TY - JOUR T1 - Heartburn, Barrett’s oesophagus and cancer: implications for primary care JF - British Journal of General Practice JO - Br J Gen Pract SP - 120 LP - 121 DO - 10.3399/bjgp14X677383 VL - 64 IS - 620 AU - Anthony Watson AU - John Galloway Y1 - 2014/03/01 UR - http://bjgp.org/content/64/620/120.abstract N2 - 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.Approximately 30% of the UK population experience regular heartburn.3 In 2010, the number of prescriptions for heartburn and/or dyspepsia totalled 58 million at a cost of £336 million.4 Some 5% of heartburn sufferers, or 1 million people, have Barrett’s oesophagus in whom the lifetime risk of OAC development is 7–12.5%. The risk is higher in white males, smokers, obesity, Rh– blood group, and those with Barrett’s segments >7 cm.5 OAC usually presents late and 5-year survival is only 5–10%. To compound these depressing statistics, the incidence of Barrett’s continues to increase and age at diagnosis is falling, 27% of the 12 000 patients registered with the UK National Barrett’s Oesophagus Registry (UKBOR) being diagnosed aged <55 years.Controversial issues in management of heartburn and its sequelae include endoscopy prior to long-term proton pump inhibitors (PPI) … ER -