Optimizing Patient Outcomes through Early Detection of Uncontrolled Acid Reflux after Endoscopic Therapy for Pre-Cancerous Lesions in the Setting of Barrett’s Esophagus

Principal Investigator: Sri Komanduri, MD

Barrett’s Esophagus (BE) occurs when damaging acid reflux causes the lining of the esophagus to change from normal to pre-cancerous tissue. Although BE can be effectively treated with acid-blocking medications, some patients with more advanced disease often require endoscopic therapy to remove the abnormal tissue. While many experience successful outcomes with this treatment option, some 5 to 25 percent will redevelop the disease; recurrence puts patients at increasing high risk for esophageal cancer or adenocarcinoma. With a five-year survival rate of about 20 percent, this deadly cancer has increased by a factor of more than seven in the past 40 years. Many risk factors contribute to BE, including gender, with men are at higher risk than women; chronic heartburn and acid reflux, especially before age 30; and smoking. Interesting, the disorder has developed with increasing frequency in non-smoking young men between the ages of 20 to 45.

Sri Komanduri, MD, Director of Interventional Endoscopy at Northwestern Medicine and his research team previously found that persistent acid reflux in patients who have undergone endoscopic therapy likely causes recurrent BE. Currently, these patients must undergo placement of an uncomfortable transnasal catheter over a 24-hour period to assess and measure persistent acid reflux. This testing helps gastroenterology specialists to determine the best treatment options: a combination of medications and endoscopic treatment or perhaps a referral for surgery. Due to costs and patient intolerance, though, this type of reflux testing has proven to be impractical.

Studies of patients without endoscopically-treated BE have suggested consistent changes in the lining of esophageal biopsy samples, which strongly indicate uncontrolled acid reflux. Extrapolating from this observation, Dr. Komanduri and colleagues hope to see if such changes occur in a different patient population:  individuals who have had endoscopic therapy for BE. Thanks to a grant from the Digestive Health Foundation, the investigators will study tissue samples already collected during routine surveillance endoscopies. They plan to look for tissue markers to indicate which BE patients, who have undergone endoscopic treatment for their disease, are at high risk of developing cancer.

Improving cancer detection in this way could allow for earlier intervention for this highly treatable but potentially fatal disease. The introduction of less-invasive reflux testing after endoscopic therapy for BE could significantly optimize outcomes and save many more lives. This novel method would allow patients and providers to make more informed decisions about treatment options and risk recurrence and limit the use of costly and unpleasant procedures that today deter many patients.

Skills

Posted on

June 23, 2017