We hope that this section of our website will give you a summary of the research that is being carried out, and how this may affect outcomes in due course.
Professor Rebecca Fitzgerald at Cambridge and her team are working on Cytosponge, a ‘pill on a string’ that would enable nurses in GP surgeries to collect samples that would be analysed to diagnose Barrett’s Oesophagus, a precursor to oesophageal adenocarcinoma. In 2019 this was the subject of the BEST3 trial. Cytosponge might be introduced if the current trial is successful, and it passes NICE Guidance process (a process possibly taking 2-3 years).
Being developed by Professor George Hanna at Imperial College, a breath test would identify cells relative to oesophageal adenocarcinoma using volatile organic compounds. It is known that some dogs can smell cancer, and this project could potentially identify other cancers.
More recently, the breath test also being looked at by Rebecca Fitzgerald
Professor Laurence Lovat at University College Hospital, London, is conducting the SPIT study, examining saliva tests.
When combined with a questionnaire related to cancer risks, the saliva test can apparently predict cancer to a very significant level.
UK Barrett's Oesophagus Registry
The registry contains data on around 14,500 patients registered by gastroenterologists at 48 centres, and is the largest registry in the world for this condition.
The objective of the Registry is to identify groups of Barrett’s (BO) patients who are most likely to progress towards oesophageal adenocarcinoma (OAC). They have considered several different groups but identified men with Barrett’s who were blood group rhesus negative as being three times more likely than other groups to progress to cancer. There was a logical connection because of the distribution of nitric oxide, but more studies are needed to replicate the research. Other bodies may not have recorded blood groups. They are a very small group but a perfect example of a BO group at greater risk of OAC.
BO is being diagnosed at a younger age, possibly due to greater awareness by GPs.
A study using the government’s index of multi-deprivation from postcodes using an index from 1 to 6 where 6 was the most deprived. The second least deprived segment was most likely to get BO. In a separate study using occupation to get social class it was the Skilled Manual workers social class IIIM who were most at risk, possibly due to heavy and repetitive lifting and bending.
Mortality among people with Barrett’s was found to be greater than that of the general population, but only because of the effect of OAC oesophageal cancer. 20x as much mortality was being caused amongst the Barrett’s population from OAC. However, this had not been confirmed by all papers.
The Registry is unique; the most similar in the UK was one set up in Northern Ireland by the late Liam Murray, but it had not included blood groups.
In the US there has been a tendency to diagnose patients as having BO only when they had Intestinal Metaplasia (IM). UKBOR's research showed there was no statistical difference on progression to OAC between those with Barrett’s and IM and those just with Barrett’s at diagnosis.
Segmentation was well covered by the database, with 3cm being the criterion qualifying it as short segment. The shorter segments could give significant risk, but generally the longer the segment the higher the risk.
The biggest problem for the Registry is patient consent making it difficult to get data. Whereas patient consent for cancer research is on an 'opt in' basis, for pecursor conditions it is more difficult and expensive to achieve informed consent with limited clinic time.
Oelixir & OCCAMS
The Oelixir project comprises a number of cancer treatment centres collaborating to improve the biological understanding of oesphageal adenocarcinoma. After a series of negative Phase 2/3 trials, there is now more concentration on gaining genomic insights and using precision biology to explain why some oncological therapies worked and others did not for some patients. 23 OCCAMS centres are collaborating together. The projects within Oelixir are PREDICT, PROPER, RISE, CITADEL, ELEVATE and RISE.
"The OCCAMS (Oesophageal Cancer Clinical and Molecular Stratification) study is a network of clinical centres recruiting OAC patients for tissue collection. OAC patient data and tissue samples are used to attempt to identify clinical, demographic and molecular factors affecting disease progression"