Q&A with Prof. Jacintha O’Sullivan

When Surveillance is a Good Thing: The Barrett’s Oesophagus Registry

Dr. Jacintha O’Sullivan is a Principal Investigator of the Barrett’s Oesophagus research program at the Trinity Centre for Health Sciences at St. James’s Hospital, Dublin. The national Barrett’s Registry founded and funded by OCF is critical to the program’s success. Here we talk to Jacintha about how your donations are helping save lives by allowing hospitals to monitor people who present risk factors associated with developing oesophageal cancer, like Barrett’s Oesophagus.

What is Barrett’s Oesophagus and how does it relate to oesophageal cancer?

Barrett’s Oesophagus occurs when the condition known as GERD (Gastro-Esophageal Reflux Disease) advances a stage. Persistent heartburn is the telltale symptom of GERD – heartburn is an irritation of the oesophagus (food pipe) caused when food and liquids leak back up into it from the stomach.

Barrett’s Oesophagus is a complication of GERD but importantly only about 10% of patients with GERD go on to develop Barrett’s Oesophagus. Over time, constant exposure of the oesophagus to stomach acid can cause the lining of your oesophagus to change and start to resemble stomach lining. When this happens your risk of developing oesophageal cancer can increase.

Does Barrett’s Oesophagus inevitably lead to oesophageal cancer?

No, being diagnosed with Barrett’s Oesophagus does not mean you will go on to develop oesophageal cancer. Even though less than 1% of Barrett’s patients develop oesophageal cancer it is crucial that we identify ‘at risk’ people in time and place them on surveillance programs so we can closely monitor their health.

How do you detect Barrett’s Oesophagus?

Barrett’s Oesophagus can only be detected by endoscopy so we rely on patients being referred for a hospital appointment by their GP. Of course, it is critical that the person goes to their GP in time; anyone who has been self-medicating against heartburn, nausea or chronic coughing for any length of time should really get it checked out professionally.

The endoscopy itself is a straightforward procedure that can be done within an hour under sedation. A doctor checks your oesophagus by using a camera on a thin, flexible tube that they insert through your mouth. Inflamed, Barrett’s tissue is clearly visible next to healthy tissue.

What happens when you find that a person has Barrett’s Oesophagus?

Unfortunately, we cannot turn back the clock and return the transformed cells back to their original state. Nor can we 100% prevent oesophageal cancer from developing in the future. But, thanks to the Barrett’s Registry funded by OCF, we can now record data from every Barrett’s patient on a national database and analyse this data to answer important clinical questions e.g. Has there been any increase in incidence levels? How are treatment options changing? Discovering that you are in a high-risk category can empower people to take steps to adjust their diet and lifestyle, thus improving their chances of keeping cancer at bay.

What is the National Barrett’s Oesophagus Registry & Biobank and how has it made a difference?

Before 2009 there was no central national register where we could input all clinical information for Barrett’s Oesophagus patients. We had no way of knowing how many patients there were, no insights into geographic or demographic incidence, no possibility of comparing patient progression rates in different parts of the country or identifying trends and patterns. Now, through funding from the OCF, we have developed a national registry database with information and biopsy samples from five major hospitals – and hopefully two more soon – that we can use to better understand Barrett’s Oesophagus.

Since 2009 OCF have invested €1.6,200.000 (over €1.6m) in the Barrett’s Registry allowing us to register and surveil over 6,500 Barrett’s Oesophagus patients. The Biobank has been hugely important for scientists involved in the Barrett’s program. Consenting patients have provided us with thousands of blood and tissue samples that we can use for research studies, to make scientific investigations into factors that may be driving cells to change and transform from Barrett’s Oesophagus to oesophageal cancer. The more we understand the science behind this process, the better our chances of developing new treatments.

Where does the National Barrett’s Oesophagus Registry go from here?

Five hospitals – St. James’s, Beaumont, St. Vincent’s and The Mater in Dublin and The Mercy in Cork – are currently able to register patients on the database and we’re hoping that we’ll be able to extend this network to include Galway and Limerick University Hospitals. Keeping the Registry going requires considerable funding every year – to cover the costs of data managers, administration staff, database maintenance and licensing fees – which is why it is so important that Lollipop Day continues to be a success.

This year is a particularly important one for everyone involved in the Barrett’s program. We are currently putting together our first National Publication, which will contain a comprehensive audit report of the Registry. Building the Registry from scratch to where it is today has been a labour of love, involving hard work and a lot of commitment from many people. It has been an important accomplishment and we are very grateful to OCF and their supporters for their continued backing.

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