This case presents a 2-year-old spayed female cat that developed a complete esophageal stricture following 14 days of oral dry doxycycline therapy. Following treatment, the patient developed symptoms of regurgitation, loss of appetite, and vomiting. Direct radiography revealed marked aerophagia in the esophagus, while contrast radiography showed esophageal dilatation at the level of the first thoracic vertebra (T1) and complete stricture preventing the contrast medium from passing into the stomach. Endoscopic examination verified a complete stricture in the middle esophagus, and computed tomography (CT) revealed that the stricture was localized at T1; no extraluminal mass or vascular ring anomaly was identified. The absence of a history of anesthesia, foreign body ingestion, or trauma in the medical history confirms that the stricture developed due to chemical damage to the esophageal mucosa caused by doxycycline in capsule form. Reports in the literature indicate that administering doxycycline capsules to cats without adequate fluids increases the risk of esophageal ulceration and scarring. Unfortunately, because of the poor prognosis of the complete stricture in the patient, the patient's poor general condition, and the owner's reluctance to pursue treatment, the decision was made to euthanize the patient. In conclusion, the presented case highlights the diagnostic value of combined radiography, contrast esophagography, endoscopy, and computed tomography for diagnosing esophageal strictures that develop after oral administration of doxycycline. Furthermore, it is essential to consider the pharmaceutical formulation and administration technique for oral drug delivery to cats to prevent potential complications.

Herpetic esophagitis is a rare condition that occurs predominantly in immunocompromised patients. Diagnosis is based on the macroscopic findings of upper gastrointestinal endoscopy, with confirmation by histopathological examination and molecular testing (PCR). Intravenous acyclovir remains the treatment of choice. We report a case of an isolated herpetic esophageal ulcer in a patient with Crohn’s disease and a newly diagnosed retroviral infection, who was admitted to our department for the initial evaluation of Crohn’s disease. The diagnosis of herpetic esophagitis was suspected in the presence of odynophagia, high-grade fever (39°C), and marked deterioration of the general condition. Upper gastrointestinal endoscopy revealed a solitary superficial ulcer located in the middle third of the esophagus. HIV serology subsequently returned positive. Histopathological examination and tissue PCR confirmed the diagnosis of herpetic esophagitis. The patient was treated with intravenous acyclovir, with a favorable clinical outcome.

This review discusses the latest progress in hydrogel adhesives for upper gastrointestinal wound healing. The specific acidic environment of the upper gastrointestinal tract makes treating upper gastrointestinal wounds, especially gastric bleeding and perforation, quite challenging. Recent research on hydrogels in biomedical applications has demonstrated immense potential, particularly in wound dressing. With three-dimensional network structures, hydrogels provide an efficient and safe strategy for hemostasis and wound repair in the digestive tract. Moreover, hydrogels possess excellent properties, including biocompatibility, biodegradability, mechanical strength, cell/tissue adhesion, and controllable release, making them suitable for complex wound-healing processes. This review summarizes the latest advancements in hydrogels for various upper gastrointestinal conditions, including esophageal stenosis, gastric ulcers, gastric bleeding, gastric perforation, and endoscopic submucosal dissection. We also highlight the merits and demerits of current hydrogel dressings to provide a deep understanding of their working mechanisms. Finally, the challenges and prospects of hydrogels for upper gastrointestinal applications are reviewed, aiming to inspire researchers in different fields and encourage the development of multifunctional hydrogels for effective upper gastrointestinal wound healing.

Background: A subset of patients with T1-T2 oesophageal cancer are not candidates for surgery or chemotherapy and have a poor prognosis due to limited treatment options. This study evaluated the combination of external beam radiotherapy (EBRT) and endo-oesophageal brachytherapy (EBT) as a curative treatment in these patients, with cause-specific survival (CSS) and local recurrence-free survival (LRFS) as the primary endpoints. Methods: This was a single-centre retrospective analysis of 11 patients with T1-T2 oesophageal cancer treated between 2005 and 2024 with combined EBRT and EBT schedules. Clinical data, treatment schedules, outcomes, and complications were obtained from patient medical records and follow-up documentation. Descriptive statistics and Kaplan–Meier survival analysis were used. Results: The median follow-up was 22 months (2–61 months). CSS rates were 79.5% at 2 years, 66% at 3 years, and 30% at 5 years. LRFS rates were 74.1%, 59%, and 39%, respectively. One severe toxicity (grade ≥ 3) was observed. The most frequent mild toxicities were oesophageal mucositis (18.2%) and ulceration (18.2%). Conclusions: EBT in combination with EBRT seems to be a feasible and well-tolerated treatment with curative intent for inoperable T1-T2 oesophageal cancer patients, offering favourable survival outcomes in a population with limited therapeutic alternatives.

