Research

UK Barrett's Oesophagus Registry

Professor A Watson, co-founder and Executive Director, writes:

The UK National Barrett’s Registry (UKBOR) is a database which contains information on many thousands of patients with Barrett’s Oesophagus, registered by Gastroenterologists throughout the UK. The Registry was established in 1996 as a joint initiative of the Oesophageal Section of the British Society of Gastroenterology and the European Cancer Prevention Organisation. The stimulus for this was the rapidly increasing incidence of adenocarcinoma (AC) of the oesophagus, now ten times more common than it was 30 years ago. Whilst Barrett’s Oesophagus is the predominant precursor lesion, only a small proportion of Barrett’s patients (less than 10%) will develop AC and aim the of UKBOR was to facilitate studies on the characteristics of patients with Barrett’s, the natural history of the condition, which patients are at greatest risk of AC development and therefore need closest follow up and the effect of various treatments for Barrett’s including pharmacological, endoscopic and surgical treatments. Because it is difficult for individual groups of researchers to conduct these studies due to the small numbers of Barrett’s patients seen in individual centres, it was felt that the way forward was that followed in the case of other relatively uncommon yet important conditions of establishing a national database of cases registered by motivated Gastroenterologists.

UKBOR is under the auspices of the University Department of Surgery at the Royal Free Hospital, London. It is staffed by a part time Registrar with an epidemiological background (Dr CPJ Caygill) and is overseen by an Executive Director (Prof A Watson). UKBOR has no dedicated funding, being maintained in the early days by monies raised by the Medical Directors and more recently by the Barrett’s Oesophagus Foundation (renamed Barrett’s Oesophagus Campaign in 2009), which was established in 1999 with the objectives of supporting UKBOR, establishing patient support groups and services and funding research. The Foundation has raised over £50,000 from grant awarding bodies who have stipulated that these grants are specifically to support UKBOR and these monies have been ring-fenced within the Foundation’s accounts. A series of research grants has augmented this core funding and facilitated the employment of research fellows to increase the research output from UKBOR.

Currently, the UKBOR database contains information on over 12,500 Barrett’s patients, registered by gastroenterologists from 46 UK centres. More detailed information on patient characteristics, results of investigations , follow up and treatment employed has been obtained in more than 3,000 of these by Registry staff and research fellows visiting individual centres and abstracting and databasing detailed information from patients’ medical records. This considerable achievement is despite a temporary embargo on registrations in 2004 due to the Patient Information Advisory Group (PIAG) declining exemption from Section 60 of the Health and Social Care Act, which meant that patient consent had to be obtained in order to register patients with UKBOR.

Registrations were resumed in 2005 with consented patients, although at a reduced level because of the extra workload on Gastroenterologists in obtaining consent. However, despite these constraints, at a workshop convened in Venice in 2007 for European Barrett’s Registries, it emerged that UKBOR was the largest and most advanced of the 9 European Registries. It is also larger than any of the 4 USA Regional Registries, making it the largest Barrett’s Registry in the world. UKBOR is in the process of applying for exemption from Section 251 of the Health and Social Care Act (2006) which will hopefully reverse the PIAG decision.

UKBOR has been enormously successful and has achieved an international reputation by virtue of the 34 studies it has performed, resulting in 49 presentations at national and international conferences and 32 publications in international peer reviewed journals (see publication list). Several of its presentations at international conferences have been awarded distinctions, depicting the fact that these studies have been ranked in the top 10% submitted from around the world. Our two Research Fellows, Piers Gatenby and James Ramus have each been awarded MD degrees by the University of London based on their research work in UKBOR performed under the supervision of Prof A Watson and Prof MC Winslet and have since then attained consultant status. Although the initial studies fulfilled our original intention of being epidemiological and relating to demographics of Barrett’s patients, we recognised with the intervention of PIAG that complete UK coverage was unlikely without significant additional funding and that UKBOR represented the largest published cohort of Barrett’s patients in the world. This conferred scientific and statistical credibility on its subsequent studies related principally to natural history of Barrett’s and risk factors for AC development, a fact confirmed by the large numbers of publications and presentations.

