Evidence-based Medical Research On Barrett’s Esophagus Treatment

Background Barrett’s esophagus (BE) is a premaligant condition in which the normal squamous epithelium of the lower esophagus segment is replaced by the simple columnar epithelium, with or without an intestinal metaplasia.. With the development of clinical medicine, the treatment of BE arise more and more attention in medical practice.Objective To make an individualized treatment plan for a newly diagnosed Barrett esophagus patient by means of evidence-based medicineMethods After clinical problems were put forward, systematic reviews and randomized controlled trials were collected from The Cochrane Library(Issue3,2009) and Pubmed(1995-2010) and SCIE(1995-2010).Treatment protocol was produced by combining the evidence and the values of the patient. Results A total of21RCTs and6systematic reviews were identified. A rational treatment plan was made upon a serious evaluation of the data to control symptoms and improve the quality of life for the patient. Improve the lifestyle and use the APC therapy, then the medical therapy (Omeprazole,40mg, bid) for six weeks. The condition of the patient is much better after three months. After a twelve-month follow-up, the plan proved to be optimalConclusion The treatment efficacy in a diagnosed Barrett esophagus has been improved by determining an individual treatment according to evidence-based methods. Background The current endoscopic ablative therapy has been the subject of heated discussion, which has led to the consideration of alternative therapies for BE. Many new techniques have been reported to produce successful ablation of BE, such as argon plasma coagulation (APC), photodynamic therapy (PDT). Although these therapies are effective and beneficial, some heavy side-effects are still exist.Objective Systematically evaluate the efficacy and side effects of APC versus PDT for the patients with Barrett’s esophagusMethods Such databases as The Cochrane Library, PubMed, EMBASE were searched to collect the randomized controlled trials(RCTs) about APC versus PDT for the treatment of Barrett’s esophagus published before2012. After literature screening, data extraction and methodological quality evaluation, RevMan4.2was used for meta-analysis.Results Five studies involving167patients were included. The results of meta-analysis showed that, on the epidermal clearance of BE, the APC therapy was better than the PDT therapy[OR=2.92,95%CI (1.51,5.62)]. On the side effects, the chest pain caused by PDT was worse than APC[OR=0.03,95%CI (0.13,0.51)], but no significance was found in stenosis[OR=1.78,95%CI(0.33,9.73)], odynophagia[OR=0.93,95CI(0.18,4.93)]. Conclusion As the current results shows, APC therapy was better than the PDT therapy on the epidermal clearance of BE, such side effect as chest pain was lighter than PDT. Background:Clinical economics is the interdispcipline subject combing the clinical medicine, epidemiology, statistics and economics, to get the cost and benefit accordingly. It can provide different diagnostic economics parameters for the clinical physicians, which can help them make the optimal strategies. We research on the clinical economics in order to allocate the health resources reasonablely, produce the most social benefit.Objective We evaluate the economic benefit of various therapies in BE treating by the evidence-based medicine methodMethod We search the therapies and clinical evaluation parameters of BE with the help of Cochrane Library and PubMed, according to our result we analyse the optimal clinical economic method for the patient.Result We totally search eight article about the economic therapy, for the BE patient with low or high atypical epithelium, under the help of cost-effective analysis, therapeutic endoscopy is better the surgical therapy. In all of the therapeutic endoscopies, the cost-effective analysis result of APC is higher than PDT therapy. PDT with endoscopic surveillance is better than PDT therapy alone. If condition permitted.Conclusion we suggest to use the clinical cost-effective analysis, to find economic, effective therapy, so we can utilize the health resources reasonablely in order to produce the best social benefit and economic benefit.