This week, we’re shining a light on acid reflux, a condition that affects millions. From raising awareness of symptoms to sharing tips for managing it, we’re here to support patients, caregivers, and families every step of the way.

Stay tuned for informative posts and resources throughout the week! Let’s work together to spread awareness and empower those affected.

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Professor Grant Fullarton – OPA Trustee

Grant has taken up an advisory post with the Scottish Government as the Clinical Lead for General Surgery. Grant has managed to introduce the Cytosponge in NHS Scotland as a National Service. The Cytosponge, now known as EndoSign, is a new technique to screen Barrett’s oesophagus patients.

Grant is the former lead Oesophago-Gastric Consultant Surgeon in Glasgow Royal Infirmary with major interests in management of malignant and complex benign upper GI disease. Grant is a former Associate Professor of Clinical Surgery with extensive research interest in benign and malignant upper GI disease. His particular interest is in the field of Barrett’s oesophagus including its role in cancer development and treatment with Radiofrequency Ablation.

Scotland to become first country to offer widespread capsule sponge testing for the detection of oesophageal cancer and Barrett’s oesophagus

  • EndoSign® capsule sponge technology allows patients suffering from heartburn to get a quick and easy diagnosis of oesophageal cancer and Barrett’s oesophagus
  • Sponge capsule can also be used to risk stratify known Barrett’s cases allowing identification of serious pathology with significant reduction in endoscopy requirements 
  • Over 4,000 capsule sponge tests were performed during the pilot programme, increasing concerning test results found at endoscopy from under 10% to over 50% 

NHS Scotland through the CytoScot program  has introduced the national adoption of capsule sponge test technology across all 14 health boards. The test is currently available to patients in secondary care with known Barrett’s oesophagus or severe reflux where there is suspicion of Barrett’s or early cancer .  This will ensure the early diagnosis of oesophageal cancer and Barrett’s oesophagus is readily available to patients across Scotland.

The capsule sponge test takes less than ten minutes and can help ensure that oesophageal cancer and precancerous conditions are quickly detected and treated. It will vastly improve the availability of vital diagnostic services for patients suffering from chronic heartburn, which could be a sign of Barrett’s oesophagus, a condition that carries a high risk of developing oesophageal cancer. 

Patients swallow a capsule the size of a multivitamin pill containing a small sponge on a strong thread, which collects cell samples for analysis. The test reduces the need for invasive endoscopies which can often require a lengthy hospital visit and sedation, limiting access for certain patients. Patients have found the sponge test to be simple and more acceptable than endoscopy.

Capsule sponge testing has helped provide more targeted care for patients, cutting waiting times and boosting clinical capacity as demand for endoscopy is reduced and detection rates increase. In addition there are major health economic benefits with significant cost savings by moving to a capsule sponge diagnostic service.

Patients suffering from persistent heartburn, or indigestion should be aware that these could be symptoms of Barrett’s oesophagus, or even oesophageal cancer, and should speak with their GP about being referred for a capsule sponge test. 

Many patients currently have to travel long distances to receive an endoscopy, but the option of taking the capsule sponge test, which can be delivered in community settings closer to home, means that unnecessary travel can be avoided if Scotland chooses to offer the service in primary and community care.

In 2020, gastrointestinal health company Cyted and NHS Scotland launched a pilot programme with the goal of detecting oesophageal cancer at an earlier stage, reducing the demand for endoscopy services and improving patient access to vital diagnostic services. Approximately 4,000 tests were delivered during the four-year programme. As a result of the improvements to patient triage, 1 in 2 endoscopies now find concerning pathologies compared with 1 in 10 before, waiting times have been cut from nine to five months, with more early vs late stage abnormal cell changes being detected.

“It’s great to have the support of NHS Scotland, and we are excited to continue working closely to see how the technology can help further improve access to early cancer detection for patients,” said Dr Marcel Gehrung, CEO and Co-founder at Cyted. “This is the first national roll-out of many and we are scaling globally to realise the full potential of patient impact for our technology.”

