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Dr. Nigel Trudgill brings us an update on his research program into oesophageal and gastric cancers

We were very pleased to have Dr. Nigel Trudgill bring us an update on his research program into oesophageal and gastric cancers at our meeting at Sandwell Hospital on Friday 12th December.

Dr . Trudgill accepted our thanks for the presentation of the work carried out by Dr. Danny Cheung over the past two years and informed us of the research to be carried out by his new research fellow Dr. James Reece. Nigel is getting Dr. Reece to look into the genetic factors that could affect the chances of a patient developing oesophageal or gastric cancers.

Research so far shows that there are two genes that can increase your chances of developing upper gi cancers, specifically squamous cell cancer of the upper oesophagus. Having either of these genes means an increased chance of developing the disease, while having both greatly increases this chance.

What Dr. Trudgill wants to do is to get a number of G.Ps who have patients who regularly suffer with gastric reflux or heartburn, or who have had these symptoms for a period of time to have a blood test to show if these genes are present and if they are to put the patient onto a regular monitoring program so that cancers can be discovered at an early stage.

As we have previously been informed, the only way at present of detecting oesophageal or gastric cancers is by endoscopy. Dr. Trudgill has pointed out two of the main reasons why early stage tumours are often missed, especially in the upper gullet, (squamous cell cancers). One of these is because of the amount of mucus on the lining of the oesophagus and stomach obscuring the picture shown by the endoscope.

This can be overcome by drinking a solution that clears the mucus from the gullet and stomach prior to the endoscopy, a practice regularly used in Japan and what Dr. Trudgill would like to see introduced in this country. Another problem is in the actual endoscopy procedure.

Everyone who has had an endoscopy knows of the awful gagging sensation that you get as the scope first enters the gullet. Because of this the person carrying out the endoscopy has a tendency to pass the scope into the gullet as quickly as possible, sometimes missing small signs of tumours at the top of the gullet. A similar thing happens when the practitioner removes the scope, doing so as quickly as possible to cause less stress to the patient.

One thing that has been noticed during the start of an endoscopy is that when a nurse holds a patients hand, as an act of reassurance the patient will often squeeze the nurses hand very tightly as the scope enters the gullet.

This has shown that doing this relaxes the patient's chest and throat and a clearer picture can be seen. This however can be rather painful for the nurse and some have been known to cry out at the sudden pressure.

Dr. Trudgill is now experimenting with giving the patient a ball to hold and squeeze during the endoscopy and this stress ball technique is showing some success and could be far better and of course much safer and cheaper than sedating the patient.

We look forward to hearing from Dr. James Reece on his work into this project.