Barrett’s esophagus is considered an important risk factor for the pathogenesis of esophageal adenocarcinoma. Treatment strategies for diseases from high-grade dysplasia （HGD） to adenocarcinoma are different. The recurrence rates of endoscopic treatment and anti-reflux surgery are comparatively higher. Abnormal lesions of the esophagus can be completely resected by esophagectomy for the treatment of HGD to adenocarcinoma, and treatment outcomes are confirmed.But appropriate surgical strategies and lymph node dissection scopes should be chosen according to different cancer staging.Lymph node metastasis is a major factor in determining prognosis.
Objective To formulate the treatment of Barrett esophagus and provide evidence-based solutions for doctors and patients. Methods We attempted to obtain evidence for treating Barrett esophagus by searching MEDLINE (1978 to 2005), CBMdisc (1978 to 2005) and The Cochrane Library (Issue 4, 2005). The quality of the retrieved evidence was evaluated. Results The therapies for Barrett esophagus include dietary intervention, change of life style, drug therapy, endoscopic therapy and surgery. We should choose different therapies according to the specific conditions of patients. Conclusions Endoscopic therapy has been developed a lot in recent years. The combination of two or more therapies may produce better effects.
目的:探討內鏡下氬離子凝固術(APC)聯合抑酸治療對Barrett食管的臨床療效。方法:選擇經內鏡及病理確診的Barrett食管患者40例,隨機分為兩組,治療組21例,對照組19例,治療組經內鏡下APC治療后聯合埃索美拉唑20mg 2次/日連續3月,對照組單用埃索美拉唑20mg 2次/日連續3月,分別于3月、6月、12月對兩組進行臨床癥狀積分和內鏡及病理隨訪。結果:兩組治療后3、6、12月臨床癥狀積分緩解無明顯差異性(Plt;0.05),但從內鏡、病理隨訪的有效率來看,治療組與對照組相比有顯著差異性(Plt;0.05)。結論:BE內鏡下APC聯合抑酸治療能有效逆轉Barrett上皮,是一種安全、有效的治療方法。
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.