2010）和SCIE（1995～2010）上檢索Barrett食管治療的系統評價和RCT。根據當前最好證據結果及病人意愿為患者制定治療目標和治療方案。
結果　共檢出與不同問題相關的RCT 21篇，系統評價/Meta分析6篇。通過對檢索結果進行分析并結合患者意愿，為患者制定了合理的治療方案：改善生活習慣，內鏡下行氬等離子凝固術（APC）結合抑酸藥物（奧美拉唑，40 mg，bid）治療6周。3個月后內鏡復查，患者癥狀減輕，病灶消失。又經過12個月隨訪證實，患者滿意該方案適合該患者。
結論　采用循證治療方法，為初診男性Barrett食管患者確定合理的治療目標和方案，能有效減輕患者癥狀，提高生活質量。

引用本文： 林丹丹,董衛國,呂曉光,劉啟勝,田珍,施華秀. 一例Barrett食管患者的循證治療. 中國循證醫學雜志, 2012, 12(4): 484-488. doi: 10.7507/1672-2531.20120075 復制

1.	Kamat P, Wen S, Morris J, et al. Exploring the association between elevated body mass index and Barrett’s esophagus: a systematic review and meta-analysis. Ann Thorac Surg, 2009, 87(2): 655-662.
2.	Cook MB, Greenwood DC, Hardie LJ, et al. A systematic review and meta-analysis of the risk of increasing adiposity on Barrett’s esophagus. Am J Gastroenterol, 2007, 103(2): 292-300.
3.	Winzer BM, Paratz JD, Reeves MM, et al. Exercise and the Prevention of Oesophageal Cancer(EPOC) study protocol: a randomized controlled trial of exercise versus stretching in males with Barrett’s oesophagus. BMC Cancer, 2010,10: 292.
4.	Cook MB, Kamangar F, Whiteman DC, et al. Cigarette smoking and adenocarcinomas of the esophagus and esophagogastric junction: a pooled analysis from the international BEACON consortium. J Natl Cancer Inst, 2010, 102(17): 1344-1353.
5.	Edelstein ZR, Bronner MP, Rosen SN, et al. Risk factors for Barrett’s esophagus among patients with gastroesophageal reflux disease: a community clinic-based case-control study. Am J Gastroenterol, 2009, 104(4): 834-842.
6.	DiBaise JK, A randomized, double-blind comparison of two different coffee-roasing process on development of heartburn and dyspepsia in coffee-sensitive individuals. Dig Dis Sci, 2003, 48(4): 652-656.
7.	Veugelers PJ, Porter GA, Guernsey DL, et al. Obestiy and lifestyle risk factors for gastroesophageal refulx disease, Barrett esophagus and esophageal adenocarcinoma. Dis Esophagus, 2006, 19(5): 321-328.
8.	Kristal AR, Blount PL, Schenk JM, et al. Low-fat,high fruit and vegetable diets and weight loss do not affect biomarkers of cellular proliferation in Barret esophagus. Cancer Epidemiol Biomarkers, 2005, 14(1): 2377-2383.
9.	Murphy SJ, Johnston BT, Murray LJ. British Society of Gastroenterology guidelines for the diagnosis of Barrett’s oesophagus: are we casting the net too wide? Gut, 2006, 55(12): 821-822.
10.	El-Serag HB, Aguirre TV, Davis S, et al. Proton pump inhibitors are associated with reduced incidence of dysplasia in Barrett’s esophagus. Am. J. Gastroenterol, 2004, 99(10): 1877-1883.
11.	Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol, 2006, 101(8): 1900-1920.
12.	冉紅梅, 王一平. Barrett食管治療的臨床證據. 中國循證醫學雜志, 2006, 6(12): 912-917.
13.	White KL, Chalmers DM, Martin IG, et al. Dietary antioxidants and DNA damage in patients on long-term acid-suppression therapy: a randomized controlled study. Br J Nutr, 2002, 88(3): 256-271.
14.	Smythe A, Bird NC, Troy GP, et al. Does the addition of a prokinetic to proton pump inhibitor therapy help reduce dudenogastroesophageal reflux in patients with Barrett’s oesophagus? European journal of gastroenterology & hepatplogy, 2003, 15(3): 305-312.
15.	Espinel J, Pinedo E, Rascarachi G. Endoscopic mucosal resection with a multiband ligator for the treatment of Barrett´s high-grade dysplasia and early gastric cancer. Rev Esp Enferm Dig, 2009, 101: 403-407.
