Research priority setting in Barrett's oesophagus and gastro-oesophageal reflux disease

Abstract

The incidence of gastro-oesophageal reflux disease and Barrett's oesophagus is increasing. Barrett's oesophagus is the main precursor to oesophageal adenocarcinoma, which has a poor prognosis. In view of the vast potential burden of these diseases on patients and health-care resources, there is a real need to define and focus research efforts. This priority setting exercise aimed to produce a list of the top ten uncertainties in the field that reflect the priorities of patients and health-care providers. We adopted the robust and transparent methodologies previously outlined by the James Lind Alliance. This qualitative approach firstly involves an ideas gathering survey that, once distilled, generates a longlist of research uncertainties. These uncertainties are then prioritised via an interim ranking survey and a final workshop to achieve consensus agreement. The initial 629 uncertainties, generated from a survey of 170 individual respondents (47% professional, 53% non-professional) and one workshop, were narrowed down to the final top ten uncertainties of priority for future research. These priorities covered a range of issues, including a need for improved patient risk stratification, alternative diagnostic and surveillance tests, efficacy of a dedicated service for Barrett's oesophagus, cost-effectiveness and appropriateness of current surveillance, advances in development of non-drug treatments for gastro-oesophageal reflux disease, safety of long-term drug treatment, and questions regarding the durability and role of different endoscopic therapies for dysplastic Barrett's oesophagus. This is the first patient-centred assessment of priorities for researchers in this chronic disease setting. We hope that recognition and dissemination of these results will shape the future direction of research and translate into meaningful gains for patients.

Dedicated service improves the accuracy of Barrett’s oesophagus surveillance: a prospective comparative cohort study

“…Indeed, this area was ranked number 4 in the top 10 research priorities for future BO and gastro-oesophageal reflux disease research in a recent UK-wide exercise which engaged both patients and healthcare providers 20. The latest British Society of Gastroenterology (BSG) guidelines provided clearer diagnostic criteria, defined surveillance intervals and a minimum endoscopic dataset for reporting 15.…”

Gastroesophageal reflux disease and Barrett’s oesophagus: an overview of evidence-based guidelines

“…Moreover, it should be performed with high -resolution endoscopy by an experienced physician (89% agreement), this was supported by a recent research priority setting exercise, in which clinicians and patients voted assessing the effectiveness of a dedicated Barrett eosphagus service as fourth out of the top 10 key research priorities. 78 Allowing patients to have a clear understanding of the actual risk and the benefits and risks of BE surveillance empowers them to engage or disengage. Some of the risk factors described above can help a clinician explain an individual's risk of progression with more accuracy, but the reality of a regular endoscopy should be clearly explained, and a clinician needs to be wary of their ability to bias a patient's decision to engage or not.…”

Assessment of Gastro-Oesophageal Reflux Disease Symptoms in Type 2 Diabetic Patients

“…Other less common symptoms are chest pain, cough, laryngitis, dysphagia, sensation of lump in the throat, nausea, vomiting, bloating, early satiety, loss of appetite, weight loss. 6 The primary mechanism against GERD is Lower esophageal sphincter (LES). Anti-reflux mechanism include flap valve is formed by the oblique angle at which the esophagus enters into and integrates with the stomach.…”