We present a case of incidental PSMA uptake in the mid-esophagus on 99mTc-HYNIC-PSMA SPECT/CT in a 67-year-old man undergoing staging for high-grade prostate adenocarcinoma. While uptake in the prostate lesion was expected, unexpected focal avidity was noted in the esophagus. Given the rarity of esophageal metastases from prostate cancer, further evaluation was performed. Contrast-enhanced CT showed esophageal fluid levels, and endoscopy revealed linear ulcers in distal esophagus. Biopsy confirmed mild reflux esophagitis. This case underscores the potential for benign esophageal inflammation to mimic metastatic disease on PSMA imaging. Accurate interpretation requires careful clinical and pathologic correlation to avoid misdiagnosis.

Objective Current guidelines recommend using the presence of alarm features to help determine if an upper endoscopy is appropriate as an initial diagnostic tool in young adults with dyspepsia. The study aimed to assess whether young adults without alarm features had clinically significant findings on gastroscopy. Methods This was a retrospective study on patients 18–50 years who underwent their first gastroscopy at Landspitali University Hospital 2018–2022. Data was collected on symptoms and endoscopic findings. American Society for Gastrointestinal Endocopy (ASGE) from 2015 were used to determine adequate indication for gastroscopy. The following were considered adequate indications: suspected gastrointestinal bleeding and/or iron deficiency anemia, dysphagia, persistent vomiting, unintentional weight loss, a family history of upper gastrointestinal cancer, or suspicious findings on imaging. Results Among 748 patients, 515/748 (69%) had an adequate indication, 52% males and 233/748 (31%) without. Endoscopic findings in the group with adequate indications were: esophagitis (20%), gastric ulcers (4.1%), duodenal ulcers (4.1%), esophageal ulcers (2.1%), gastric cancer (1.0%) and esophageal cancer (0.2%). Clinically relevant findings were rare in the group without an adequate indication and only 4/233 (1.7%) had a duodenal ulcer, all due to an H.pylori infection and only 1 gastric ulcer (0.4%). No cancers were diagnosed among those without an adequate indication. Conclusions Patients without alarm features were less frequently diagnosed with clinically significant diseases on gastroscopy compared to patients presenting with alarm features. No cancers were diagnosed in those without an adequate indication and clinically significant findings were rare in that group.

INTRODUCTION:Endoscopic removal of a bony foreign body is accompanied by risks, such as perforation. The use of a transparent cap attached to the tip of the endoscope has become an increasingly recommended technique for removing esophageal foreign bodies. However, its effectiveness specifically for bony foreign bodies remains uncertain, as does the optimal timing for cap application. This study aimed to investigate the effectiveness and the optimal timing of a transparent cap.METHODS:From January 1, 2010-May 30, 2025, patients with reported bony esophageal foreign body for endoscopic removal were retrospectively analyzed. The primary outcome was the technical failure rate of endoscopic removal of a bony foreign body.RESULTS:A total of 595 patients with bony esophageal foreign bodies underwent endoscopic removal during the study period: 216 underwent the transparent cap-assisted method and 379 underwent the conventional method. Among these foreign bodies, fish bones accounted for the majority (91.4%). The endoscopic failure rate of bony foreign body removal was lower in the cap-assisted group than in the conventional group (3.2% vs 7.9%, P = 0.022). Subgroup analysis demonstrated the incidence of esophageal erosions and ulcerations was higher in patients who underwent endoscopy withdrawal for capping than in those who received capping before the examination (58.5% vs 32.8%, P < 0.001).DISCUSSION:The use of a transparent cap is an effective method to reduce the technical failure rate for endoscopic removal of an esophageal bony foreign body. Applying the transparent cap before the start of the endoscopic examination reduced the complication rates.