Under the roll-out, approximately 5,000 tests are expected to be delivered per year for the first two years, which will then be increased to 8,000 per year. Scaling up the number of tests deployed will allow more patients to be tested, helping identify a greater number of patients at risk of developing oesophageal cancer. There are around 9,300 new oesophageal cancer cases in the UK every year. The key to saving lives is to detect cancer at an earlier stage of Barrett’s oesophagus before it becomes cancerous.

“The development of the capsule sponge test has been a major breakthrough in improving early diagnosis of pre and early oesophageal cancer in Scotland. It has prioritised patients care where a rapid diagnosis is critical. We hope that ultimately this will lead to improved survival in this  high mortality cancer “- Professor Grant Fullarton, Clinical Lead CytoScot NHS Scotland spokesperson.

“In February 2019, my dad, Rich, was diagnosed with Oesophageal cancer. At the time, Dad described it as a “bolt from the blue” and hearing the ‘C’ word (not that one…) felt huge. His main symptom had been hiccups. He’d been going to the doctors for about a year being given various pills and potions to try and get rid of his hiccups before his diagnosis.

Following his diagnosis, and thanks to our wonderful NHS, Dad went through years of chemotherapy, immunotherapy research drug trials, radiotherapy & a huge operation, which gave him a couple of impressive shark-bite style scars. He approached his diagnosis and treatment with a brave, positive mental attitude. He didn’t let it grind him down and he continued to say yes to every opportunity and new experience whilst he could.

We sadly lost Dad in December 2023. He did so well for so long and his positivity was incredible. He was the best Dad and I feel very lucky that we had him in our lives for the time that we did. We are now adjusting to our lives with a dad-shaped hole in it and we miss him beyond belief.

OPA are one of the fantastic charities that helped my Dad and for that, I am very grateful.

My best friend, Faye, and I decided to run the Bristol Half Marathon and thought it would be a good way to raise money for OPA. Together our friends and families managed to raise over £1300 and it was such a great day! We had a picture of my dad on our backs & the support from the crowds and fellow runners (not sure I can call myself that!) was incredible! It was 23° and absolutely sweltering but so worth it!!”

– Rosie Murrell

More images can be found on Rosie’s Gallery Page – https://oldsite.opa.org.uk/news/portfolio-item/rosie-murrell-bristol-half-marathon/

“My name is Ryan and I want to help raise as much money as I possibly can to help the OPA Cancer Charity.

The reason I’m passionate about it is my father was diagnosed with it 13 years ago and due to early diagnosis Mr Grant Fullarton, the consultant he was blessed to be assigned, was able to operate and save his life. He is still alive today thanks to the amazing work done by all supporting this noble cause.

It was a long dark road for my dad and our family and I appreciate other families aren’t so lucky. With more money the OPA can really make a difference to peoples lives.

The OPA does a lot of good work helping families of people who get this horrible killer disease.

Oesophageal is the fastest rising and most under funded cancer type, so lets do our bit to help the cause.

I’m running a charity golf tournament via my work, Aviva, with a raffle of prizes people have kindly  donated to the cause. Aviva will £ match monies raised!

Please, only if you have it, can you help us reach our target of £3k. We have stalled at £660. Your help would be appreciated and for an amazing cause.

The link to donate is below, and if you would like to;
* Donate a gift to be raffled (that would be very helpful)
* want to play in the golf day
Please email me at – ryan.mcgrory123@yahoo.com

Link to donate straight to the cause- Ryan’s fundraiser for OPA Cancer Charity

My Story of Stage 2 Oesophageal Cancer​

I was diagnosed with stage 2 inoperable oesophageal cancer in November 2020, just after the start of the second lockdown. On further investigation it emerged that there was a ‘bulky tumour’ in my oesophagus and wrapped around the pericardium of my heart. There was one affected lymph node which was contained within my chest cavity.

I have none of the risk factors associated with oesophageal cancer as I have always had a low BMI, have never smoked, hardly ever drunk alcohol, didn’t eat spicy food and had no evidence of acid reflux, indigestion, burping or any of the reported risk factors. The only possible symptom I had, prior to having difficulty swallowing, was a constant gnawing sensation with which I had presented to my GP in 2016, and been referred me for an endoscopy ( I have an excellent GP). I observed this scope as I was not sedated and could see nothing suspicious, not that I would necessarily know, but nor could the Doctor who did it. Retrospectively I wonder if there were some very early cell changes (pre- cancerous), that the current research into the use of the cystosponge may have picked up back then.

