Heartburn, Barrett's oesophagus and cancer:
implications for primary care
The incidence of oesophageal adenocarcinoma (OAC) has increased eightfold in the past three decades to become the sixth most common cancer in the UK. Before the 1970s, 90% of oesophageal cancers were squamous but now 70% are adenocarcinomas. The reason for this major epidemiological shift is an increase in gastro-oesophageal reflux disease (GORD) and its principal complication, Barrett’s oesophagus, the only known precursor lesion for OAC.1 Barrett’s oesophagus, described in 1950 by thoracic surgeon Norman Barrett, is a replacement of normal squamous epithelium by a metaplastic columnar epithelium in the distal oesophagus consequent on chronic GORD. A landmark Swedish study quantified the link between heartburn and OAC, finding an odds ratio (OR) for OAC development of 8 in patients suffering heartburn once weekly, OR = 11 in those with the more damaging nocturnal reflux, and OR = 44 in those with severe, long standing heartburn.2 Therefore, heartburn, previously regarded as a trivial symptom, has a strong association with OAC development.