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Scientists have developed what they are calling a "pill on a string" which researchers hope will improve prevention of esophageal cancer by diagnosing a precursor disease known as Barrett's esophagus. They announced the development in an article published in the journal Nature Genetics.
The "pill on a string" is a soluble pill housing a small "cytosponge" that is swallowed while remaining attached to a piece of string. Upon entering the stomach, the multivitamin-sized pill dissolves to release the small sponge. Five minutes later, the sponge is pulled back up the esophagus by a nurse, in the process collecting around a million cells from the gullet wall which can then be analyzed for signs of Barrett's.
Rebecca Fitzgerald, a researcher with the Medical Research Council cancer unit at the University of Cambridge, originally designed the cytosponge and has been working on uses for it in the past few years. She admits the procedure might not be an entirely comfortable experience for the patient — but it is, she says, much safer and more efficient method than an endoscopy, which is how esophageal cancer is most commonly diagnosed at present.
"Any of these diagnostic tests are never going to be 100 percent pleasurable, but an endoscopy is really not very nice — it's quite invasive and you have to go to the hospital. This is much quicker and you are at your [general practitioner's] surgery. It's not pleasant and you're not going to want to do it every day but I think it's quite bearable," says Fitzgerald.
An endoscopy involves feeding a small camera down the esophagus to allow doctors to view the gullet wall and remove cells for analysis. Fitzgerald says the cytosponge could cost as little as $40 providing a much more cost-effective diagnostic method than endoscopies, which she says can cost up to $465.
Barrett's esophagus is a consequence of acid reflux, when stomach bile comes back up the gullet. The condition results in the mutation of esophageal cells and up to five in every 100 sufferers of Barrett's go on to develop esophageal cancer. Esophageal cancer is largely the result of lifestyle factors, particularly smoking. Obesity and excessive alcohol consumption are also significant risk factors, while a diet high in fruit and vegetables could protect against the disease.
According to Cancer Research UK, esophageal cancer killed 400,000 people worldwide in 2012. Fitzgerald says that the cytosponge could potentially save thousands of lives by enabling early diagnosis of Barrett's, thereby expediting preventative treatment of patients at risk of developing oesophageal cancer.
"It's all about detecting it earlier. At the moment, a lot of patients with symptoms of heartburn and indigestion never get investigated, so we never find the people at risk because GPs can't be sending everyone off for an endoscopy," says Fitzgerald. She hopes that the pill will be widely available within five years.