I have been a nurse for 45 years, and I do remember learning from my medical texbook as a student nurse, about gnawing being a symptom of gastric or duodenal ulcers, as they were referred to in those days. But I never hear that symptom mentioned in current literature so I do wonder what current thoughts would be about this. The only other risk factor that I could have had, and again is not frequently quoted in the literature, was that I tended to drink my fluids quite hot.  I was also shown to have a positive result for faecal occult bloods when I was screened for bowel cancer the year before. I was called for a colonoscopy and again there really was nothing to show on that investigation. I retrospectively wonder if this could have been from my oesophageal tumour, which when diagnosed a year later, was 8cm long in the mid- region of my oesophagus. I asked my Oncologist if this could be the case and she said she thought it was possible. My colleague believes I had had it for a long time, as I hadn’t looked well.

On diagnosis I set out on what was a challenging 3 months of active treatment, which I think was quite aggressive. I was eligible to enter the SCOPE 2 trial for which I had a raft in investigations (hampered a little by lockdown). Scope 2 is a first line trial that you may be eligible for from the start. You start with the standard chemo and before your next three weekly chemo have a further PET scan. You are then randomised into the standard chemo or an alternative, depending, I think, on certain factors such as the amount of reduction in the size of the tumour in those three weeks. I was randomised into an alternate chemo, but one that is already used, certainly at the Trust I was being treated at. As well as this you are randomised into the standard radiotherapy of 50 rads, or the experimental dose of 60 rads – I was randomised into the standard radiotherapy, which was to prove a ‘blessing’ given later treatment outcomes.

I was used to visiting patients who where having or had had chemo, so I think I was very well prepared for how unwell I would be. I am also very determined but maybe I was lucky to tolerate the treatment (just about although very poorly), and also had a naso-jejunal feeding tube which goes into the jejunam, beyond the stomach (NJ tube). This was my ‘life saver’ as I couldn’t eat for weeks. I made it through the full treatment, ending up in hospital only at the end with septicaemia and pancytopenia (very few blood cells), for which I was treated with strong IV antibiotics and a blood transfusion.  I was poorly and weak and had dealt with the treatment almost on my own, due to lockdown. I was very lucky to be able to organise a rota of just a few people who offered to drive me to the hospital for all the chemo and combined chemo and radiotherapy (the latter being for 5 weeks at the end with weekly chemo. I am eternally grateful to all those friends and other friends who have helped or supported during this difficult time (especially with lockdown).

After the treatment I still couldn’t swallow very much and kept being sick. I continued with the feed and NJ tube while it lasted. Initially my Oncologist thought it was inflammation of my oesophagus, but at my post treatment CT scan after 6 months, it was very evidently a stricture. I then spent the next year having further endoscopies under sedation and dilations (having to self-isolate for three days prior to them each time). I think I had at least ten in total. Whilst I was having these I developed severe back pain in the November of 2021, which revealed a spontaneous vertebral wedge fracture of the thoracic vertebra, behind the region of the tumour. Further pain resulted in a cascade of four more vertebral fractures which became evident when I had a Dexa scan (scan of my bones), which my GP had arranged speedily. I turned out to have pre-existing severe osteoporosis, probably due to anorexia nervosa (but never made myself sick), that I had for a number of years in my late teens/early 20’s at a time when this was not monitored.

So I have been on a bit of journey. I walked off my shift the day before that diagnostic endoscopy in November 2020. I didn’t believe it could be anything so serious, as that would have been making a fuss, but I have never returned to nursing as it just hasn’t been realistic with my back pain, stricture and vomiting and the fatigue I experience even now. I have now survived for 3 1/2 years and so far can’t find anyone else in my situation. I think I may be lucky, but it has meant really adjusting and adapting to a changed lifestyle, as I was so active before and worst of all nursing. But life serves you challenges and I was lucky to be able to survive the treatment and still get out and about and I walk each day now, albeit in a more limited way- especially with the fatigue.

