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Heartburn, Barrett's oesophagus and cancer:

implications for primary care

Read full article from British Journal of General Practice, March 2014 >

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.

Read full article from British Journal of General Practice, March 2014 >

Peter Johnstone: A Son's Tribute

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