16.	May A, Gossner L, Pech O, et al. Local endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett’s oesophagus: acute-phase and intermediate results of a new treatment approach. Eur J Gastroenterol Hepatol, 2002, 14(10): 1085-1091.
17.	Soehendra N, Seewald S, Groth S, et al. Use of modified multiband ligator facilitates circumferential EMR in Barrett’s esophagus (with video). Gastrointest Endosc, 2006, 63(6): 847-852.
18.	Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med, 2009, 360(22): 2277-2288.
19.	Rees JRE, Lao-Sirieix P, Wong A, et al. Treatment for Barrett’s oesophagus. Cochrane Database of Systematic Reviews, 2010, 1.
20.	Canady J, Wiley K, Ravo B. Argon plasma coagulation and the future applications for dual-mode endoscopic probes. Rev Gastroenterol Disord, 2006, 6(1): 1-12.
21.	Kelty CJ, Ackroyd R, Brown NJ, et al. Endoscopic ablation of Barrett’s oesophagus: a randomized-controlled trial of photodynamic therapy vs. argon plasma coagulation. Alimentary pharmacology & therapetutics, 2004, 20(11-12): 1289-1296.
22.	Kahaleh M, Van Laethem JL, Nagy N, et al, Long-term follow-up and factors predictive of recurrence in Barrett’s esophagus treated by argon plasma coagulation ablation and acid suppression. Endoscopy, 2002, 34(12): 950-955.
23.	Ackroyd R, Brown NJ, Davis MF, et al. Photodynamic therapy for dysplastic Barrett’s oesophagus: a prospective, double blind, randomized, placebo controlled trial. Gut, 2000, 47(5): 612-617.
24.	Overholt BF, Lightdale CJ, Wang KK, et al. Photonamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett’s esophagus: international, partially blinded, randomized phase III trial. Gastrointest Endosc, 2005, 62(4): 488-498.
25.	Li YM, Li L, Yu CH, et al. A systematic review and meta-analysis of the treatment for Barrett’s esophagus. Dig Dis Sci, 2008, 53(11): 2837-2846.
26.	Chang EY, Morris CD, Seltman AK, et al. The effect of antireflux surgery on esophageal carcinogenesis in patients with barrett esophagus: a systematic review. Aann Surg, 2007, 246(1): 11-21.
27.	Parrilla P, Mart?´nez de Haro LF, Ortiz A, et al. Long-term results of a randomized prospective study comparing medical and surgical treatment of Barrett’s esophagus. Ann Surg, 2003, 237(3): 291-298.
28.	Rossi M, Barreca M, de Bortoli N, et al. Efficacy of Nissen fundoplication versus medical therapy in the regression of low-grade dysplasia in patients with Barrett esophagus: a prospective study. Ann Surg, 2006, 243(1): 58-63.
29.	Sujendran V, Sica G, Wwarren B, et al. Oesophagectom remains the gold standard for treatment of high-grade dysplasia in Barrett’s oesophagus. Eur J Cardiothorac Surg, 2005, 28(5): 763-766.
30.	Moraca RJ, Low DE. Outcomes and health-related quality of life after esophagectomy for high-grade dysplasia and intramucosal cancer. Arch Surg, 2006, 141(6): 545-549.
31.	Wolfsen HC, Hemminger LL, De Vault KR. Recurrent Barrett’s esophagus and adenocarcinoma after esophagectomy. BMC Gastroenterol, 2004, 8(25): 18.
32.	Csendes A, Braghetto I, Burdiles P, et al. Late results of the surgical treatment of 125 patients with short-segment Barrett esophagus. Arch Surg, 2009, 144(10): 921-927.
33.	Waxman I, Konda VJ. Mucosal ablation of Barrett esophagus. Nat Rev Gastroenterol Hepatol, 2009, 6(7): 393-401.
34.	Horvath OP, Surgical treatment for early Barrett cancer. Magy Seb, 2009, 62(2): 51-58.
35.	Pohl H, Sonnenberg A, Strobel A. Endoscopic versus surgical therapy for early cancer in Barrett’s esophagus: a decision analysis. Gastrointest Endosc, 2009, 70(4): 623-631.

