Objective To discuss the common clinical problems and make the individualized treatment for a patient with obscure gastrointestinal bleeding by means of evidence-based medicine, so as to ultimately control the symptoms and reduce the mortality. Methods After the clinical problems were put forward, the systematic reviews and randomized controlled trials (RCTs) were collected in The Cochrane Library (online), MEDLINE, EMBase, SCIE and CNKI databases, from the date of their establishment to 2010. The treatment protocol was made by combining the assessment of evidence with the willingness of both patient and relatives. Results A total of 30 RCTs and 5 systematic reviews were identified. A rational diagnostic and therapeutic plan was made upon a serious evaluation of the data and willingness of patients. The Mickel’s diverticulum was found through capsule endoscopy, which was then locally excised under laparoscopy. After a 6-month follow-up, the plan proved to be optimal. Conclusion The treatment efficacy in diagnosed obscure gastrointestinal bleeding has been improved by adopting an individualized treatment plan according to evidence-based methods.
Objective Through the methods of evidence-based medicine, to make an individualized treatment plan for a patient with achalasia. Methods Based on an adequate assessment of the patient’s condition, clinical issues aimed at this case were put forward. And the best clinical evidence related to achalasia treatment was evaluated after being retrieved from The Cochrane library (1990 to 2010) and PubMed (1980 to 2010). Results 33 studies were retrieved including 29 RCTs and 4 systematic reviews. The efficacy and safety of drug therapy, endoscopic injection of botulinum, endoscopic balloon dilatation and surgical therapy were evaluated. Cosidering symptoms,age and comorbidities, we recommended endoscopic balloon dilatation or laparoscopic Heller postoperative plus Dor fundoplication surgery for treatment. The patient’s choice is endoscopic balloon dilatation. Symptoms of patient were relieved after treatment. Conclusion Making a rational therapeutic plan for achalasia patients by means of evidence-based treatment not only can improve therapeutic effect but also be beneficial for both doctors and patients to share uncertain risks.
Objective To formulate an evidence-based treatment plan for a patient with advanced hepatocellular carcinoma. Methods The clinical problems were put forward after full evaluation of patient’s conditions, and then the evidence related to the diagnosis and treatment of primary hepatocellular carcinoma was collected from The Cochrane Library (Issue 4, 2010), PubMed (1980 to 2010), Embase (1990 to 2010) and Wanfang Data (1990 to 2010). All the collected evidence was critically assessed. Both patient preferences and physician clinical experience were also taken into consideration in the decision-making treatment. Results A total of 153 relevant literatures were detected, and 13 meta-analyses or systematic reviews, 23 RCTs and 4 practice guidelines were identified. A rational treatment plan was made upon a serious evaluation of the data and the opinion of the patient. After a 6-month follow-up, the plan proved to be optimal. Conclusion The individualized treatment plan according to evidence-based methods for patients with advanced hepatocellular carcinoma can effectively improve the therapeutic efficacy and the life quality.
Helicobacter pylori (HP) infection is closely associated with the occurrence of such common upper gastrointestinal diseases as chronic gastritis, peptic ulcer and gastric cancer. However, even with the currently most effective treatment regimens, approximately 10% to 20% of patients still fail to obtain eradication of the infection and remain HP positive. So the eradication of HP infection remains one of the major challenges in the medical field. This article aims to introduce the evidence for the choice of the second-line regimens after the failure of the first therapy. And the evidence includes the quadruple therapy proposed by the Maastricht III Consensus and the triple regimens with different antibiotics in all kinds of randomized clinical trials.
Objective To make an individualized treatment plan for one first-visit gastro-esophageal reflux disease patient via evidence-based medicine methods. Methods The condition of the patient was evaluated comprehensively, then clinical problems were put forward according to PICO principle, and high-quality evidence was collected from The Cochrane Library (1990 to 2010), PubMed (1990 to 2010), and EMbase (1990 to 2010). The treatment plan was designed based on the evaluation of evidence, doctor’s experience, and patient’s preferences. Results A total of 17 RCTs and 10 meta-analyses/ systematic reviews were included. The evidence showed that the therapeutic effect of PPI was better than that of H2RA, and meanwhile prokinetic drugs should be used. When PPI needed to be use for a long time, HP eradication operation was required for the combination of HP inflammation. Laparoscopic fundoplication surgery was a better choice if the operation was required. Based on the above evidence combined with the patient’s preferences, the combination of general treatment, esomeprazole and cisaPride were adopted to treat. Meanwhile, anti-HP medicine was used to control the HP inflammation caused by the long-term maintenance therapy. The gastro-esophageal reflux symptoms were remarkably relieved six months after the treatment. Conclusion PPI plus prokinetic drugs, combined with HP eradication of gastroesophageal reflux surgery, can improve the clinical outcomes and patient’s quality of life. However, long-term prognostic benefits need to be confirmed by further follow-up.