In attempting to summarise the most noteworthy achievements of UKBOR, two studies presented at the International society for Diseases of the Oesophagus and the World Congress of Gastroenterology and subsequently published in international journals are worthy of mention. The first showed for the first time that the risk of AC development in so-called “short segment” Barrett’s was similar to that in conventional longer segment disease. The importance of this was that both in UK and USA it was believed on the basis of small series that short segment Barrett’s conferred minimal AC risk and therefore surveillance of such patients was unnecessary. The second study related to a histological abnormality seen in many Barrett’s patients called Intestinal Metaplasia (IM). In USA and many parts of Europe it is believed that only patients showing IM are at risk of AC development and should undergo surveillance. The UKBOR study, on account of its large numbers, was able to demonstrate firstly that 34% of Barrett’s patients do not demonstrate IM at diagnosis and secondly, that the risk of AC development is similar whether or not IM is demonstrated at diagnosis. Both of these studies have influenced patient management in the UK in recommending that patients with short segment Barrett’s and those without IM should be enrolled in surveillance programmes where these are practised.

As a result of this latter study, contact was made from Harvard University, USA firstly to congratulate UKBOR on publication of this study and secondly to seek the collaboration of UKBOR in a joint study with Harvard. Harvard have developed a technique called image cytometry, which detects DNA abnormalities in archived histological material from Barrett’s patients. They have made two important discoveries using this technique. The first is that it has been shown in a small series to predict very accurately which Barrett’s patients are at risk of AC development. Importantly, this prediction occurs very shortly after diagnosis of Barrett’s, at a time when AC can be prevented. The second, again in a small series, is that Barrett’s patients, with and without IM, have a similar proportion of DNA abnormalities and that it is these, rather than the presence of IM, which determines AC development. It is believed that with UKBOR’s unique resource of information on a very large number of Barrett’s patients and access to histological material on a significant number of patients who have progressed to AC, both of these hypotheses can be evaluated on a sound scientific and statistically valid footing. Protocols for these studies have been produced, NREC approval obtained and funding is being sought.

More recently, UKBOR has been invited to collaborate in three further studies, one with Prof Stephen Meltzer of Johns Hopkins University to study methylation markers in the process of malignant progression in Barrett’s one with with Prof Andrew Hart of the University of East Anglia to study the influence of statins on cancer incidence in Barrett’s patients and the third with the Wellcome Trust Centre for Human Genetics to study genetic influences on Barrett's oesophagus and oesophageal adenocarcinoma.

In conclusion, UKBOR has a strong record of achievement despite its modest funding and staffing levels. It comprises a precious resource which is recognised internationally and is poised, with the Harvard and other proposed studies, to continue its achievement well into the future. With appropriate funding and staffing, it is capable of achieving much more.

Professor A Watson

Co-founder and Director of UKBOR 2000-2007.Executive Director 2010-present

Co-founder and Chairman of BOF 1999-2007

Vice-President of BOUK

Publications

PAPERS

Published:

1. Caygill CPJ, Reed PI, McIntyre A, Hill MJ (1998). The UK National Barrett's Oesophagus Registry: A Study Between Two Centres. Eur J. Cancer Prev; 7: 161-164.

2. Caygill CPJ, Reed PI, Johnston BJ, Hill MJ, Ali M, Levi S (1999). A single centre's 20 years' experience of columnar-lined (Barrett's) oesophagus diagnosis. Eur J Gastroent and Hep 11: 1355 - 1358.

3. Caygill CPJ, Reed PI, Hill MJ, Watson A (1999) An initial comparison of nine centres registering patients with the UK National Barrett’s Oesophagus Registry (UKBOR). Eur J. Cancer Prev; 8: 539-542.

