GETTING HEARTBURN OR acid reflux occasionally is fairly normal – but some people find themselves chronically affected by these ailments.
Some of those people could also have a condition that can have an even more serious impact on their health.
Up to 10% of people with chronic heartburn could be at risk of developing the condition known as Barrett’s oesophagus – about 4-5 per cent of people with Barrett’s will go on to develop cancer.
What it is
The Irish Society of Gastroenterology wants more people to know about the condition, which is where the cells lining the lower part of the oesophagus undergo change as a result of constant acid reflux from the stomach.
Barrett’s is considered a pre-cancerous condition, and endoscopic screening for it and for early pre-malignant changes is generally recommended in all adults aged 50 and over who have a long history (over five -10 years) of heartburn.
What the experts say
Prof Dermot O’Toole is an upper GI consultant gastroenterologist at St James’s Hospital and a member of the Irish Society of Gastroenterologists. He’s a leading consultant and expert on Barret’s oesophagus.
He spoke at the recent summer meeting held by the society, where the latest discoveries on Barrett’s were discussed.
Prof O’Toole pointed out that a lot of people get the odd bout of heartburn or reflux every now and again, and “this is normal”. It’s termed physiological reflux.
He pointed out that when changes are detected early, patients with Barrett’s can be entered into programmes where they are put under medical surveillance.
Keeping an eye on the condition
Under these programmes, they undergo an endoscopy every three to five years to monitor for any cancerous changes.
Prof O’Toole said that there may be an element of “overkill” in having everyone with the condition to have a scope, so it would be good to narrow down who would be most at risk of malignant cancer.
At the summer meeting, a number of free papers and research were presented that looked at the genetics of Barrett’s.
The experts were able to discuss whether genes may be useful in predicting patients who go on to experience malignant cancer with Barrett’s.
If work can be done in determining the patients with Barretts who are going to go on to eventually develop malignant cancer, this could mean targeting the screening at the at-risk group.
In the meantime, surveillance for all people with Barrett’s is still recommended.
Diagnosing patients
Some people who are diagnosed don’t have major symptoms of Barrett’s, but instead the condition is found when they have a scope for another reason.
“We are trying to better understand the genetics,” said Prof O’Toole, saying it may be helpful to look at disease modifying genes, and genes that show patients are predisposed to a more aggressive form of Barrett’s.
About 95% of patients with Barrett’s go on to die of unrelated causes.
Testing and treating Barrett’s
Currently, testing for Barrett’s involves a scope.
There is a new form of screening undergoing testing that sees the patient swallow a tablet on a string. Inside the tablet capsule is a small sponge.
After swallowing, the capsule dissolves and the sponge can be pulled back up, bringing with it some of the lining of the lower oesophagus.
This can then be analysed to make a diagnosis.
Treating cancer in Barrett’s patients also involves new technology. “If they go on to get early malignant changes or cancer, we now are capable of getting rid of that endoscopically,” said Prof O’Toole.
In the past, the treatment of early (‘non-invasive’) cancers in Barrett’s oesophagus was surgical removal of the oesophagus. These days we have minimally invasive procedures (endoscopic based) that can eradicate both pre-cancerous and early cancerous cells completely.
Weight and Barrett’s oesophagus
Weight plays a role in Barrett’s – as it does in many other physical conditions.
Reflux is common in Ireland, “especially in the Irish population where obesity is prevalent”, said Professor O’Toole. “There is a definite link between reflux and obesity.”
“We have a high degree of prevalence in our society of obesity or overweight,” he said. The national registry shows that 70 per cent of patients with Barrett’s are either overweight or obese.
Prof O’Toole encourages patients to get down to a normal body weight and make sure they eat quality fruit and fibre. He pointed out that vegetables and fruit have anti-oxidants, so help to introduce protective elements into people’s diets.
Patients are given treatments to suppress their acid production, whether they have symptoms or not.
People are encouraged to make lifestyle modifications alongside taking their medication, and avoid food and beverages that trigger acid production.
At the summer meeting, the gastroenterologists discussed the incidence of Barrett’s in America, and how incidence rates are in perfect correlation to obesity rates.
If you are concerned that you may have Barrett’s, you’re encouraged to speak to your GP.
People with chronic reflux who are on medication but have difficulty controlling their symptoms, and who have not had an endoscopy can speak to their GP about referral for specialist assessment.
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