A critical review of the diagnosis and management of Barrett's esophagus: the AGA Chicago Workshop

BACKGROUND & AIMS: The diagnosis and management of Barrett's esophagus (BE) are controversial. We conducted a critical review of the literature in BE to provide guidance on clinically relevant issues. METHODS: A multidisciplinary group of 18 participants evaluated the strength and the grade of evidence for 42 statements pertaining to the diagnosis, screening, surveillance, and treatment of BE. Each member anonymously voted to accept or reject statements based on the strength of evidence and his own expert opinion. RESULTS: There was strong consensus on most statements for acceptance or rejection. Members rejected statements that screening for BE has been shown to improve mortality from adenocarcinoma or to be cost-effective. Contrary to published clinical guidelines, they did not feel that screening should be recommended for adults over age 50, regardless of age or duration of heartburn. Members were divided on whether surveillance prolongs survival, although the majority agreed that it detects curable neoplasia and can be cost-effective in selected patients. The majority did not feel that acid-reduction therapy reduces the risk of esophageal adenocarcinoma but did agree that nonsteroidal antiinflammatory drugs are associated with a cancer risk reduction and are of promising (but unproven) value. Participants rejected the notion that mucosal ablation with acid suppression prevents adenocarcinoma in BE but agreed that this may be an appropriate strategy in a subgroup of patients with high-grade dysplasia. CONCLUSIONS: Based on this review of BE, the opinions of workshop members on issues pertaining to screening and surveillance are at variance with published clinical guidelines.     

藏药脉花党参的化学成分(英文)

目的:研究藏药脉花党参 Codonopsis nervosa ( Chipp.) Nannf.地上部分的化学成分。方法:采用 D101 大孔树脂柱、硅胶柱、ODS 柱、凝胶柱等色谱手段进行化学分离和纯化, 并利用各种波谱技术进行结构鉴定。结果:分离并鉴定了 15 个化合物, 分别为柯伊利素(1), 苜蓿素(2), 芹菜素(3), 琥珀酸(4), β-胡萝卜苷(5), 木犀草素(6), 木犀草素-7-O-β-D-葡萄糖苷(7),ethylsyringin (8), 芹菜素-7-O-β-D-葡萄糖苷(9), 木犀草素-7-O-β-D-葡萄糖基-(1→6)-[(6’’’-O-咖啡酸)-β-D-葡萄糖苷](10), 木犀草素-7-O-β-D-龙胆二糖苷(11), 丁香苷(12), 绿原酸(13), 新绿原酸(14), 对羟基苯甲酸葡萄糖苷(15)。结论:化合物 1 5, 8, 9, 12, 14,15 均首次从该植物中分离得到。     

多指标成分定量结合指纹图谱分析评价不同来源藏紫草的质量

高效液相色谱法-二极管阵列检测器(HPLC-DAD)同时测定藏紫草中紫草素、乙酰紫草素、β,β'-二甲基丙烯酰紫草素的含量,结合藏紫草的HPLC指纹图谱研究,对西藏地区不同来源的藏紫草药材的质量进行初步比较和评价。采用Agilent ZORBAX SB-C₁₈ (4.6 mm×250 mm,5μm)色谱柱,以乙腈-水为流动相梯度洗脱,流速0.8 mL·min^-1,柱温30℃,检测波长516 nm。利用化学计量法对色谱数据进行相似度比较和聚类分析。测定了7批不同来源藏紫草药材,发现7批药材中3种萘醌类成分的含量差异巨大。指纹图谱相似度比较显示5,6,7号样品间相似度大于0.99,2,3号样品间相似度大于0.97,3,4号样品相似度大于0.90,其余相似度均不超过0.8,7批样品可分为4类,与3种萘醌类成分的含量测定结果基本一致。说明市场上藏紫草药材来源混杂,质量参差不齐。该方法重复性好,可以为不同来源藏紫草药材的质量控制和评价提供依据。