4. Caygill CPJ, Johnston DA, Lopez M, Johnston BJ, Watson A, Reed PI, Hill MJ. (2002). Lifestyle Factors and Barrett’s Oesophagus. Amer J Gastroenterology97: 1328-1331.

5. Caygill CPJ, Watson A, Reed PI, Hill MJ (on behalf of the UK National Barrett’s Oesophagus Registry (UKBOR) and the twenty seven participating centres)* (2003). Characteristics and Regional Variations of Patients with Barrett’s oesophagus in the UK. Eur J Gastro Hep 15: 1217-1222.

6. Van Blankenstein M, Looman CWN, Johnston BJ, Caygill CPJ (2005). Age and sex distribution of the prevalence of Barrett’s Esophagus found in a primary referral endoscopy center. Amer J Gastroenterology 100: 568-576.

7. Ramus JR, Gatenby PAC, Caygill CPJ, Watson A (2007) Helicobacter Pylori infection and severity of reflux-induced oesophageal disease in a cohort of patients with Columnar-Lined Oesophagus Dig Dis Sci 52: 2821-2825 .

8. Gatenby PAC, Caygill CPJ, Ramus J R, Charlett A, Watson A (2007) Short Segment Columnar-Lined Oesophagus (CLO) - an underestimated cancer risk? A large cohort study of the relationship between Barrett's CLO segment length and adenocarcinoma risk. Eur J Gastro Hep 19: 969-975.

9. Gatenby PAC, Ramus JR, Caygill CPJ, Watson A (2007). Does the length of columnar-lined esophagus change with time? Dis Oesophagus 20: 497-503.

10. Ramus JR, Caygill CPJ, Gatenby PAC, Watson A (2008) Current UK practice in the diagnosis and management of columnar-lined oesophagus; results of the UK National Barrett's Oesophagus Registry (UKBOR) endoscopist questionnaire. Eur J Cancer Prev 17: 422-425.

11. Gatenby PAC, Caygill CPJ, Ramus J R, Charlett A, Watson A (2008). "Barrett's Columnar-Lined Esophagus: Demographic and Lifestyle Associations and Adenocarcinoma Risk" Digestive Diseases and Sciences 53: 1175-85.

12. Gatenby PAC, Ramus JR, Caygill CPJ, Shepherd NA, Watson A (2008).

The Relevance of the Detection of Intestinal Metaplasia in Non-Dysplastic Columnar-Lined Oesophagus. Scand J Gastro 43: 524-530

13. Gatenby PAC, Ramus JR, Caygill CPJ, Charlett A, Winslet MC, Watson A (2009). Treatment modality and risk of development of dysplasia and adenocarcinoma in columnar-lined esophagus. Dis Oesophagus 22: 133-42

14. Ramus JR, Gatenby PAC, Caygill CPJ, Winslet MC, Watson A (2009) Surveillance of Barrett's columnar-lined oesophagus in the UK: endoscopic intervals and frequency of detection of dysplasia. Eur J Gastro Hep 21: 636-641.

15. Wall CM, Charlett A, Caygill CPJ, Gatenby PAC, Ramus JR, Winslet M, Watson A. (2009) Are Newly Diagnosed Columnar-lined Oesophagus(CLO) Patients Getting Younger? Eur J Gastro Hep 21: 1127-113.

16. Gatenby PAC, Ramus JR, Caygill CPJ, Charlett A, Winslet MC, Watson A (2009). The Influence of Symptom Type and Duration on the Fate of the Metaplastic Columnar-Lined Oesophagus. Aliment Pharmacol Ther 29: 1096-1105.

