Research on Barrett’s Oesophagus and Gastrooesophageal Reflux Disease

1st September 2017

What research should we prioritise on Barrett’s Oesophagus and Gastroesophageal Reflux Disease?

Guts UK funds research, raises awareness and provides expert information on digestive disorders. As a charity we want to fund research that directly benefits people who are affected by these conditions, as well as their families and carers. The best way to understand the needs and priorities of people who suffer with digestive disorders is to ask them. Last year, in collaboration with other organisations, we did exactly that. We brought together patients and healthcare providers to identify their top ten priorities for research on Barrett’s Oesophagus, a disease that affects the gullet (oesophagus), as well as on its cause: acid reflux (also known as gastroesophageal reflux disease).

We chose these conditions because while for most people acid reflux is just a nuisance, for a small number of people it can lead to Barrett’s Oesophagus. In Barrett’s Oesophagus the cells that line the inside of the gullet, where it meets the stomach, become abnormal. This change makes them more likely to transform into cancer cells, which can lead to cancer of the gullet. This process is rare and most people with acid reflux are not at risk, but cancer of the gullet is one of the least survivable cancer types and kills almost 8,000 people each year in the UK, so it is essential that we understand the link better, who is at risk and what can be done about it. This is particularly important now because acid reflux, Barrett’s Oesophagus and cancer of the gullet are all becoming more common.

This is why in April 2016 Guts UK supported an extensive consultation with over 170 patients, health professionals and researchers to determine what are the main unknowns in gastroesophageal reflux disease (acid reflux) and Barrett’s Oesophagus, and hence understand what research needs to be prioritised. The list of top ten research priorities identified drew widespread interest among researchers and clinicians when they were showcased at the 2nd International Symposium on Oesophageal Cancer hosted by Cancer Research UK a year later, in April 2017. We are also very pleased that the top ten priorities have now been published in The Lancet Gastroenterology and Hepatology scientific journal, as this will ensure they reach an even wider audience.

You can access the journal paper from The Lancet Gastroenterology and Hepatology journal website (it is free to access but you will need to register with the journal). That webpage also has a podcast from study authors Dr James Britton and Dr Yeng Ang, discussing the research priorities. You can also read a summary of the paper’s main points and key findings, written by Dr Britton and Dr Ang.

You can learn more about Barrett’s Oesophagus and acid reflux on our website.

Knowing which research is a priority for patients, carers and health professionals strengthens our determination to support it. Guts UK is committed to raising further funds for new research grants into these identified Top Ten prioritised areas to prevent cancer of the oesophagus – Please donate here.

Research priority setting in Barrett’s Oesophagus and gastro-oesophageal reflux disease – Main points and key findings

• Research could be considered a well-established concept that aims to address important and relevant uncertainties. Who determines key research priorities is somewhat less clear. Why do some areas of research receive focus and funding, leaving others perhaps overlooked?
• Historically, researchers have not routinely engaged with the agendas of the research user (patients and healthcare staff). This misalignment of research priorities could potentially have serious deleterious consequences.
• The incidence of gastro-oesophageal reflux disease and Barrett’s oesophagus is increasing. Barrett’s oesophagus is the main precursor to oesophageal cancer, which has a poor prognosis. In view of the vast potential burden of these diseases on patients and health-care resources, there is a real need to define and focus research efforts.
• This priority setting exercise aimed to produce a list of the top ten uncertainties in the field that reflect the priorities of patients and health-care providers.
• We adopted the robust and transparent methodologies previously outlined by the James Lind Alliance. This approach brings patient and professional groups together on a level playing field. Firstly it involves an ideas gathering survey that, once distilled, generates a longlist of research uncertainties. These uncertainties were then prioritised via an interim ranking survey and a final workshop to achieve consensus agreement.
• The final top ten cover a range of issues, including a need for improved patient risk stratification, alternative diagnostic and surveillance tests, efficacy of a dedicated service for Barrett’s oesophagus, cost-effectiveness and appropriateness of current surveillance, advances in development of non-drug treatments for gastro-oesophageal reflux disease, safety of long-term drug treatment, and questions regarding the durability and role of different endoscopic therapies for dysplastic (precancerous) Barrett’s oesophagus.
• This is the first patient-centred assessment of priorities for researchers in this chronic disease setting. We hope that recognition and dissemination of these results will shape the future direction of research and translate into meaningful gains for patients.

Dr James Britton
Clinical Research Fellow in Gastroenterology, Wrightington, Wigan and Leigh NHS Trust
PhD Student at the University of Manchester

Prof. Yeng Ang

Consultant Gastroenterologist, Salford Royal NHS Foundation Trust
Honorary Reader, University of Manchester

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