BackgroundPenicillamine(D-Penicillamine) and trientine are first-line therapies for Wilson’s Disease (WD), yet real-world data on their adverse events (AEs) remain scarce. We analyzed the FDA Adverse Event Reporting System (FAERS) to comprehensively assess the safety of penicillamine and trientine in WD treatment.MethodsAEs for penicillamine and trientine (2004Q1–2024Q4) were analyzed using Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), and Bayesian Confidence Propagation Neural Network (BCPNN).ResultsWe found 1,452 and 760 AEs related to penicillamine and trientine, respectively. In all adverse event (AE) reports, the ratio of females to males was approximately 1.3, with the highest proportion of AE reports in the 21–30 age group, and the largest number of AE reports coming from the United States. Signal detection showed that the most commonly reported AEs for penicillamine and trientine were drug hypersensitivity and tremor, respectively, with the highest proportions in the SOC categories of immune system disorders and gastrointestinal disorders. The main AEs for both drugs involved condition aggravated, and identified potential safety signals requiring further validation for the two drugs, such as decreased bone density and brain atrophy for penicillamine, and memory impairment, oesophageal ulcer and starvation for trientine. In addition, we found that women were more likely to experience drug hypersensitivity in penicillamine adverse event reports, while men were more likely to experience cutis laxa.ConclusionThis study reveals the characteristics of AEs and potential associated risks in the clinical application of penicillamine and trientine, emphasizing individualized medication and vigilant monitoring strategies to provide guidance for safe medication use.

Introduction: Tuberculosis (TB) is a widespread infectious disease caused by Mycobacterium tuberculosis. It predominantly affects the lungs but can involve any organ in the body. Tracheo-oesophageal fistula (TEF) is one of the rare extrapulmonary manifestations of TB. Case Report: A 27-year-old male, otherwise healthy, reported to our outpatient department with complaints of fever, persistent cough, and significant weight loss. Subsequently, he was diagnosed with tuberculous tracheo-oesophageal fistula and pulmonary tuberculosis. Discussion: The patient had an elevated ESR (52 mm) and underwent multiple imaging studies, including two normal barium swallow tests. Upper gastrointestinal endoscopy (UGIE) revealed two esophageal ulcers, one with a fistulous tract. Biopsy results suggested chronic esophagitis with granulomatous inflammation. Contrast-enhanced CT (CECT) of the thorax showed esophageal irregularities, air foci, and contrast extravasation into the bronchi, along with mediastinal lymphadenopathy and centrilobular nodules. Clinical and investigative findings suggested pulmonary tuberculosis with a tracheoesophageal fistula. The patient was discharged on a six-month antitubercular regimen with nutritional support via a nasogastric tube. Stent installation was planned if follow-up results were unfavorable. Conclusion: Although tuberculosis is highly prevalent in India, TEF of tuberculous origin has been infrequently documented, particularly in young, healthy, immunocompetent individuals. The patient was successfully cured after initiating antitubercular therapy and subsequent follow-up.

Chemoradiotherapy using proton beam therapy is a novel and promising option for patients with esophageal squamous cell carcinoma (ESCC) who do not prefer surgical treatment. This was a single-center retrospective cohort study. Patients diagnosed with thoracic ESCC, clinical Stages I, II, or III, who underwent definitive proton-based chemoradiotherapy (PBC) or surgery-based treatment (SBT) between 2009 and 2020 were included. Patients intolerant to surgery or palliative radiotherapy were excluded. PBC was defined as radical-intent chemoradiotherapy using a proton beam with chemotherapy, and a combination of photon radiation was allowed. SBT was defined as subtotal esophagectomy with lymph node dissection with or without adjuvant chemotherapy. The propensity score matching was performed using potential confounding factors as covariates. The primary endpoints were the hazard ratio (HR) and 5-year overall survival (5yOS). This study included 247 patients (112 with SBT and 135 with PBC). Survival outcomes were compared between the 95 patients in each group using propensity score matching. The mean observation period was 57.5months. The 5yOS was 62.0% in the SBT and 55.3% in the PBT group (P = 0.421). The adjusted HR for PBC was 1.22 (0.79-1.90). No treatment-related deaths occurred in the PBC group. Serious adverse events included neutropenia (n = 5), esophageal ulcer (n = 3) in the early phase, and esophageal fistula (n = 3), pleural effusion (n = 1), and pericardial effusion (n = 1) in the late phase. Radical chemoradiotherapy using proton beams is a promising treatment option for patients with ESCC who do not prefer surgery in terms of safety and efficacy.