17. Gatenby PAC, Ramus JR, Caygill CPJ, Shepherd NA, Winslet MC, Watson A (2009). Routinely diagnosed low grade dysplasia in Barrett's oesphagus: A population-based study of natural history. Histopathology 54:814-9

18. Gatenby PAC, Ramus JR, Caygill CPJ, Winslet MC, Watson A (2009). Aspirin is not chemoprotective for Barrett's adenocarcinoma of the oesophagus in a multicentre cohort. Eur J Cancer Prev 18:381-384

19. Gatenby P, Hainsworth A, Caygill C, Watson A, Winslet M (2011) Projections for oesophageal cancer incidence in England to 2033. Eur J Cancer Prev 20(4): 283-286.

20. Caygill CPJ, Royston C, Charlett A, Wall CM, Gatenby PAC, Ramus JR, Watson A, Winslet M, Hourigan CS, BardhanKD (2011). Barrett's, blood groups and progression to oesophageal cancer: Is nitric oxide the link? Eur J Gastro Hep 23: 801-806.

21. Ramus JR, Gatenby PAC, Caygill CPJ, Watson A, Winslet M The relationship between smoking and dysplastic disease in patients with columnarised oesophagus (CLO). Eur J Cancer Prev 2012; 21: 507-510.

22. Caygill CPJ, Royston C, Charlett A, Wall CM, Gatenby PAC,RamusJR, Watson A, M. Winslet M, Bardhan KD (2012) Mortality in Barrett's Oesophagus: Three decades of experience in a single centre. Endoscopy 44: 892-898

23. Gatenby P, Caygill CP, Wall C, Bhatacharjee S, Ramus J, , Watson A, Winslet M. (2014). Lifetime risk of esophageal adenocarcinoma in patients with Barrett's esophagus (columnar-lined esophagus) World Journalof Gastroenterology 20: 9611-9617.

MD THESES

1. Gatenby PAC (2008). The Natural History of Columnar-Lined Oesophagus, University of London.

2. Ramus JR (2008). Barrett's oesophagus and its progression to

adenocarcinoma: A study of patient profile. University of London.

LETTERS

1. Caygill CPJ (1999). Treating upper digestive track cancers as a single entity may be misleading. British Medical Journal (BMJ) 318, 1289-90.

2. Caygill CPJ, Watson A (2006) The association of body mass index with Barrett's oesphagus. Alimt Pharmacol Ther 23, 1027-1028.

3. Caygill CPJ, Royston C, Charlett A, Wall CM, Gatenby PAC, Ramus JR, Watson A, Winslet M, Bardhan KD (2013). Mortality in Barrett's Oesophagus: Three decades of experience in a single centre – Reply to Schoppman et al. Endoscopy 45: 153Reply

INVITED PAPERS

1. Caygill CPJ, Reed PI, Watson A, Hill MJ. (2000). The UK National Barrett's Oesophagus Registry (UKBOR): aims and progress. Eur J Cancer Prev. 10: 97-99.

2. Caygill CPJ (2001). Barrett's Oesophagus and Oesophageal Adenocarcinoma: the Epidemiological Evidence. Acta Endoscopica 31, 485-490.

3. Caygill C PJ, Gatenby PAC, Watson A (2011). Should a decision of surveillance be based upon the presence of an intestinal metaplasia at endoscopy, also taking into consideration potential sampling errors? In Barrett's Esophagus: surveillance and reversal. Caygill C PJ, Dvorak K, Triadafilopolous G, Felix VN, Horwhat JD, Hwang JH, Upton MP, L X, Nandurkar S, Gerson LB, Falk GW. Ann NY Acad Sci, 1232 Issue Barrett's Esophagus; pp 197-198. Publishers New York Academy of Sciences.

4. Gatenby PAC, Caygill CPJ, Watson A (2011). Do Barrett's registries have a role to play in research? In Barrett's esophagus registries. Gatenby PAC, Caygill CPJ, Watson A, Murray L, Romero Y. Ann NY Acad Sci, 1232 Issue Barrett's Esophagus; pp 406-407. Publishers New York Academy of Sciences.

