Variceal bleeding in cirrhosis is one of the most challenging problems in gastroenterology. Bleeding from gastro-oesophageal varices is a main cause of early death (approximately 30%-50% at the first bleeding) in cirrhosis. The aim of our therapy is to locate the place of bleeding, control active bleeding and prevent rebleeding, but it is difficult sometimes. A number of treatment strategies, such as somatostain analogs, vasopressin, endoscopic therapy, transjugular intrahepatic portasystemic shunt (TIPS) have evolved over time, but which is better? New evidence of therapy for variceal haemorrhage will be introduced in Cirrhosis that includes: 1.Somatostatin, vasopressin, ligation, schlerotherapy and balloon tamponade for acute variceal bleeding; 2.β-blockers, ligation, schlerotherapy and shunt surgery for prophylaxis of primary variceal bleeding; 3.β-blockers, ligation, schlerotherapy, shunt surgery and TIPS for prophylaxis of variceal rebleeding; 4. Antibiotic prophylaxis for cirrhosis with gastrointestinal bleeding.
Objective To determine the effectiveness and safety of pneumatic balloon dilatation in patients with achalasia. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL, issue 1, 2007), MEDLINE or PUBMED (1978-2007), Embase (1978-2007), OVID Database (1978-2007), Chinese Biological Medicine Database (CBMDisc, 1978-2007), CNKI (1979-2007), Chinese VIP Database (1989-2007) and Wanfang Database (1978-2007). We also checked the reference lists of retrieved articles and relevant proceedings. We used the methods recommended by The Cochrane Collaboration to conduct this systematic review. Results Twenty four trials involving 1045 patients were included. Meta-analyses showed that the short-term total effective rate was much higher with pneumatic dilatation than intrasphincteric botulinum toxin injection (P=0.0007). The long-term total effective rate was higher with pneumatic dilatation compared to intrasphincteric botulinum toxin injection (P=0.005). Intrasphincteric botulinum toxin injection was superior to pneumatic dilatation in terms of clinical relapse rate (Plt;0.0001). Our analyses of complications and adverse effects found that pneumatic dilatation was superior to intrasphincteric botulinum toxin injection (P=0.0008), and endoscopic sphincterotomy was superior to balloon dilatation (P=0.0006). Conclusions The limited current evidence shows that: pneumatic dilatation is safe and effective for the short- or long-term treatment of achalasia.
Objective To provide evidence of the role of helicobacter pylori eradication in the treatment of functional dyspepsia. Methods We searched VIP, CBMdisc, MEDLINE and The Cochrane Library for systematic reviews, meta-analysis, randomized controlled trials and clinical guidelines involving helicobacter pylori and functional dyspepsia, so as to provide the best evidence for clinical practice. Results We included two systematic reviews, one meta-analysis and eleven randomized controlled trials. The evidence identified showed that helicobacter pylori infection was more prevalent in functional dyspepsia than in asymptomatic patients, but the effect of H pylori infection in the pathogenesis of functional dyspepsia remained controversial. H pylori eradication therapy had a relatively weak effect in H pylori positive functional dyspepsia. An economic model suggested that this modest benefit may still be cost-effective, but more studies are needed to assess this. Conclusion According to the current evidence, it can be concluded that helicobacter pylori eradication for the treatment of functional dyspepsia should be individualized.
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.