There are several areas I wonder about and would like to raise awareness of, to try to help others going through what I have been through.  Why isn’t the gnawing sensation ever mentioned?  Would I ever have been presented for screening with the cystosponge, as I had no real recognised risk factors and could I have been diagnosed sooner?  Could the knowing sensation have been an indicator of oesophageal cancer? For breast cancer, patients have a Dexa scan to screen for osteoporosis due to the hormone involvement. Would this ever happen for oesophageal or certain other cancers where radiotherapy is quite strong and the patient has a history of an eating disorder? It may not have made a difference but I could I could maybe have started the treatment of Denusomab injections every six months for my oesteoporosis, sooner? Denusomab injections are used to slow and strengthen bones. I also think I was very lucky not to have been randomised into the higher dose of radiotherapy as the standard dose did enough damage.

I am most grateful to my Consultant and the Team at the  University Hospital of Coventry and my wonderful GP ( who was and is always ‘there for me’) – my care has been ‘second to none’, despite all the challenges of COVID.

A growing epidemic of preventable cancers will lead to 184,000 people in the UK being diagnosed with the disease this year and will cost the country more than £78bn, research reveals.

The cost of the cancer cases diagnosed in 2023 caused by smoking, drinking, obesity and sunburn leads to £40bn in lost productivity, costs the people affected £30bn and takes up £3.7bn of the NHS’s budget, the study found. Preventable cancers also cost families and carers £3.4bn and the social care system £1.3bn.

The stark findings sparked calls by doctors and public health campaigners for a crackdown on smoking, drinking and poor diet to reduce avoidable cancers because of the huge human toll they involve and their financial consequences.

Continue Reading…

This article is from the Guardian- 184,000 in UK to get preventable cancer diagnosis this year, study finds | Cancer | The Guardian

“As it was my 70th Birthday on 6th June and thank goodness I have my good health!!
I decided to organise a party to fund raise and support the charity close to my heart OPA.

My brother Brian served in the West Midlands police for 30yrs he was very fit and healthy at the age of 48, till he started showing the signs of this awful disease oesophageal cancer. We knew nothing about the systems of this disease which is one reason now why I want to help make people aware of the systems, its at times like this we need support for the patient and the families going through it.

We had a fantastic night in memory of Brian, I had over 30 raffle prizes and some amazing hand made items and paintings donated by our Sister Sally for the silent auction which that alone reached over £700, I made little goody boxes for every one containing cakes ,chocs, an OPA badge and of course a leaflet with what signs to look out for in this disease.

Music by DJ and entertainer Mark Tolliss and a personal friend sang 60s / 70s for us to dance to. In total the evening raised £4,000, for the OPA.  I am still over whelmed by the whole evening and generosity of people, it was so worth while organising it and a night to remember forever.

Mo xx”

More photos and videos can be found here- https://opa.org.uk/opa-gallery/

My name is Mike, I suppose I deserved my cancer!

After years of smoking, drinking alcohol to excess and bad diet choices I suffered with acid reflux and was diagnosed with a hiatus hernia in 1987 at a Bupa Hospital in Harpenden, but wasn’t told anything about what to do or what it could lead to.

Fast forward to around July 2017 when I had a medication review, by this time it was being controlled by tablets and Endoscopies. I was told I was overdue for an endoscopy which I thought was recent, turned out it was 6 years ago rather than every year that they suggested.

The following fortnight I made an appointment with the doctor for 3 things.

  • I had burnt my armpits using a new flavour of Right Guard deodorant.
  • I was getting bad night cramps
  • I had a strange feeling in my tummy which was a tummy ache, just strange and had been there for about 2 weeks.

Little did I know that that tin of Right Guard was to save my life!

I was given a cream for my armpits. Tablets for the night cramps and sent for an Endoscopy a week later.

I was sent a letter from the consultant asking me to attend an appointment at Bedford Hospital where they conducted the endoscopy on 4th October 2017 and I was told I had a cancer at the base of my oesophagus where it joined the stomach.

They had already had a video call meeting to discuss my case with Addenbrooks Hospital.

I left the appointment that I attended on my own and cried when I got in my car. I rang my wife who was at work and told her.