5. Romero Y, Caygill CPJ (2011). Barrett's registries: what are the demographic, lifestyle, and diagnostic differences between the United States and Europe, and can these be overcome for future collaborative studies? In Barrett's esophagus registries. Gatenby PAC, Caygill CPJ, Watson A, Murray L, Romero Y. Ann NY Acad Sci, 1232 Issue Barrett's Esophagus; pp 408-410. Publishers New York Academy of Sciences.

6. Caygill CPJ, Watson A, Reed PI . Barrett's oesophagus: raising awareness in heartburn sufferers. Trends in Urology & Mens Health, 2012; 3: 22-24.

7. Caygill CPJ, Gatenby PAC, Herceg Z, Lima SCS, Pinto LFR, Watson A, Wu MS (2014) 'How does the UK Barrett's Registry (UKBOR) operate?' In comparative genomic analysis of esophageal cancers NY Acad Sci, 1325: p74

8. Watson A, Galloway J.Heartburn, Barrett's oesophagus and cancer: Brit J Gen Practice, 2014; 64: 120-121.

9. Caygill CPJ, Gatenby PAC, (2014). Radiofrequency ablation of Barrett's oesophagus with confirmed low-grade dysplasia reduces risk of development of high-grade dysplasia and adecocarcinoma. Evidence-based Medicine doi: 10. 1136/ebmed-2014-110019

INVITED REVIEWS

1. Reed PI, Caygill CPJ, Watson A (2003). The United Kingdom Barrett's Oesophagus Registry (UKBOR) - the first six years. Gastroenterologia Polska10: 299-304.

2. Caygill CPJ, Watson A, Lao-Sirieix P, (2004). Barrett’s Oesophagus and Adenocarcinoma. World Journal of Surgical Oncology 2: 12. (Web publication)www.wjso.com/content/2/1/12.

REPORTS

1. Caygill CPJ, Zaninotto G, Rugge M (2008) Barrett’s Registries in Europe: Report of an International Workshop. Eur J Cancer Prev.17: 426- 429.

ABSTRACTS AND POSTERS

Published:

1. Caygill CPJ, Reed PI, Hill MJ, Watson A (1997). The UK National Barrett’s Oesophagus Registry. Gut 40 (suppl.1): A35.

2. Caygill CPJ, Reed PI, Johnston, BJ, Hill MJ, Levi S (1997). A Study of Barrett’s Oesophagus Registrations From a Single Centre Over a 20 Year Period. Gut 41 (suppl.3): E43.

3. Caygill CPJ, Reed PI, Watson A, McIntyre A, Hill MJ (1998). The First Year of the UK National Barrett’s Esophagus Registry. Gastroenterology 114, A87

4. Reed PI, Caygill CPJ, Hill MJ, Watson A (1998). The UK National Barrett’s Oesophagus Registry (UKBOR): The first Two Years. Eur. J. Surgical Oncology24, 457.

5. Caygill CPJ, Reed PI, Hill MJ (1998).UK National Barrett’s Oesophagus Registry: A Comparison of Nine Centres. Digestion 59 (suppl. 3):580.

6. Watson A, Reed PI, Caygill CPJ, Epstein O, Winslett MC, Pounder RE (1999). Changing incidence of columnar-lined (Barrett’s) oesophagus (CLO) in the UK. Gut 44, Suppl. 1, A45

7. Caygill CPJ, Reed PI, Johnston BJ, Hill MJ, Deru K, Watson A, Levi S (1998) UK National Barrett’s Oesophagus Registry: role of obesity, tobacco and alcohol in Barrett’s oesophagus. Eur. J. Cancer Prev. 7, 481

8. Watson A, Reed PI, Caygill CPJ, Epstein O, Winslett MC, Pounder RE (1999). Changing incidence of columnar-lined (Barrett’s) oesophagus (CLO) in the UK. Gastroenterology 116, Suppl 2, A351.