Objective To assess the efficacy and safety of histamine H2 receptor antagonist (H2RA) for the prevention of stress ulcer bleeding (SUB) in critically ill patients. Methods Trials were identified by searching Cochrane Controlled Trials (Issue 4, 2006), MEDLINE (1980 to October 2006),EMbase (1984 to October 2006) and the Chinese Biological Medicine Database (1978 to October), Chinese VIP Database (1989 to October 2006) and Chinese EBM Database. We also handsearched the proceedings of relevant conferences, 5 kinds of important Chinese journals and the references of all included trials. Two reviewers assessed the quality of studies and extracteddata independently. Disagreement was resolved by discussion . The primary outcomes included were incidence of SUB, incidence of nosocomial pneumonia (NP), mortality and adverse events. Secondary outcomes were gastric pH, length of hospital stayand length of ICU stay. RevMan4.2.7 software was used for meta-analyses. Results Sixteen trials involving 2 014 patients were included. Most of the trials were of poor quality. Meta-analyses showed that H2RA significantly less SUB comparedwith patients in the placebo or non-prophylaxis group (RR 0.39, 95%CI 0.28 to 0.56; Plt;0.000 01, NNT=6), but but there was no significant difference in the incidence of clinically important bleeding (RR 0.51 , 95%CI 0.17 to 1.53; P=0.11). No significant difference was observed in the incidence of NP(RR 1.02, 95%CI 0.55 to 1.89,P=0.95). H2RA significantly decreased mortality in comparison with placebo or non-prophylaxis (RR 0.68, 95%CI 0.52 to 0.90; P=0.007, NNT=18). H2RA had a good safety profile. We did not perform meta-analysis for gastric pH due to the methodological limitations. Conclusion H2RA may significantly reduce the incidence of SUB and mortality, but cannot reduce the incidence of clinically important bleeding. Due to the poor quality of included studies, the conclusion should be interpreted cautiously. More randomized controlled trials with sufficient sample size, uniform standards, higher quality and scientifically sound methodology should be performed.
Objectives To assess the effectiveness and safety of additional bedtime H2-receptor antagonists (H2RAs) in suppressing nocturnal gastric acid breakthrough (NAB). Methods We identified eligible trials by searching The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMbase and CINAHL. We handsearched the data from the proceedings of correlated conferences, eight kinds of important Chinese journals and references of all included trials. All randomized controlled trials evaluating H2RAs for the control of NAB were eligible for inclusion. The systematic review was conducted using methods recommended by The Cochrane Collaboration. Results Only two randomized crossover studies including 32 participants met the inclusion criteria. Because the design, dosage and duration of the treatment were different between the studies, it was impossible to conduct Meta-analysis. There was no consistent conclusion between the two included studies in evaluating H2RAs for the control of NAB. Conclusion We can not conclude any implications for practice at this stage. Appropriately designed large-scale randomized controlled trials with long-term follow-up are needed to decide the effects of additional bedtime H2RAs in suppressing NAB.
Objective To systematically evaluate the effectiveness and safety of itopride vs. mosapride in patients with functional dyspepsia, so as to provide references for clinical practice. Methods According to strict inclusive and exclusive criteria, relevant randomized controlled trials (RCTs) on itopride vs. mosapride for functional dyspepsia were searched in CENTRAL, Medline, Embase, ISI, OVID, CBM, VIP, WanFang Data and CNKI from the date of their establishment to November 2011. Two reviewers independently screened literature, extracted data and evaluated methodological quality. Meta-analyses were conducted using Revman 5.1 software. Results A total of 4 trials involving 363 patients were included and data were coped with meta-analysis. a) About the improvement of overall symptoms: itopride was not superior to mosapride, with no significant difference (OR=1.62, 95%CI 0.53 to 4.93, P=0.4); b) About the improvement of single symptom: itopride was not superior to mosapride in improving single symptom as follows: postprandial fullness, upper abdominal distention, poor appetite, and upper abdominal pain, with no significant difference; and c) About the incidence of adverse events: itopride was similar to mosapride (OR=0.63, 95%CI 0.31 to 1.29, P=0.21). Conclusion Current evidence shows that itopride is similar to mosapride in effectively improving overall symptoms and single symptom, and it has fewer side effects than mosapride does. Due to the low quality of most included studies, more strictly-designed and large-scale RCTs are needed to provide reasonable proofs for clinic.