ABSTRACTThe contribution of circulating micronutrients to ulcer susceptibility remains poorly defined across anatomical sites. In this study, we constructed a systematic trace element–ulcer map by integrating genetic‐instrumented inference, pleiotropy‐aware modeling, and heterogeneity‐sensitive clustering. Summary‐level data were obtained from large‐scale genome‐wide association studies (GWAS) encompassing 10 circulating micronutrients (calcium, iron, zinc, copper, magnesium, selenium, carotene, vitamin B12, vitamin C, and vitamin D) and nine ulcer phenotypes (corneal ulcer, recurrent oral aphthae, esophageal ulcer, gastric ulcer, duodenal ulcer, vaginal/vulvar ulcer, decubitus ulcer, lower limb ulcer, and chronic skin ulcer), covering more than 3 million individuals of European ancestry. Our two‐sample Mendelian randomization (MR) analysis identified genetically elevated zinc levels as a risk factor for gastric (OR: 1.141, 95% CI: 1.060–1.228, p = 4.57 × 10−4) and esophageal ulcers, but inversely associated with vaginal/vulvar ulcer risk. Protective effects were observed for iron with gastric ulcers and calcium with duodenal ulcers. Carotene and magnesium were nominally associated with increased risk of oral aphthae and vaginal ulcers, respectively. To refine these associations, we applied Causal Analysis Using Summary Effect estimates (CAUSE) and MR‐Clust. While CAUSE did not confirm robust putative causal relationships in most pairs, MR‐Clust uncovered three distinct SNP clusters in the vitamin C‐corneal ulcer pair, indicating potential mechanistic heterogeneity. These pleiotropy‐aware and cluster‐based approaches enhanced the interpretability of borderline signals and revealed genetic heterogeneity beyond mean‐effect estimates. Collectively, this study offers a panoramic view of trace element‐ulcer relationships and prioritizes zinc as a key candidate for further mechanistic exploration in gastric ulcer pathogenesis. Our integrative framework may serve as a foundation for future etiological and nutritional intervention studies.

Odynophagia is a common complaint among individuals living with HIV, with candidiasis being the predominant cause. We present a case of 38-year-old man with poorly controlled HIV who presented with odynophagia and oropharyngeal candidiasis that is refractory to antifungal therapy. Further investigations showed esophageal candidiasis with esophageal ulcers, which pathology revealed extensive filamentous bacteria in addition to fungal hyphae. Diagnosis of esophageal candidiasis superimposed with actinomycosis was made, and he responded well to amoxicillin in addition to fluconazole therapy.Keywords: Esophageal actinomycosis, Actinomycosis, Actinomyces, HIV

S4430 Rituximab-Induced Esophageal Ulcers and Strictures Presenting as Dysphagia

S4799 Esophageal Stent as Salvage Therapy for Refractory Esophageal Ulcer Bleeding

S4413 A Rare Case of a Giant Idiopathic Esophageal Ulcer in a Pregnant Woman With HIV/AIDS

S4462 A Case Report of Idiopathic Esophageal Ulcer in a Renal Transplant Patient Responsive to Steroid Therapy

Abstract Background This case report addresses the diagnostic challenge of distinguishing intestinal tuberculosis (ITB) from Crohn’s disease, with a focus on the potential role of fecal zonulin as a noninvasive biomarker. Case presentation A 43-year-old female with a history of deep vein thrombosis, asthma, and previously treated pulmonary tuberculosis presented with fatigue, chronic diarrhea, diffuse abdominal pain, significant weight loss (~ 20 kg), and anorexia. Laboratory findings included a positive fecal occult blood test and markedly elevated fecal calprotectin (3370 µg/g, normal range: &lt; 50 μg/g). Celiac disease serologies were negative. Abdominopelvic tomography showed pathological thickening of the digestive tract wall. Fecal zonulin was normal (10.75 ng/mL, reference range &lt; 107 ng/mL). Upper endoscopy revealed multiple gastric ulcers and an esophageal ulcer suggestive of tuberculosis. Despite clinical and biochemical features mimicking IBD, endoscopic findings and normal fecal zonulin levels prompted suspicion of gastrointestinal TB. The pulmonology department confirmed intestinal tuberculosis and reactivation of the pulmonary tuberculosis after microscopic examination of the patient’s sputum and fecal samples. Antituberculous therapy was initiated with favorable evolution. Conclusion This case highlights the diagnostic overlap between ITB and Crohn’s disease and underlines the importance of integrating clinical history, imaging, and biomarkers. Fecal zonulin may aid in differentiating ITB from Crohn’s disease by reflecting intestinal permeability patterns, potentially preventing misdiagnosis and inappropriate immunosuppressive treatment. As a biomarker reflecting intestinal barrier integrity, fecal zonulin measurement may have broader implications that warrant further investigation.