9. Caygill CPJ, Jankowski J, Ali M, Reed PI, Hill MJ (1999). Expression of Bile Acid Receptors: A preliminary report. Eur. J. Cancer Prev.8, 354.

10. Caygill CPJ, Reed PI, Hill MJ, Watson A (1999). The UK National Barrett’s Oesophagus Registry: a Progress Report.. Eur. J. Cancer Prev. 8, 354

11. Caygill CPJ, Reed PI, Johnston DA, Lopez M, Hill MJ (1999) Obesity and Barrett’s oesophagus in a UK Population. 1999. Gut. 45, A81.

12. Caygill C, Reed P, Watson A, Hill M (2000). UK National Barrett’s Oesophagus Registry: An Update. Eur. J Cancer Prev. 9: 456-7.

13. Caygill C, Reed P, Watson A, Hill M (2000). UK National Barrett’s Oesophagus Registry: An Update. Gut 47, (suppl. III) A68.

14. Watson A, Caygill CP (2002). The frequency of development of adenocarcinoma in Barrett’s oesophagus – implications for surveillance. Gastroenterology 122: A350.

15. Van Blankenstein M, Caygill CPJ, Johnston BJ (2002). The prevalence of Barrett’s oesophagus (BO) in an U.K. Centre over 15 years. Gut 50, (suppl. II) A123

16. Gatenby PAC, Caygill CPJ, Charlett A, Watson A (2003) Length of Barrett’s Oesophagus Segment: Demographic Associations and Cancer Risk. Gut 52: (suppl. I) A41.

17. Gatenby PAC, Caygill CPJ, Watson A, Charlett A (2003) Length of Barrett’s Oesophagus Segment: Demographic Associations and Cancer Risk. Gastroenterology 124: A638.

18. Gatenby P, Caygill C, Ramus J, Bateson M, Johnston D, Watson A (2003) Distribution of obesity by age and gender in Barrett’s oesophagus patients at two culturally different centres registering with UK National Barrett’s Oesophagus Registry. J Clin Oncology 38: 185 (P57). (Selected for oral presentation at plenary session)

19. Gatenby PAC, Ramus JR, Caygill CPJ, Watson A (2003). Association Between Lifestyle Factors and Histology in Barrett's Oesophagus. Gut 52: (suppl Vl) A221.

20. Gatenby PAC, Caygill CPJ, Ramus JR, Watson A (2004). Metaplasia-Dysplasia-Adenocarcinoma Sequence in Barrett's Oesophagus (CLO) in a Large UK Series. Gut 53: (suppl III) A55.

21. Gatenby PAC, Caygill CPJ, Ramus JR, Watson A (2004). Does the Length of the Columnar-lined Oesophagus (CLO) Change with Time. Gut 53: (suppl III) A35. (Selected for plenary session).

22. Gatenby PAC, Ramus JR, Caygill CPJ, Watson A (2004). Incidence of adenocarcinoma in short and long segment columnar-lined oesophagus. Gastroenterology 126: (suppl 2) A308. (awarded a distinction).

23. Gatenby PAC, Caygill CPJ, Ramus JR, Watson A (2004). Does the length of columnar-lined oesophagus (CLO) change with time. Gastroenterology 126: (suppl 2) A177. (selected as a poster of special interest).

24. Gatenby PAC, Ramus JR, Caygill CPJ, Watson A (2004). Histological Sequence in a Large UK Series of Columnar-Lined Oesophagus (CLO). Diseases of the Esophagus 17: (suppl 1) A22

25. Gatenby PAC, Ramus JR, Caygill CPJ, Watson A (2004). Histological Sequence in a Large UK Series of Columnar-Lined Oesophagus (CLO). Diseases of the Esophagus 17: (suppl 1) A126-7

26. Gatenby PAC, Ramus JR, Caygill CPJ, Watson A (2004). Adenocarcinoma (AC) Risk in Short (SS) and Long (LS) Segment Columnar-Lined Oesophagus (CLO). Diseases of the Esophagus 17: (suppl 1) A46-7

27. Gatenby PAC, Ramus JR, Caygill CPJ, Watson A (2004). Adenocarcinoma (AC) Risk in Short (SS) and Long (LS) Segment Columnar-Lined Oesophagus (CLO). Diseases of the Esophagus 17: (suppl1) A127.

