The Cochrane Nursing Care Field writes a column for the American Journal of Nursing
on a regular basis. The May issue featured a review titled: Treatment for Barrett's Esophagus.
Barrett's esophagus is a premalignant stage of esophageal adenocarcinoma which is a complication of chronic gastroesophageal reflux disease (GERD).
The review was derived from a meta-analysis of 16 randomized controlled trials that looked at 1,074 adults over the age of 18 years. The meta-analysis compared three interventions for their ability to completely eradicate the condition at 12 months. The three interventions that were compared were pharmacologic management with proton-pump inhibitors (PPI) or histamine-2 receptor blockers (H2 blockers); anti- reflux procedures; and endoscopic ablation using argon plasma coagulation (APC) or photodynamic therapy (PDT). The results demonstrated that endoscopic ablation with either APC or PDT was superior to the other therapies including PPI's and H2 blockers. The use of PPI's and H2 blockers had little or no significant effect on eradication of Barrett's esophagus (Zhang & Liu, 2012).
I found this evidence summary particularly interesting because of the number of people who take PPI's and H2 blockers on a regular basis for the management of GERD symptoms. How many of these people are walking around with Barrett's esophagus and don't even know it? As healthcare providers, we need to advise our patients that if they are taking these drugs to control GERD symptoms and the symptoms are not improved within the recommended time period for the particular drug, they need to seek evaluation from a healthcare provider skilled in gastroenterology.
Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC
Chief Nurse & Publisher
Wolters Kluwer Health / Lippincott Williams & Wilkins / Ovid Technologies