Objective To systematically review the correlation between epidermal growth factor (EGF) 61A/G polymorphism and the risk of esophageal carcinoma. Methods Such databases as PubMed, EMbase, CJFD, CBM, CNKI, VIP and WanFang Data were electronically searched from inception to January 1st, 2013, to collect case-control studies on the correlation between epidermal growth factor (EGF) 61A/G polymorphism and the risk of esophageal carcinoma. Two reviewers independently identified the literature according to inclusion and exclusion criteria, extracted data, and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 and Stata 12.0 software. Results A total of six studies involving 1 448 cases and 1 728 control subjects were included. The results of meta-analysis showed that, there was no significant association between EGF 61A/G polymorphism and the risk of esophageal carcinoma (dominant model: AG+GG vs. AA: OR=1.22, 95%CI 0.91 to 1.65; and recessive model: GG vs. AG+AA: OR=1.35, 95%CI 0.94 to 1.94; AG vs. AA: OR=1.12, 95%CI 0.93 to 1.35; GG vs. AA: OR=1.43, 95%CI 0.83 to 2.47). The results of subgroup analysis grouped by ethnicity showed that, EGF 61A/G polymorphism increased the risk of esophageal carcinoma of the White population (dominant model: AG+GG vs. AA: OR=1.39, 95%CI 1.14 to 1.71; and recessive model: GG vs. AG+AA: OR=1.75, 95%CI 1.37 to 2.25; GG vs. AA: OR=1.93, 95%CI 1.47 to 2.55). However, it had no correlation to the risk of esophageal carcinoma of Asian population. Conclusion Current studies showed that, EGF 61A/G polymorphism is not associated with susceptibility to esophageal carcinoma , but it may increase the risk of esophageal carcinoma in White population. Due to limited quality and quantity of the included studies, the above conclusion needs to be verified by more studies with large sample size.
Objective To compare proton pump inhibitors (PPI) and H2 receptor antagonists (H2RA) for both the prevention of bleeding and the healing of ulcer after endoscopic submucosal dissection (ESD), so as to provide best evidence for treating ESD-induced ulcer in clinic. Methods Databases including PubMed, CENTRAL, EMbase, ISI Web of Knowledge, VIP, CNKI, CBM and WanFang Data were searched from the date of their establishment to October 26, 2012 to collect the randomized controlled trials (RCTs) about comparison of PPI and H2RA on the prevention of bleeding and the healing of ulcer after ESD. Meanwhile the references of the included studies were also retrieved manually. According to the inclusion and exclusion criteria, literature selection, data extraction and quality assessment were performed by four reviewers independently, and meta-analysis was performed using RevMan 5.1 software. Results A total of 6 studies involving 616 patients were included finally. The results of meta-analysis showed that: for the prevention of ulcer bleeding after ESD, PPI preceded H2RA apparently (OR=0.51, 95%CI 0.29 to 0.89, P=0.02), especially when the treatment course was 8-week (OR=0.43, 95%CI 0.22 to 0.82, P=0.01); but among the merged, 8-week and 4-week groups, there were no significant differences between PPI and H2RA in the healing of ESD-induced ulcer (OR=0.85, 95%CI 0.39 to 1.86, P=0.69; OR=1.33, 95%CI 0.28 to 6.27, P=0.72; OR=0.75, 95%CI 0.31 to 1.79, P=0.52). Conclusion PPI is superior to H2RA for the prevention of ulcer bleeding induced by ESD, but there is no significant difference between them in the healing of ulcer, so PPI is recommended to prevent ESD-induced ulcer bleeding in clinic. Due to the limitation of quantity and quality of the included studies, the safety of PPI has to be further proved by conducting more high quality, large scale and multicenter RCTs.
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.
Objective To study the expressions of human ether-a-go-go related gene (HERG) in CD1 mice gallbladder and interstitial cells of Cajal (ICC) and explore their possible implications. Methods The expression of HERG protein in gallbladder tissue slices obtained from CD1 mice was detected by immunohistochemistry method. The expression of HERG mRNA in gallbladder tissue was detected by reverse transcription (RT)-PCR. The production of HERG protein was confirmed in the CD1 mice gallbladder by Western blot. Enzymatically dispersed cells were identified as ICC using the specific ICC marker c-kit antibody, and the double positive cells of c-kit and HERG were observed by laser passing confocal microscope. Results HERG was present in the CD1 mice gallbladder tissues for the yellow or buffy positive reaction. At the same time, the expression of mRNA specific for the HERG gene and production of HERG protein in the CD1 mice gallbladder tissues were indicated by RT-PCR and Western blot analysis, respectively. Using double labeling of anti-c-kit and anti-HERG, the double positive cells of c-kit and HERG were observed in the CD1 mice ICC by laser passing confocal microscope. Conclusion The study demonstrates that HERG is present in the CD1 mice gallbladder tissues and ICC, which is likely related to the pacemaking activity of ICC.