An appointment was made to try a laser endoscopy to burn it out but it wasn’t an option then to see one of only 6 surgeons in the country who could do key hole surgery to remove my oesophagus and stretch my stomach to replace it.

On January 30th 2018 (isn’t it funny that you remember the exact dates ) I had a 8.5 hour operation in which they also sewed up a hernia and took my appendix out while they were there.

The operation was a complete success and no need for chemotherapy or radiotherapy.

I was supposed to be in for 3 nights and come out with a feeding tube. Unfortunately, I complicated it by having a stroke on ICU the next day. It wiped out my right side completely, I woke up 12 days later, with a tracheotomy and not being able to move.

I was in hospital and rehab until 21st June 2018.

Here I am 6 years later, can eat well, can walk and use my right arm, still have right side weakness and only one step away from a face plant but a survivor.

I am a typical bloke who didn’t look after myself and left things too long, but well done for burning my armpits Right Guard!

^(A UHS nurse, Danielle Harding, and consultant general and oesophagogastric surgeon at UHS Fergus Noble. Danielle Harding, 30, is the first patient with gastro-oesophageal reflux disease to undergo the RefluxStop procedure at UHS (University Hospital Southampton/PA Wire)

The first patients in the UK have had a new device implanted to prevent severe acid reflux disease.

University Hospital Southampton (UHS) and Imperial College London have become the first NHS trusts in the country to install the device called the RefluxStop, with Southampton being the first to use robotic surgery for the procedure.

Known as gastro-oesophageal reflux disease (GORD), the condition occurs when contents from the stomach flow back into the oesophagus – the long tube that carries food from the throat to the stomach.

This can result in a range of symptoms including heartburn, regurgitation, difficulty swallowing, bloating, excessive salivation, coughing, nausea and a hoarse voice, as well as teeth and gum damage, nutritional problems, and sleep impairment.

It happens when the muscular valve – the lower oesophageal sphincter – at the bottom of the oesophagus becomes weakened because it has moved too close to the diaphragm or even into the chest which affects its function to allow food in and stop acid leaking out.”

This article is from the Independent, to continue reading click here – First patients in UK receive revolutionary device to stop acid reflux and heartburn | The Independent

If you would like more information on RefluxStop, check out our leaflet here- RefluxStop Leaflet – The OPA

“Findings from the phase 3 ESOPEC trial demonstrate an overall survival advantage with a perioperative chemotherapy regimen known as FLOT compared with a neoadjuvant chemoradiation approach, called CROSS, in patients with resectable, locally advanced esophageal adenocarcinoma.

The study results, presented as a late-breaking abstract at the American Society of Clinical Oncology (ASCO) annual conference, help settle a long-standing debate about whether chemotherapy with FLOT — 5-florouracil, leucovorin, oxaliplatin, and docetaxel — before and after surgery, or neoadjuvant radiation plus CROSS — carboplatin and paclitaxel — followed by surgery is the best approach.

There has been “considerable disagreement as to whether giving all adjuvant therapy upfront versus ‘sandwich’ adjuvant therapy before and after surgery is the better standard of care for locally advanced resectable esophageal cancer,” Jennifer Tseng, MD, of Boston Medical Center, Boston, said in an ASCO press release. This randomized clinical trial shows the sandwich approach “provides better outcomes.”

The practice-changing ESOPEC findings will have an important effect on the management of patients with resectable esophageal adenocarcinoma and gastroesophageal junction adenocarcinoma, but local and distant failures remain a challenge in this population, explained invited discussant Karyn A. Goodman, MD.

Advances since the initiation of ESOPEC — such as immunotherapy options and personalized strategies — suggest the esophageal adenocarcinoma story is still evolving, said Goodman, professor and vice-chair of research and quality in the Department of Radiation Oncology at Icahn School of Medicine at Mount Sinai, New York City.

The ESOPEC trial

Both the FLOT and CROSS regimens are established standards of care in resectable esophageal adenocarcinoma, and the choice of treatment has largely varied based on geographical location.

The current randomized, prospective, open-label ESOPEC trial, however, demonstrated that FLOT can prolong overall survival, first author Jens Hoeppner, MD, from the University of Bielefeld in Detmold, Germany, reported.

