Background

Incidence of the cancer type oesophageal adenocarcinoma (OAC) has increased 6-fold since the 1990s and carries a dismal prognosis. The UK has some of the worst outcomes from this disease in Europe. Clinical guidelines have focussed on minimising endoscopy referrals unless patients have "alarm symptoms" suggestive of cancer. Nevertheless, General Practice referral rates vary widely, and low endoscopy referral rates have been linked with poor outcomes from oesophageal cancer.

 

A major risk factor for this cancer is chronic heartburn caused by reflux. Three to six percent of individuals with reflux predominant symptoms may have the precursor lesion called Barrett's oesophagus, but only around 20% of patients with Barrett's are diagnosed. It is estimated that the burden of OAC could be reduced by up to 50% as a result of increasing the proportion of individuals with reflux symptoms who are investigated. This is a formidable task since heartburn symptoms affect between 5%-20% of the population and account for up to 10% of GP consultations. GPs therefore focus on controlling reflux symptoms with acid-suppressant medication, particularly proton pump inhibitor therapy (PPI). PPIs are highly effective but patients often continue taking them life-long and there are increasing concerns about long-term side effects including osteoporosis, pneumonia and recently allergy.

 

In 2008, the Chief Medical Officer, Sir Liam Donaldson, raised oesophageal cancer as a public health concern and identified an urgent need to develop a need for a safe, minimally invasive, affordable test applicable to the office setting to diagnose Barrett's oesophagus. We have developed a new minimally invasive test for patients with reflux that can be performed in the GP surgery. This test is called Cytosponge-TFF3 which has been tested in over 4,000 individuals across 3 continents with very promising results.