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Title: Barrett's oesophagus and its progression to adenocarcinoma : a study of patient profile, diagnostic criteria and surveillance practice in the UK
Author: Ramus, James
ISNI:       0000 0004 2671 9283
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2008
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Background The incidence of oesophageal adenocarcinoma has increased dramatically over the last 30 years. It is thought to be the endpoint of progression of oesophageal mucosa through Barrett's columnar-lined oesophagus (CLO) to dysplasia a process induced by gastr oesophageal reflux. Various patient characteristics have been attributed to the development of the disease, although evidence for specific risk factors is limited. The diagnosis and surveillance of CLO are areas of controversy with published criteria and management protocols varying over time and between centres. This study aimed to establish some of the patient characteristics and risk factors for progression of Barrett's, and to examine diagnostic criteria and surveillance practice in the UK. Patients and methods 1282 patients registered with the UK Barrett's Oeosphagus Registry were studied. Data from medical records and endoscopic and histological examinations were entered onto an Access database and analysed. Principal Results Men were diagnosed with CLO at a significantly younger age than women and with a significantly higher frequency. Smoking was found to be a significant risk factor for development of severe dysplasia and cancer both in current and ex-smokers. Alcohol and associated Helicobacter Pylori infection did not significantly affect oesophageal disease severity. Diagnostic criteria for Barrett's varied significantly over time and between centres. Surveillance was performed commonly but variably throughout the U.K. Endoscopic intervals were consistent between those centres undertaking surveillance for all grades of disease except low-grade dysplasia. Shorter intervals for surveillance of low-grade dysplasia were significantly associated with an increased detection of cancer. There was a trend towards increased survival in patients who had cancer detected as part of a surveillance programme. Conclusions Specific risk factors for the development of dysplasia in CLO exist. Diagnostic criteria and surveillance practice vary and have implications on further management and outcome of the disease. Early detection of dysplasia in surveillance programmes may confer some survival benefit.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available