Overall, 438 patients with locally advanced, resectable esophageal adenocarcinoma recruited between February 2016 and April 2020 from 25 sites in Germany and randomized to either FLOT (n = 221) or CROSS (n = 217). The median age was 63 years, and most (89.3%) were men. Patients were followed until November 2023, and median follow-up was 55 months.

Patients in the FLOT arm received four cycles — one every 2 weeks for 8 weeks —followed by surgery 4-6 weeks later. FLOT cycles were reinitiated 4-6 weeks after surgery and given every 2 weeks for 8 weeks.

Those in the CROSS arm received one cycle per week of radiation therapy for 5 weeks plus carboplatin and paclitaxel followed by surgery 4-6 weeks after the last cycle.

Overall, 86% received both neoadjuvant therapy and surgery in the FLOT arm vs 82.9% in the CROSS group. Among these patients, 16.8% in the FLOT group achieved a pathological complete remission vs 10.0% in the CROSS arm.

In the intention-to-treat population, median overall survival was almost twice as long in the FLOT group — 66 months vs 37 months. At 3 years, those who received FLOT had a 30% lower risk of dying (hazard ratio [HR], 0.70), with 57.4% patients alive at that point compared with 50.7% patients in the CROSS arm.

The 5-year overall survival was 50.6% in the FLOT group vs 38.7% in the CROSS group.

Patients receiving FLOT also demonstrated improved progression-free survival (PFS), with a median PFS of 38 months vs 16 months. The 3-year PFS was 51.6% with FLOT vs 35.0% with CROSS (HR, 0.66). The exploratory subgroup analyses for sex, age, ECOG status, and clinical T and N stages also favored FLOT.

The 30-day postoperative mortality was 1.0% in the FLOT group and 1.7% in the CROSS group, and the 90-day postoperative mortality rate was 3.2% and 5.6%, respectively.

Based on these findings, perioperative chemotherapy with FLOT should be preferred over neoadjuvant chemoradiation with CROSS, Hoeppner concluded.

Goodman agreed, noting that, in the wake of ESOPEC, FLOT will likely be adopted as a more standard approach in the United States for patients who are fit. And, for patients who are not candidates for FLOT, CROSS is a reasonable option, she said.

But, she asked, does it really have to be an either/or situation?

Multiple studies, including Goodman’s 2021 Alliance/CALGB 80803 study, have demonstrated promising outcomes with combined modalities and adapting therapy based on treatment response. Several trials, for instance, are evaluating combining FLOT and CROSS, with some showing the approach is feasible and comes with manageable toxicity.

It’s also important to look outside of FLOT and CROSS. During ESOPEC, new approaches entered the treatment landscape, including the use of adjuvant immunotherapy following neoadjuvant chemoradiation and surgery for noncomplete response.

Take the CheckMate 577 study, which found that adjuvant nivolumab immunotherapy after preoperative CROSS and surgery significantly reduced metastatic recurrence and doubled disease-free survival in patients who did not achieve a complete response. This approach is now a standard of care for those patients.

FLOT plus neoadjuvant nivolumab may also be a viable option, Goodman noted, but we haven’t yet seen “any benefit in survival with the combo of chemotherapy and immunotherapy for resectable esophago-gastric cancer.”

Further studies are needed to evaluate the synergy of immunotherapy and radiotherapy. The next chapter of the esophageal adenocarcinoma story may feature a “best-of-both-worlds” approach that combines induction chemotherapy, followed by personalized chemoradiation, surgery, and potentially adjuvant immunotherapy, Goodman explained.

While the ESOPEC findings are impressive, the 5-year overall survival of only 50% is still suboptimal, she noted. “Given the poor prognosis with this disease, we need to continue to develop clinical trials to identify better targets, novel treatment combinations, and select patients that will respond best to specific treatment.”

ESOPEC was funded by the Deutsche Forschungsgemeinschaft (German Research Foundation). Hoeppner reported receiving travel, accommodations, and expenses from Intuitive Surgical. Goodman reported a relationship with the national Cancer Institute and consulting or advisory roles for Novartis, Philips healthcare, RenovoRX, and Roche/Genentech.”

 

This article is from: Medscape Registration