1. Kamat P, Wen S, Morris J, et al. Exploring the association between elevated body mass index and Barrett’s esophagus: a systematic review and meta-analysis. Ann Thorac Surg, 2009, 87(2): 655-662.
2. Cook MB, Greenwood DC, Hardie LJ, et al. A systematic review and meta-analysis of the risk of increasing adiposity on Barrett’s esophagus. Am J Gastroenterol, 2007, 103(2): 292-300.
3. Winzer BM, Paratz JD, Reeves MM, et al. Exercise and the Prevention of Oesophageal Cancer(EPOC) study protocol: a randomized controlled trial of exercise versus stretching in males with Barrett’s oesophagus. BMC Cancer, 2010,10: 292.
4. Cook MB, Kamangar F, Whiteman DC, et al. Cigarette smoking and adenocarcinomas of the esophagus and esophagogastric junction: a pooled analysis from the international BEACON consortium. J Natl Cancer Inst, 2010, 102(17): 1344-1353.
5. Edelstein ZR, Bronner MP, Rosen SN, et al. Risk factors for Barrett’s esophagus among patients with gastroesophageal reflux disease: a community clinic-based case-control study. Am J Gastroenterol, 2009, 104(4): 834-842.
6. DiBaise JK, A randomized, double-blind comparison of two different coffee-roasing process on development of heartburn and dyspepsia in coffee-sensitive individuals. Dig Dis Sci, 2003, 48(4): 652-656.
7. Veugelers PJ, Porter GA, Guernsey DL, et al. Obestiy and lifestyle risk factors for gastroesophageal refulx disease, Barrett esophagus and esophageal adenocarcinoma. Dis Esophagus, 2006, 19(5): 321-328.
8. Kristal AR, Blount PL, Schenk JM, et al. Low-fat,high fruit and vegetable diets and weight loss do not affect biomarkers of cellular proliferation in Barret esophagus. Cancer Epidemiol Biomarkers, 2005, 14(1): 2377-2383.
9. Murphy SJ, Johnston BT, Murray LJ. British Society of Gastroenterology guidelines for the diagnosis of Barrett’s oesophagus: are we casting the net too wide? Gut, 2006, 55(12): 821-822.
10. El-Serag HB, Aguirre TV, Davis S, et al. Proton pump inhibitors are associated with reduced incidence of dysplasia in Barrett’s esophagus. Am. J. Gastroenterol, 2004, 99(10): 1877-1883.
11. Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol, 2006, 101(8): 1900-1920.
12. 冉紅梅, 王一平. Barrett食管治療的臨床證據. 中國循證醫學雜志, 2006, 6(12): 912-917.
13. White KL, Chalmers DM, Martin IG, et al. Dietary antioxidants and DNA damage in patients on long-term acid-suppression therapy: a randomized controlled study. Br J Nutr, 2002, 88(3): 256-271.
14. Smythe A, Bird NC, Troy GP, et al. Does the addition of a prokinetic to proton pump inhibitor therapy help reduce dudenogastroesophageal reflux in patients with Barrett’s oesophagus? European journal of gastroenterology & hepatplogy, 2003, 15(3): 305-312.
15. Espinel J, Pinedo E, Rascarachi G. Endoscopic mucosal resection with a multiband ligator for the treatment of Barrett´s high-grade dysplasia and early gastric cancer. Rev Esp Enferm Dig, 2009, 101: 403-407.
16. May A, Gossner L, Pech O, et al. Local endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett’s oesophagus: acute-phase and intermediate results of a new treatment approach. Eur J Gastroenterol Hepatol, 2002, 14(10): 1085-1091.
17. Soehendra N, Seewald S, Groth S, et al. Use of modified multiband ligator facilitates circumferential EMR in Barrett’s esophagus (with video). Gastrointest Endosc, 2006, 63(6): 847-852.
18. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med, 2009, 360(22): 2277-2288.
19. Rees JRE, Lao-Sirieix P, Wong A, et al. Treatment for Barrett’s oesophagus. Cochrane Database of Systematic Reviews, 2010, 1.
20. Canady J, Wiley K, Ravo B. Argon plasma coagulation and the future applications for dual-mode endoscopic probes. Rev Gastroenterol Disord, 2006, 6(1): 1-12.
21. Kelty CJ, Ackroyd R, Brown NJ, et al. Endoscopic ablation of Barrett’s oesophagus: a randomized-controlled trial of photodynamic therapy vs. argon plasma coagulation. Alimentary pharmacology & therapetutics, 2004, 20(11-12): 1289-1296.
22. Kahaleh M, Van Laethem JL, Nagy N, et al, Long-term follow-up and factors predictive of recurrence in Barrett’s esophagus treated by argon plasma coagulation ablation and acid suppression. Endoscopy, 2002, 34(12): 950-955.
23. Ackroyd R, Brown NJ, Davis MF, et al. Photodynamic therapy for dysplastic Barrett’s oesophagus: a prospective, double blind, randomized, placebo controlled trial. Gut, 2000, 47(5): 612-617.
24. Overholt BF, Lightdale CJ, Wang KK, et al. Photonamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett’s esophagus: international, partially blinded, randomized phase III trial. Gastrointest Endosc, 2005, 62(4): 488-498.
25. Li YM, Li L, Yu CH, et al. A systematic review and meta-analysis of the treatment for Barrett’s esophagus. Dig Dis Sci, 2008, 53(11): 2837-2846.
26. Chang EY, Morris CD, Seltman AK, et al. The effect of antireflux surgery on esophageal carcinogenesis in patients with barrett esophagus: a systematic review. Aann Surg, 2007, 246(1): 11-21.
27. Parrilla P, Mart?´nez de Haro LF, Ortiz A, et al. Long-term results of a randomized prospective study comparing medical and surgical treatment of Barrett’s esophagus. Ann Surg, 2003, 237(3): 291-298.
28. Rossi M, Barreca M, de Bortoli N, et al. Efficacy of Nissen fundoplication versus medical therapy in the regression of low-grade dysplasia in patients with Barrett esophagus: a prospective study. Ann Surg, 2006, 243(1): 58-63.
29. Sujendran V, Sica G, Wwarren B, et al. Oesophagectom remains the gold standard for treatment of high-grade dysplasia in Barrett’s oesophagus. Eur J Cardiothorac Surg, 2005, 28(5): 763-766.
30. Moraca RJ, Low DE. Outcomes and health-related quality of life after esophagectomy for high-grade dysplasia and intramucosal cancer. Arch Surg, 2006, 141(6): 545-549.
31. Wolfsen HC, Hemminger LL, De Vault KR. Recurrent Barrett’s esophagus and adenocarcinoma after esophagectomy. BMC Gastroenterol, 2004, 8(25): 18.
32. Csendes A, Braghetto I, Burdiles P, et al. Late results of the surgical treatment of 125 patients with short-segment Barrett esophagus. Arch Surg, 2009, 144(10): 921-927.
33. Waxman I, Konda VJ. Mucosal ablation of Barrett esophagus. Nat Rev Gastroenterol Hepatol, 2009, 6(7): 393-401.
34. Horvath OP, Surgical treatment for early Barrett cancer. Magy Seb, 2009, 62(2): 51-58.
35. Pohl H, Sonnenberg A, Strobel A. Endoscopic versus surgical therapy for early cancer in Barrett’s esophagus: a decision analysis. Gastrointest Endosc, 2009, 70(4): 623-631.

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《中國循證醫學雜志》

一例Barrett食管患者的循證治療

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《中國循證醫學雜志》

一例Barrett食管患者的循證治療

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