Co-existing inflammatory bowel disease and Barrett’s esophagus is associated with esophageal dysplasia: a propensity score-matched cohort

Background and study aims Barrettʼs esophagus (BE) and inflammatory bowel disease (IBD) predispose to the development of dysplasia and cancer. It is unclear if the inflammatory cascade seen in IBD affects disease progression in BE. We aimed to determine if patients with BE who have co-existing IBD had a higher risk of dysplasia, nodular disease, or longer segments than BE patients without IBD. Patients and methods This was a multicenter, retrospective propensity score-matched cohort study. We compared rates of dysplasia, nodular disease, and segment length in patients with BE and IBD (cases) to patients with BE who did not have IBD (controls). Controls were 1:1 propensity score matched with controls for age, sex, body mass index (BMI), smoking, and hiatal hernia. Results A total of 132 patients were included in the IBD + BE group and 132 patients in the BE group. Patients with IBD + BE had higher rates of esophageal dysplasia compared to controls (15.9 % vs. 6.1 % [adjusted odds ratio [OR]: 2.9, 95 % CI: 1.2–6.9]) and more nodules (9.8 % vs. 3.0 % [adjusted OR: 3.5, 95 % CI: 1.1–11.0]). IBD + BE group was also associated with longer BE segments (43.9 % vs. 12.1 % [OR: 5.7, 95 % CI: 3.0–10.6]). Conclusions Co-existing IBD may increase the risk of dysplasia and esophageal nodules in patients with BE. Our findings may have implications for BE surveillance intervals in IBD patients. Prospective studies are needed to confirm our findings.

Is a proton-pump inhibitor necessary after endoscopic submucosal dissection for superficial esophageal neoplasms? A propensity score analysis

Background: Little is known about the efficacy of proton-pump inhibitor (PPI) therapy in the management of esophageal ulcers after endoscopic submucosal dissection (ESD). Therefore, the objective of this study was to investigate the efficacy of PPI in ulcer healing following ESD for superficial esophageal neoplasms, using a propensity score analytic approach. Methods: This retrospective cohort study was conducted at a single referral center. Between April 2005 and August 2015, 199 consecutive patients with superficial esophageal cancer and esophageal dysplasia underwent ESD. For patients with PPI administration, intravenous PPI therapy was commenced immediately after ESD, and oral PPI was administered daily from post-operative day 3, until ulcer healing was identified. We compared the remnant-ulcer rate at 4 weeks after esophageal ESD between the PPI administration and non-PPI groups, using propensity scores and the inverse probability of treatment weighting (IPTW) method. Results: After exclusions, a total of 88 patients were analyzed. The remnant-ulcer rate at 4 weeks after ESD was 25.5% (12/47) and 14.6% (6/41) in the PPI administration and non-PPI groups ( p = 0.21). After adjusting for background factors using IPTW, the risk of a remnant ulcer in the PPI administration group was not decreased significantly compared with that in the non-PPI group [odds ratio (OR) = 2.42, 95% confidence interval (CI): 0.73–7.97, p = 0.15]. Furthermore, PPI therapy did not decrease significantly the remnant-ulcer rate on logistic regression analysis after adjusting for the propensity score (OR = 2.40, 95% CI: 0.69–8.32, p = 0.15). Conclusion: PPI administration does not promote ulcer healing after ESD for superficial esophageal squamous cell carcinoma.

Fifty five years old male with gastrointestinal stromal tumor: a case report

Esophageal Gastrointestinal Stromal Tumors (GISTs) were extremely rare, with an incidence of 0,2% of GIST cases. Majority of esophageal GISTs were classified as high-risk category (70.83%), thus, it was required more aggressive approaches, e.g. radical surgery, chemotherapy and radiotherapy. This was a case of a 55-year-old male patient who was referred to surgery department complained of atypical chest pain and swallowing difficulty. Based on thorax X-Ray, it was suspected mediastinal mass. In addition, based on chest CT scan, it was suspected a mass at distal esophagus with multiple nodular lesions in liver dd/fatty liver. X-ray Oesophagus Maag Duodenum (OMD): Esophageal mass at 1/3 middle-distal part. Upper endoscopy diagnosis showed a fragile circularly spreading tumor mass which it was easily bleeds. Biopsy also showed a mild esophageal dysplasia with non-specific inflammation and necrotic tissue which was difficult to assess. This patient underwent McKeown esophagectomy. Moreover, pathology report showed diagnosis of a malignant tumor which fitted with criteria of malignant GIST, with both ends tumor-free. Finally, the patient was administered for imatinib as adjuvant therapy 1x400mg daily. This report illustrated complexity in diagnosing and treating esophageal GIST. The tumor size and mitotic rate of tumor were associated with poor survival.