Objective To evaluate the difference of oral sodium phosphate (NaP) and polyethylene glycol-electrolyte lavage solution (PEG-ELS) in the aspects of cleansing efficacy, tolerance, and safety in clinical practice, so as to provide evidence for clinical practice. Methods A systematic review of all the relevant randomized controlled trials (RCTs) was performed according the handbook of the Cochrane Collaboration. RCTs were identified from The Cochrane Library(Issue1,2004) MEDLINE(1980-2004), EMBASE(1984-2004),and CBM(1978-2004).Handsearching was also performed .RCTs comparing the two methods were selected .Tow reviewers independently assessed the quality of included trials and extracted data independently .Results Eighteen trials involving 3668 patients were included .Sub-group analysis was performed. Nap tablet had higher rate of adequate cleansing quality (RR1.08,95%CI1.02 to 1.05,p=0.01).Two-day ,divided-dose oral Nap was superior in the rate of adequate cleansing quality (RR1.27,95%CI1.06 to 1.52,p=0.009). .The. rate of adequate cleansing quality in right colon of Nap was lower than PEG-ELS(RR0.79,95%CI 0.64 to 0.98,p=0.03).The rate of abdominal cramps (RR 0.84,95%CI 0.72 to 0.99),the rate of abdominal fullness (RR 0.48,95%CI 0.26 to 0.89),the rate of nausea (RR 0.65,95%CI 0.56 to 0.76)and the percentage of patients who didn’t finished their prescribed regimen (RR 0.23,95%CI0.14 to 0.36)in Nap group were lower (plt;0.05).Conclusions Compared with PEG-ELS,Nap is superior in cleansing efficacy , patients’ tolerance ,safety and economy . It is possible to promote the use of Nap in clinical practice in China .
Objective To provide best available evidence for clinical practice and further research planning on IBS treatment, we reviewed systematically all the randomised controlled trials on calcium channel blockers for irritable bowel syndrome. The primary objective was to determine whether there was enough evidence that calcium channel blocker was effective and safe in the treatment of patients with IBS. Method Searches were performed in Trials Register of the Cochrane Complementary Medicine Field, data from the pharmaceutical company were also retrieved. In addition we searched the electronic bibliographic databases: Cochrane Controlled Trials Register, Medline, Embase, Chinese Biological Medical Database (CBM-disc). We handsearched some important Chinese journals. Two reviewers included studies, assessed the quality of studies and extracted data independently. Disagreement was resolved by discussion or the third party when needed. The following primary outcomes were assessed: ① Effective rate at the end of experiment, ② Improvmemnt in abodeminal pain and distention, ③ Adverse events. Results 49 potentially eligible trials were identified, of which 9 trials (831 patients) were included. 8 trials were waiting for assessment. The mean percentage of patients with global improvement was 48.9% in control group and 75% in the calcium channel blockers group. In favour of calcium group with a mean OR 4.54, 95%CI (2.38, 8.66). Conclusions Selective calcium channel blockers might be effective and safe in the treatment of patients with IBS.Because the methodological quality of all included studies was poor,further high-quality randomised controlled trials should be performed.
Objective To elucidate the effect of first-aid fast track in triaging earthquake trauma patients by studying the earthquake trauma patients staying in the Emergency Department of West China Hospital after “5•12 Wenchuan Earthquake” so as to accumulate experience in the treatment of disaster traumas. Methods A retrospective study was done on earthquake trauma patients staying in the Emergency Department of West China Hospital after “5•12 Wenchuan Earthquake” from 14:28 May 12, 2008 to 14:27 May 15, 2008. Differences in care given during the time period were analyzed. Results There were 536 earthquake trauma patients in West China Hospital within 72 hours after the earthquake. Twohundred and seven earthquake trauma patients staying in the Emergency Department had an average stay of 129 minutes during the 24 hours after the quake; 104 earthquake trauma patients staying in the Emergency Department had an average stay of 97 minutes in the second 24 hours; and 226 earthquake trauma patients staying in the Emergency Department had an average stay of 86 minutes in the third 24 hours. Each consecutive day showed shorter average stays. Conclusion The first-aid fast track not only guarantees earthquake trauma patients are saved as soon as possible but also shortens the time in the Emergency Department.