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Senior men with history of reflux disease need test for Barrett’s Esophagus

New treatment for common digestive condition Barrett's Esophagus also recommended by landmark study

By Tucker Sutherland, editor

Art showing esophagus, stomach, small intestineApril 14, 2015 – Men over 60 with 10-year history of a serious form of reflux disease should be screened for Barrett’s esophagus, which makes them more likely to develop a rare cancer called esophageal adenocarcinoma.

This recommendation was published by U.K. researchers who also found that invasive procedures are often not the best option to treat and diagnose patients suffering from Barrett's.

While Barrett’s esophagus doesn’t cause symptoms, many people with Barrett’s have gastro esophageal reflux disease (GERD), which does cause symptoms. GERD is a more serious, chronic form of gastro esophageal reflux, a condition in which stomach contents flow back up into your esophagus. Refluxed stomach acid that touches the lining of your esophagus can cause heartburn and damage the cells in your esophagus.

(More about Barrett's Esophagus below news story.)

Publishing their findings in the American Journal of Gastroenterology, the researchers looked at a wide range of studies about this condition.

This new research from leading UK institutions - the University of Warwick, and University Hospitals Coventry and Warwickshire (UHCW) NHS Trust - could transform treatments and diagnosis for a common digestive condition which affects thousands of patients.

 

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The esophagus or food pipe (gullet) is part of the digestive system. It is the tube that carries food from your mouth to your stomach. Barrett's Esophagus (also known as BE) and low-grade dysplasia affects approximately 2% of the adult population, particularly men with heartburn, as acid reflux from the stomach can, over time, damage the lining of the esophagus and lead to BE.

BE is seen in people undergoing endoscopy to determine the cause of their digestive problems.

Patients are currently commonly offered surgery for pre-cancerous changes in BE. The researchers found, however, that in most cases, medical therapies and continuous monitoring are more effective to identify and prevent cancer for patients than surgery.

Where patients had a more advanced form of the condition, however, the team found that endoscopic resection surgery was the best option.

The researchers have developed a new definition of BE to standardize diagnosis of the condition for clinicians in the USA and Europe. The team has also proposed a clear plan for treating patients depending on how their condition develops.

The world-leading study is believed by the researchers to be one of the largest reviews of this kind in internal medicine. The team reviewed 20,300 papers by over 100 world experts.

"This paper could have huge implications for the thousands of patients diagnosed with Barrett's Esophagus. We hope that our findings will transform care for patients, and also help to identify patients at risk of developing cancer at the earliest possible opportunity," said Professor Janusz Jankowski, Professor of Acute Medicine at Warwick Medical School and UHCW NHS Trust, said:

Professor Cathy Bennett, Professor in Systematic Reviews, at Coventry University  said, "We created a unique opportunity for doctors and scientists from around the world to work together. We used a specially designed web-based platform to interact, discuss and summarize the vast amount of medical evidence available for the management of this condition.

"As a result of our work, healthcare professionals from all parts of the world will be able to access these new key recommendations"

The group now plans to look at genetic markers for BE patients, to determine the risk of patients going on to develop cancer.

Ř  University of Warwick

Ř  Coventry University


About Barrett's Esophagus:

National Institute of Diabetes and Digestive and Kidney Diseases

What is Barrett's Esophagus?

Barrett’s esophagus is a condition in which tissue that is similar to the lining of your intestine replaces the tissue lining your esophagus. Doctors call this process intestinal metaplasiaExternal Link Disclaimer.

Are people with Barrett’s esophagus more likely to develop cancer?

People with Barrett’s esophagus are more likely to develop a rare type of cancer called esophageal adenocarcinomaExternal Link Disclaimer.

The risk of esophageal adenocarcinoma in people with Barrett’s esophagus is about 0.5 percent per year.1 Typically, before this cancer develops, precancerous cells appear in the Barrett’s tissue. Doctors call this condition dysplasia and classify the dysplasiaExternal Link Disclaimer as low grade or high grade.

You may have Barrett’s esophagus for many years before cancer develops. Visit the National Cancer Institute to learn more about esophageal adenocarcinomaExternal Link Disclaimer.

How common is Barrett’s esophagus?

Experts aren’t sure how common Barrett’s esophagus is. Researchers estimate that it affects 1.6 to 6.8 percent of people.2

Who is more likely to develop Barrett’s esophagus?

Men develop Barrett’s esophagus twice as often as women, and Caucasian men develop this condition more often than men of other races.1 The average age at diagnosis is 55.3 Barrett’s esophagus is uncommon in children.3

1Johnston MH. Barrett esophagus. Medscape website. http://emedicine.medscape.com/article/171002-overview#showallExternal Link Disclaimer. Updated April 7, 2014. Accessed July 22, 2014.

2Gilbert EW, Luna RA, Harrison VL, Hunter JG. Barrett’s esophagus: a review of the literature. Journal of Gastrointestinal Surgery. 2011;15:708–718.

3Spechler SJ, Souza RF. Barrett esophagus and esophageal adenocarcinoma. In: Yamada T, ed. Textbook of Gastroenterology. Vol. 1. West Sussex, UK: Wiley-Blackwell; 2009: 826–848.​

What are the symptoms of Barrett’s esophagus?

While Barrett’s esophagus itself doesn’t cause symptoms, many people with Barrett’s esophagus have gastroesophageal reflux disease (GERD), which does cause symptoms

What causes Barrett’s esophagus?

Experts don’t know the exact cause of Barrett’s esophagus. However, some factors can increase or decrease your chance of developing Barrett’s esophagus.

What factors increase a person’s chances of developing Barrett’s esophagus?

Having GERD increases your chances of developing Barrett’s esophagus. GERD is a more serious, chronic form of gastroesophageal reflux, a condition in which stomach contents flow back up into your esophagus. Refluxed stomach acid that touches the lining of your esophagus can cause heartburn and damage the cells in your esophagus.

Between 5 and 10 percent of people with GERD develop Barrett’s esophagus.1

Obesity—specifically high levels of belly fat—and smoking also increase your chances of developing Barrett’s esophagus. Some studies suggest that your genetics, or inherited genes, may play a role in whether or not you develop Barrett’s esophagus.

What factors decrease a person’s chances of developing Barrett’s esophagus?

Having a Helicobacter pylori (H. pylori) infection may decrease your chances of developing Barrett’s esophagus. Doctors are not sure how H. pylori protects against Barrett’s esophagus. While the bacteria damage your stomach and the tissue in your duodenum, some researchers believe the bacteria make your stomach contents less damaging to your esophagus if you have GERD.

Researchers have found that other factors may decrease the chance of developing Barrett’s esophagus, including

  ● frequent use of aspirin or other nonsteroidal anti-inflammatory drugs

  ● a diet high in fruits, vegetables, and certain vitamins

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