一例Barrett食管患者的循证治疗_《中国循证医学杂志》

作者：

林丹丹 ,  董卫国 , 吕晓光 , 刘启胜 , 田珍 , 施华秀

武汉大学人民医院消化内科（武汉 430060）;

关键词：

Barrett食管循证治疗随机对照试验系统评价

DOI：

10.7507/1672-2531.20120075

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　借助循证医学方法为1例成年男性Barrett食管患者确定治疗方案。
方法　在充分评估患者情况后，提出临床问题，从Cochrane图书馆（2009年第3期）、PubMed（1995～2010）和SCIE（1995～2010）上检索Barrett食管治疗的系统评价和RCT。根据当前最好证据结果及病人意愿为患者制定治疗目标和治疗方案。
结果　共检出与不同问题相关的RCT 21篇，系统评价/Meta分析6篇。通过对检索结果进行分析并结合患者意愿，为患者制定了合理的治疗方案：改善生活习惯，内镜下行氩等离子凝固术（APC）结合抑酸药物（奥美拉唑，40 mg，bid）治疗6周。3个月后内镜复查，患者症状减轻，病灶消失。又经过12个月随访证实，患者满意该方案适合该患者。
结论　采用循证治疗方法，为初诊男性Barrett食管患者确定合理的治疗目标和方案，能有效减轻患者症状，提高生活质量。

引用本文： 林丹丹,董卫国,吕晓光,刘启胜,田珍,施华秀. 一例Barrett食管患者的循证治疗. 中国循证医学杂志, 2012, 12(4): 484-488. doi: 10.7507/1672-2531.20120075 复制

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.	冉红梅, 王一平. Barrett食管治疗的临床证据. 中国循证医学杂志, 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, Martı´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. 冉红梅, 王一平. Barrett食管治疗的临床证据. 中国循证医学杂志, 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, Martı´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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《中国循证医学杂志》

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《中国循证医学杂志》

一例Barrett食管患者的循证治疗

摘要 全文 图表 视频 参考文献 施引文献 补充材料

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