28. Gatenby PAC, Ramus JR, Caygill CPJ, Watson A (2004). Change in Length of the Columnar-Lined Oesophagus (CLO) over Time and Cancer Risk. Diseases of the Esophagus 17: (suppl1) A16.

29. Gatenby PAC, Ramus JR, Caygill CPJ, Watson A (2004). Time course of metaplastic and dysplastic changes in columnar-lined oesophagus (CLO) and relationship to symptom onset. Accepted by UEGW Sep. 2004. Gut 53 (suppl VI) A99.

30. Gatenby PAC, Ramus JR, Caygill CPJ, Watson A (2004). Relationship of presenting symptoms to outcome in columnar-lined oesophagus (CLO). Gut53 (suppl VI) A101.

31. Ramus JR, Gatenby PAC, Caygill CPJ, Watson A (2004). Helicobacter pylori infection and severity of oesophageal disease in a cohort of patients with Barrrett's oesophagus. Accepted by UEGW for oral presentation. Gut 53 (suppl VI) A61.

32. Gatenby PAC, Ramus JR, Caygill CPJ, Watson A (2005). Impact of treatment on Barrett’s Cancer incidence. Gut 54 (suppl 11) A52.

33. Gatenby PAC Caygill CPJ, Ramus JR, Watson A (2005). Barrett’s oesophgus treatment: effect on high grade dysplasia – oesophagageal cancer incidence. Gastoenterology 128, (suppl 2), S1713.

34. Gatenby PAC, Caygill CPJ, Ramus JR, Shepherd N, Watson A (2005). The significance of detection of intestinal metaplasia (IM) in columnar- lined oesophagus (CLO). The Canadian J of Gastroenterology HOME WCOG abstracts R0078.

35. Ramus JR, Gatenby PAC, Caygill CPJ, Watson A (2005). Endoscopic surveillance intervals for columnar-lined oesophagus (CLO) in the U.K. and Impact on detection of dysplastic disease. The Canadian J of Gastroenterology HOME WCOG abstracts R0090.

36. Ramus JR, Caygill CPJ, Gatenby PAC and Watson A. (2006). Diagnosis and management of Barrett’s oesophagus; results of the UK National Barrett’s Oesophagus Registry (UKBOR) endoscopist questionnaire. Gut 55 (suppl 11) A104-105.

37. Wall C, Charlett A, Caygill C, Gatenby P, Ramus J, Watson A (2006). Are newly diagnosed columnar-lined oesophagus patients getting younger? J Clin Gastroenterol 40 (suppl 4) S207.

38. Gatenby P, Ramus J R, Caygill C P J, Watson A (2007). The Relevance of Low-grade Dysplasia in Columnar-lined Oesophagus. Gut 56 (suppl 11) A70.

39. Gatenby P, Ramus J R, Caygill C P J, Watson A (2007). The Outcome of Low-Grade Dysplasia in Barrett's Columnar-Lined Esophagus - A large cohort study from the UK National Barrett's Oesophagus Registry. Gastrointestinal Endoscopy 65: AB133

40. Gatenby PAC; Ramus JR; Caygill CPJ; Winslet MC; Watson A (2008). No Evidence of Aspirin Chemoprotection in Barrett's Adenocarcinoma of the Esophagus? Gastrointestinal Endoscopy 67: AB178 – AB179

41 Caygill, CPJ, Charlett A, Wall C, Bardhan KD, Royston C, Gatenby P, Ramus JR, Winslet M (2009) Blood group distribution in reflux disease, columnar-lined oesophagus and oesophageal adenocarcinoma compared with the blood donating population. Gastroenterology 136: (Supple 1) A601.

