Correlation of predisposing factors and Esophageal Malignancy in high risk population of Baluchistan

Objectives: To determine frequency of esophageal malignancy in Balochistan and to evaluate its correlation with predisposing and dietary factors. Methods: This cross-sectional study was conducted from Jan 2019 to Dec 2020, at two tertiary care hospital of Quetta which caters to the entire population of province. The total number of 207 cases of esophageal biopsies were received and morphological diagnosis done by H&E staining. Results: Out of 207 (N) esophageal biopsies cases, malignancy were observed in 65%, chronic esophagitis in 19%, benign esophageal lesion in 1% and other esophageal lesions were observed in less than 4% of samples. Association with aggravating factors included tea 80.5%, use of drugs 64%, spicy food 57%, salted food 53%, quid & tobacco taken orally and through nose 44% and cigarette smoking 21.5%. The protective factors include fresh fruit 90%, fish 64% and milk 55% which were never or occasionally taken, meat chicken and beef intake was 63% & 53% and vegetable intake was 52%, but 72.5% of cases never used alcohol and mutton meat was not used by 50%. Conclusion: Esophageal cancer was associated in those groups of people which may regard as having high risk factors. These include increased intake of spicy/salted food, hot beverages, drugs, quid and smoked tobacco, coupled with low intake of fruits and vegetables, lack of awareness and low socioeconomic status. doi: https://doi.org/10.12669/pjms.38.3.4612 How to cite this:Ishaque SM, Achakzai MS, Ziauddin, Pervez S. Correlation of predisposing factors and Esophageal Malignancy in high risk population of Baluchistan. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4612 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The Yield of Endoscopy and Histology in the Evaluation of Esophageal Dysphagia: Two Referral Centers’ Experiences

Background and Objectives: The initial diagnostic test required to evaluate esophageal dysphagia is upper endoscopy (EGD) to assess the structure of the esophagus and the esophageo-gastric junction (EGJ). Taking biopsies during EGD has become a common practice in patients with dysphagia to rule out eosinophilic esophagitis (EoE). The aims of this study were to evaluate the endoscopic findings of patients who underwent EGD for esophageal dysphagia, to assess the rate of biopsy taking from the esophagus to diagnose/exclude EoE, and to report histology outcomes of these biopsies. Materials and Methods: This was a retrospective multicenter study that included individuals ≥18 years who underwent EGD due to esophageal dysphagia between the years 2015 and2020, (with no other alarm signs, such as weight loss, new iron deficiency anemia, and lymphadenopathy). We obtained data from patients’ electronic files. The endoscopy and histology findings were obtained from endoscopy reports saved in our electronic files. Results: A total of 209 patients were included in the study. The average age was 57.1 ± 17.1 years. The most common endoscopic findings were normal endoscopy in 76 patients (36.4%) and erosive esophagitis in 75 patients (35.9%). Barrett’s esophagus and esophageal malignancy were encountered in 11 patients (5.3%) and 2 patients (0.95%), respectively. Esophageal biopsies were taken in 50.2% of patients, and one patient had histological evidence of EoE (0.5%). On univariate analysis, there was a trend for association between proton pump inhibitors (PPIs) use and a normal EGD, but it was not statistically significant (OR 0.28, 95% CI 0.07–1.11, p = 0.07). Conclusions: Endoscopic findings were prevalent in dysphagia patients even when no other alarm symptoms exist. Neoplastic lesions and EOE were rare in our study.

Esophageal carcinoma with acro-metastasis: a rare case report

The aim of this case report was to present a rare case of bony metastases originated from squamous cell carcinoma of the mid esophagus, thus, underline the need for early diagnosis and possible treatment of suspicious bony lesions among patients with esophageal malignancy. A 35-year-old man with esophageal carcinoma underwent esophagectomy whose pathology revealed stage III-C disease. During follow up, he was diagnosed to have bony hand metastasis. The patient died after some time. Therefore, follow-up of patients who are diagnosed with esophageal malignancy and underwent esophagectomy is mandatory in order to reveal early surgical stages as esophageal cancer is emerging as leading cause of cancer mortality worldwide. Complete resection of esophageal cancer and adjacent malignant lymph nodes is the only potentially curative treatment. Accurate preoperative staging and assessment of therapeutic response after neoadjuvant therapy are crucial in determining the most suitable therapy and avoiding inappropriate attempts at curative surgery.

The EphB2-MYC Axis is a Major Determinant of Barrett's Pathobiology and a Therapeutic Vulnerability in Esophageal Cancer

Esophageal adenocarcinoma (EAC), a highly aggressive cancer with limited therapeutic options, often arises in the backdrop of a molecularly-complex esophageal metaplasia disorder, Barrett's Esophagus (BE). Using transcriptomics and systems biology analyses of treatment-naïve malignant/pre-malignant biopsy tissues, we found Eph receptor B2 (EphB2) tyrosine kinase signaling to be frequently hyperactivated during early stages of EAC development, and across the BE-EAC continuum. Functional studies revealed EphB2 to be an upstream post-translational regulator of c-MYC activity and as a key molecular dependency in BE/EAC. Single-cell transcriptomics in a porcine esophageal 3D spheroid model showed enhanced EphB2 and MYC activity to be significantly associated with BE-like cell fate. shRNA-based knockdown of EphB2 or small molecule inhibitors of MEK, that modulate MYC protein stability, proved effective in suppressing EAC tumor growth in vivo. These findings point to EphB2-MYC axis as an early promoter of EAC and a novel therapeutic vulnerability in this increasingly-prevalent esophageal malignancy.