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A 14-year-old girl presented with diarrhea and bloody stools was initially diagnosed with infectious colitis and anal fissure. The patient was treated with antibiotics; however, the symptoms persisted and purpura appeared on the patient's lower abdomen. Abdominal computed tomography indicated diffuse wall thickening of the entire colon. A colonoscopy revealed extensive edema, several ulcers, and mucosal friability, resulting in the diagnosis of ulcerative colitis. Blood tests revealed hypoalbuminemia, increased inflammatory marker levels, and high proteinase3 anti-neutrophil cytoplasmic antibody (PR3-ANCA) levels. Urinalysis showed hematuria and casts, raising the suspicion of concurrent vasculitis syndrome. Esophagogastroduodenoscopy revealed multiple punched-out ulcers in the esophagus. Granulomatosis with polyangiitis with gastrointestinal involvement was diagnosed combined with the positive PR3-ANCA results and skin and renal involvement. Steroid therapy was initiated, leading to the rapid improvement of diarrhea, purpura, and esophageal ulcers. While high PR3-ANCA levels are occasionally observed in ulcerative colitis, esophageal ulcers in patients with granulomatosis with polyangiitis often result in poor symptoms. Thus, esophagogastroduodenoscopy should be considered in patients with high PR3-ANCA levels, even in the absence of upper gastrointestinal symptoms.

The long-term use of proton pump inhibitors (PPIs) can induce fundic gland polyps (FPs) in the stomach, sometimes leading to numerous large FPs (LFPs). Although PPI discontinuation can reduce LFP size and number, the underlying process remains unstudied.

A 63-year-old woman on esomeprazole (20 mg daily for 10 years) was scheduled for endoscopic LFP removal. After PPI discontinuation, her LFPs regressed to <10 mm within 35 days. A 60-year-old male physician on rabeprazole (10 mg daily for 12 years) had LFPs detected via esophagogastroduodenoscopy screening. He opted for weekly esophagogastroduodenoscopy with pathological evaluations to monitor changes post-discontinuation.

One week after PPI withdrawal, gastric juice acidity and viscosity increased, with erosion observed on nearly all LFP surfaces. By day 35, all LFPs regressed and resembled sporadic FPs. This study demonstrated that PPI-induced LFPs regress within a short period post-discontinuation and suggests that LFP volume reduction is linked to gastric environment changes, particularly increased acidity.

Oxygen saturation imaging is a new technology that determines biological features from the perspective of oxygen concentration. Therefore, this exploratory study aimed to evaluate the biological implications of oxygen saturation imaging and further assess tumor heterogeneity in gastric cancer. Biopsy samples were selectively obtained from treatment-naïve patients with gastric cancer under real-time oxygen saturation imaging. Tissue oxygen saturation level calculations, immunohistochemistry, and RNA sequencing were performed. The mean tissue oxygen saturation levels at the sampling sites were 32.2%, 70.8%, and 56.2% for hypoxic, hyperoxic, and non-tumor areas, respectively, with significant differences between each pair. CD-31 and glucose transporter 1 protein expression were significantly upregulated in hypoxic tumors. Comprehensive transcriptomic analysis revealed enriched biological processes related to the regulation of insulin-like growth factor transport and uptake by insulin-like growth factor-binding proteins in hypoxic tumors and the type I interferon signaling pathway in hyperoxic tumors. Oxygen saturation imaging has the potential to clarify hypoxia-induced heterogeneity in gastric cancer from both clinical and fundamental perspectives.

We report the case of a 97-year-old male with recurrent gastric volvulus who was successfully treated with nasogastric tube-assisted endoscopic reduction followed by percutaneous endoscopy-assisted gastropexy with gastric wall fixation. The nasogastric tube facilitates endoscopic reduction by enhancing the procedure's efficiency. In contrast, percutaneous endoscopy-assisted gastropexy provides an effective, minimally invasive method to prevent the recurrence of gastric volvulus, even in patients with poor overall health. This case highlights the clinical utility of these combined approaches in managing gastric volvulus in elderly patients with significant comorbidities.

During the initial diagnosis of superficial esophageal squamous cell carcinoma, a 70-year-old man was treated with endoscopic submucosal dissection (ESD). Two years after the first ESD, follow-up endoscopy revealed that the extent of hyperkeratosis gradually expanded over the following 4 years; however, biopsies conducted only detected Candida mycelia and no cancer at that time and every 6 months for 4 years. Despite initiating fluconazole treatment for persistent Candida esophagitis 6 years after the first ESD, the lesions did not resolve, and the second ESD was performed 6 years after the first ESD, which revealed squamous cell carcinoma. This case highlights that esophageal cancer should be considered when localized, hyperkeratotic Candida esophagitis is unresponsive to antifungal treatments, especially with a history of esophageal cancer or high-risk factors such as drinking alcohol and smoking.