42 Ramus JR, Gatenby PAC, Caygill CPJ, Watson A, Winslet M (2009) The risk of smoking on development of dysplastic disease in patients with columnarised oesophagus. (in press).

43. Caygill CPJ, , Royston C, Charlett A, Wall CM, Gatenby PAC, Ramus JR, Watson A, Winslet M, Bardhan K (2010). Mortality in patients with columnar-lined oesophagus (CLO) Gastroenterology 2010; 138: S-16 (accepted for oral presentation).

44. Gatenby P, Ramus J, Caygill C, Wall C, Hainsworth A, Watson A, Winslet M (2010). Columnar-Lined Oesophagus Segment Length and High-Grade Dysplasia and Adenocarcinoma Risk. J Clinl Gastroenterol 2011; 45: A039.

45. Gatenby P, Caygill C, Ramus J, Wall C, Watson A, Winslet M (2010) Same risk of dysplasia but decreasing risk of cancer in Barrett's oesophagus. J Clinl Gastroenterol 2011; 45: A038.

46. Gatenby P, Hainsworth A, Caygill C, Watson A, Winslet M (2010) Projections for oesophageal cancer incidence in England. J Clinl Gastroenterol 2011; 45: A030.

47. Gatenby P, Caygill CP, Wall C, Bhatacharjee S, Ramus J, , Watson A, Winslet MC and on behalf of the 35 collaborating centres (2011). Lifetime risk of oesophageal adenocarcinoma in patients with Barrett's columnar-lined oesophagus registered with UK National Barrett's Oesophagus Registry. Gut 2011; 60: A35.

48. Gatenby P, Caygill CP, Wall C, Bhatacharjee S, Ramus J, , Watson A, Winslet MC and on behalf of the 35 collaborating centres (2011). Lifetime risk of oesophageal adenocarcinoma in patients with Barrett's columnar-lined oesophagus registered with UK National Barrett's Oesophagus Registry. Gastroenterology 2011; 140: S222

49. Gatenby P, Ramus J, Bhatacharjee S, Wall C, Caygill C, Watson A (2013) Examination of the Time Trends in Dysplasia and Cancer Incidence in Barrett's Oesophagus Results From a Large Multicentre Cohort Study Oeso World conference (shortlisted for prize)

50. Caygill CPJ, Bhattacharjee S, Charlett A, Fox AJ, Gatenby PAC, Watson A, Royston C, Bardhan. KD. Index of social deprivation in a Barrett's esophagus cohort: the influence of affluence? Gastroenterology 2014 (poster of distinction)

51. Bhattacharjee S,Caygill C, Charlett A, Fox AJ, Gatenby P, Watson A, Royston C, Bardhan KD. Social deprivation in Barrett's oesophagus? Gut 2014

BOOK CHAPTERS

1. Caygill C, Hill M (2005). Bacteria and cancer. In Advances in molecular and cellular pathology, Lax A (Ed).Cambridge University Press, Cambridge, p199-225.

2. Caygill CPJ, Gatenby PAC (2012). Epidemiology of the association between bacterial infections and cancer In Bacteria and cancer, Khan AA (Ed). Springer, p1-24.

Notes

1. Reed PI, Watson A (1996). UK National Barrett's Oesophagus Registry. Gut;39: 499-500.

2. Reed PI, Watson A (1996). UK National Barrett's Oesophagus Registry. Eur J Cancer Prev; 5: 207.

3. Salmon P (2007) Barrett's Oesophagus Foundation. Gastrointestinal Nursing; 5: 14-17.

4. Research Highlights (2011). Blood group linked to risk of cancer in patients with Barrett's oesophagus. Nature Reviews Gastroenterology & Hepatology 8: 457.