The underwater technique is an important innovation in gastrointestinal endoscopy, which has been used for the treatment of colonic lesions, esophageal, and gastric neoplasms. Endoscopic injection sclerotherapy (EIS) is a safe and effective way to treat and prevent gastroesophageal variceal bleeding (GEVB). However, paravascular submucosal injection may result in the failure of the procedure, bleeding esophageal ulcers, or esophageal stenosis. Esophageal peristalsis is an important problem when the endoscopist injects the sclerosant into the varices. This may cause the needle inside the vein to become unstable and be removed, and the endoscopic vision may become unclear during injection. In our clinical experience, decreased peristalsis of the esophagus can be observed in an underwater environment. To decrease peristalsis of the esophagus and improve the success rate of intravascular injection, we propose a method called underwater endoscopic injection sclerotherapy that requires filling up the esophageal lumen with water before sclerotherapy. A case involving a 57-year-old male patient with gastroesophageal Type 1 varices is described to illustrate the underwater endoscopic injection sclerotherapy.

Background: Endoscopic variceal band ligation (EVBL) is an established therapy for esophageal variceal hemorrhage but is frequently associated with post-procedural complications including esophageal ulceration, dysphagia, retrosternal pain, and rebleeding. While proton pump inhibitors (PPIs) are commonly administered post-EVBL to promote ulcer healing, residual symptom burden and rebleeding risk remain, and the potential additive benefit of sucralfate as a mucosal protectant is uncertain. Objective: To compare symptoms and risk of rebleeding in patients receiving PPI with sucralfate versus PPI alone following EVBL. Methods: A randomized controlled trial was conducted at a tertiary care hospital over six months. Seventy-two patients undergoing EVBL were randomized 1:1 to receive PPI plus sucralfate or PPI alone. Patients were followed for two weeks for assessment of post-ligation symptoms, endoscopic ulcer occurrence, and rebleeding. Statistical analyses included independent sample t-tests and chi-square tests, with logistic regression used to adjust for confounders. Results: The PPI plus sucralfate group experienced significantly lower rates of retrosternal pain (13.9% vs 36.1%, p=0.037), dysphagia (8.3% vs 27.8%, p=0.041), ulcer formation (16.7% vs 41.7%, p=0.018), and rebleeding (5.6% vs 22.2%, p=0.042) compared to PPI alone. Conclusion: Adjunctive sucralfate significantly improves post-EVBL symptom control, reduces ulcer formation, and lowers rebleeding risk, supporting its use in routine post-ligation management.

An 81-year-old woman residing in a nursing facility due to dementia presented with a 5-day history of vomiting and anorexia. Computed tomography revealed air-containing material in the esophagus, and sponge fragments had been noted in her vomitus 4days earlier. Accidental sponge ingestion with esophageal impaction was suspected, and emergency endoscopy was performed. The sponge was friable and fragmented easily, making removal difficult. Standard tools including grasping forceps, snares, and nets were ineffective, but a five-pronged grasping forceps enabled successful removal. Follow-up endoscopy revealed an esophageal ulcer presumedly caused by pressure from the sponge, without bleeding or perforation. The ulcer recovered with proton pump inhibitor therapy. Sponge ingestion is a rare cause of esophageal foreign bodies but may become more frequent due to the growing elderly population with cognitive impairment. Sponge is potentially dangerous as it may cause mucosal injury or perforation. However, because they allow fluid passage, symptoms may be mild and diagnosis delayed. Once beyond the duodenum, endoscopic removal becomes extremely difficult. Therefore, sponge foreign bodies should be removed endoscopically when feasible, and simply displacing them to resolve obstruction is not sufficient.