Evidence-Based Treatment for a Patient with Barrett’s Esophagus_Chinese Journal of Evidence-Based Medicine

Authors：

LIN Dandan ,  DONG Weiguo , LV Xiaoguang , LIU Qisheng , TIAN Zhen , SHI Huaxiu

Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China;

Corresponding author：

DONG Weiguo, Email: dongwg66@yahoo.com.cn

Keywords：

Barrett esophagus; Evidence-based treatment; Randomized controlled trial; Systematic review

DOI：

10.7507/1672-2531.20120075

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To make an individualized treatment plan for a newly diagnosed Barrett esophagus patient by means of evidence-based medicine.
Methods 　After the clinical problems were put forward, both the systematic reviews and randomized controlled trials (RCTs) were collected from The Cochrane Library (Issue 3, 2009) and PubMed (1995 to 2010) and SCIE (1995 to 2010). The treatment protocol was made by combining the evidence and the preference of patient.
Results 　A total of 21 RCTs and 6 systematic reviews (meta-analyses) were identified. A rational treatment plan was made upon a serious evaluation and patient’s preferences: improving the lifestyle and adopting the APC therapy combined with acid-suppressive drugs (Omeprazole, 40 mg, bid) for six weeks. Three months later, the endoscope reexamination showed the patient was much better. After another twelve-month follow-up, the plan proved to be optimal.
Conclusion 　In accordance with the evidence-based methods, the rational treatment plan made for a diagnosed Barrett esophagus male can effectively relieve symptoms and improve quality of life.

Citation： LIN Dandan,DONG Weiguo,LV Xiaoguang,LIU Qisheng,TIAN Zhen,SHI Huaxiu. Evidence-Based Treatment for a Patient with Barrett’s Esophagus. Chinese Journal of Evidence-Based Medicine, 2012, 12(4): 484-488. doi: 10.7507/1672-2531.20120075 Copy

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.

Previous Article
Antibiotic Prophylaxis in Severe Acute Pancreatitis: A Systematic Review
Next Article
Evidence-Based Treatment for a Patient with Achalasia

Chinese Journal of Evidence-Based Medicine

Evidence-Based Treatment for a Patient with Barrett’s Esophagus

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content