Carafate (sucralfate) / AbbVie - LARVOL DELTA

A Rare Case of Collagenous Gastroduodenitis (ACG 2026) - "No established treatment guidelines exist, though reported therapies include corticosteroids, proton pump inhibitors, sucralfate, and sulfasalazine. This case highlights the importance of considering collagenous gastroduodenitis in patients with unexplained upper gastrointestinal symptoms and nodular mucosa on endoscopy, even without collagenous colitis, and emphasizes careful medication review. Figure: A.Nodular stomach mucosa on endoscopy B.Nodular duodenum mucosa on endoscopy C. and D. Stomach mucosa with thickened subepithelial collagen band (light pink on the H&E images, blue on the trichrome images) E. and F. Duodenal mucosa with marked villous atrophy and a thickened subepithelial collagen band"

Clinical • Cardiovascular • Celiac Disease • Dyslipidemia • Dyspepsia • Gastroenterology • Gastrointestinal Disorder • Hypertension • Immunology • Inflammation • Mucositis • Obstructive Sleep Apnea • Rare Diseases • Respiratory Diseases • Sleep Disorder

A Rare Cause of Gastric Outlet Obstruction: Duodenal Adenosquamous Carcinoma (ACG 2026) - "She had been taking Famotidine, Pantoprazole, and Sucralfate with minimal improvement. Figure: Heterogenous enhancing tumor in the first portion of the duodenum leading to gastric outlet obstruction. Figure: Endoscopic view of large extrinsic bulge into pre-pyloric region"

Colorectal Cancer • Dyspepsia • Endocrine Disorders • Gastric Cancer • Gastroenterology • Gastrointestinal Disorder • Hepatology • Hypertension • Melanoma • Metabolic Disorders • Oncology • Small Intestinal Carcinoma • Solid Tumor

Cryoballoon Ablation for Refractory Gastric Antral Vascular Ectasia (ACG 2026) - "Medical therapies, including proton pump inhibitors, sucralfate, and combination estrogen-progesterone therapy, failed to prevent progressive anemia...Endoscopic band ligation may remain an alternative option for nodular variants of GAVE. Although larger prospective studies are needed to further define the long-term efficacy and durability of nitrous oxide cryoballoon therapy, current evidence suggests that it is a safe and effective intervention capable of reducing transfusion dependence and improving chronic anemia in refractory disease."

Celiac Disease • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Immunology • Infectious Disease

Spray Coagulation as an Alternative to Argon Plasma Coagulation for the Treatment of Radiation Proctitis (ACG 2026) - "Bleeding was treated with bipolar electrocoagulation and sucralfate enemas because APC was unavailable at the time...Spray coagulation provides similar thermal coagulation while maintaining the essential lack of direct contact with friable mucosa, minimizing further tissue injury. In this patient, spray coagulation achieved reliable hemostasis despite ongoing antiplatelet therapy, suggesting a practical and accessible alternative for endoscopic management of active bleeding in patients with radiation proctitis."

Acute Coronary Syndrome • CNS Disorders • Gastroenterology • Genito-urinary Cancer • Prostate Cancer • Solid Tumor • Thrombosis

Country Cure-All or Caustic Chemical? Severe Gastric Injury Following Accidental Ingestion of 35% Hydrogen Peroxide (ACG 2026) - "The patient received intravenous proton pump inhibitor therapy twice daily, oral sucralfate three times daily, and kept NPO for 12 hours before advancing to clear liquids, with continuous monitoring for gas embolism...This case reinforces the importance of early endoscopy, poison control notification, and systematic management in caustic ingestions. Figure: Severe, diffuse hemorrhagic inflammation, erythema, and congestion of the gastric body (A) and fundus (B)"

Hematological Disorders • Infectious Disease • Inflammation • Influenza • Respiratory Diseases

An Analysis of Outpatient EGD Findings and Impact on Patient Management in a Lower Resource Rural Setting (Honduras) (ACG 2026) - "Of these, 32% were prescribed sucralfate, 32% quadruple therapy, 26% PPI, 11% antimicrobial therapy, 3% neuromodulator, and 3% beta blocker... A total of 157 patients were evaluated in GI clinic. Of these, 29% patients (N=46) underwent EGD. 17% patients underwent endoscopic intervention, including 25% for esophageal variceal banding and 75% for endoscopic dilation."

Clinical • Candidiasis • Gastroenterology • Gastrointestinal Disorder • Infectious Disease

Bleeding Esophageal Nodule Decades After Esophageal Atresia Repair: A Diagnostic Pitfall of Postsurgical Anatomy (ACG 2026) - "The patient was managed conservatively with proton pump inhibitor therapy and sucralfate with no recurrent bleeding...Figure: Image 2. Endoscopic ultrasound (EUS) image demonstrating a well-defined, homogeneous, hyperechoic submucosal nodule 12 x 10 mm in size, confined to the submucosa with intact muscularis propria and no regional lymphadenopathy."

Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hematological Disorders

EUS Guided Gastro-Jejunostomy for Management of Gastric Outlet Obstruction Secondary to Y90 Induced Ulceration (ACG 2026) - "She underwent 4 Y90 treatments and subsequently began atezolizumab plus bevacizumab...She was treated with a proton pump inhibitor and sucralfate...By restoring luminal patency, this approach can meaningfully improve oral intake and nutritional status during ulcer healing. Figure: Esophagoduodenoscopic images of the gastric antrum demonstrating an ulcer and obstruction Figure: Esophagoduodenoscopic images of the gastric antrum demonstrating an AXIOS LAMS deployment and a clip deployed to close the site of inadvertent stent misplacement"

Fibrosis • Gastrointestinal Disorder • Hepatocellular Cancer • Hepatology • Immunology • Peptic Ulcer • Solid Tumor

Still Refluxing? Defining Mechanisms and the Role of Endoscopic Pyloric Exclusion in Stepwise Foregut Reconstruction (ACG 2026) - "He developed refractory reflux with frequent bilious emesis, positional reflux, and worsening oral intolerance despite multiple medical therapies including proton pump inhibitors (PPIs), sucralfate, and ursodeoxycholic acid. Figure: Figure 1: Serial Reconstruction of Foregut Anatomy Across Sequential Surgical and Endoscopic Interventions, starting from demonstration of gastroesophageal junction carcinoma (A), partial gastrectomy (B), gastrojejunal anastomosis and J-tube placement (C), Roux-en-Y reconstruction (D), and pyloric exclusion (E). Figure: Figure 2: HIDA-CT overlay demonstrating retrograde biliary flow from the duodenum into the stomach via the pylorus"

Barrett Esophagus • Gastric Cancer • Gastroesophageal Junction Adenocarcinoma • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Solid Tumor

Adjunct Vonoprazan in the Treatment of Gastrojejunal Anastomotic Ulcers: A Novel Use (ACG 2026) - "A Stool Guaiac test was positive with a reported history of heavy ibuprofen use, melena, and hematochezia...She was therefore trialed on Vonoprazan 20mg every other day on top of her previous pantoprazole and sucralfate regimen...P-CABs are relatively novel and function via the blockade of potassium binding sites on proton pumps in gastric parietal cells. With a proven effectiveness in H. pylori eradication, additional exploration into their uses, including the treatment of marginal ulcers, is warranted."

Bipolar Disorder • CNS Disorders • Musculoskeletal Pain • Peptic Ulcer

Recurrent Upper Gastrointestinal Bleeding From a Gastrojejunal Anastomotic Ulcer With a Visible Vessel in a Post Roux-en-Y Gastric Bypass Patient: A Case Report (ACG 2026) - "Case Description/ A 73-year-old female with a history of long-standing RYGB, coronary artery disease on aspirin 81 mg, and prior gastrointestinal bleeding secondary to chronic gastrojejunal anastomotic ulcer (GJAU) presented with melena, epigastric pain, and symptomatic anemia with a hemoglobin of 8.8 g/dL with normocytic indices...Hemostasis was difficult to achieve with standard endoscopic techniques, including epinephrine injection, bipolar cauterization, and hemostatic clip placement, owing to the chronic and fibrotic nature of the ulcer...The patient was treated with high-dose proton pump inhibitor therapy, sucralfate, and intravenous iron, resulting in hemoglobin stabilization and symptom resolution...Gastrojejunal anastomotic ulcers should be considered in post-RYGB patients presenting with gastrointestinal bleeding. Optimization of acid suppression and modification of modifiable risk factors are essential to reduce the risk of recurrence."

Bariatric surgery • Case report • Clinical • Cardiovascular • CNS Disorders • Coronary Artery Disease • Diabetes • Dyslipidemia • Fibrosis • Gastroenterology • Genetic Disorders • Hematological Disorders • Hypertension • Metabolic Disorders • Obesity • Peptic Ulcer • Type 2 Diabetes Mellitus

Topical Formalin as Salvage Therapy for APC Refractory Rectal Ulceration Bleeding in Hemorrhagic Radiation Proctitis (ACG 2026) - "Six weeks later, hematochezia recurred, and colonoscopy showed a rectal ulcer at the APC site with stigmata of recent bleeding; intervention was not feasible and he was managed with sucralfate enemas (3,4)...Image 5,6: Hemorrhagic and necrotic distal rectal mucosa with active bleeding, treated with topical formalin application via rigid scope. Image 7,8: Organized rectal ulcer with minimal bleeding and reduced mucosal friability following formalin therapy"

CNS Disorders • Gastrointestinal Disorder • Genito-urinary Cancer • Prostate Cancer • Solid Tumor

Duodenal Diverticular Hemorrhage Presenting as Syncope: A Rare Case of Upper Gastrointestinal Bleeding Managed Endoscopically (ACG 2026) - "Hemostasis was achieved with epinephrine injection (9 mL, 1:10,000) and hemoclip placement...He was discharged on pantoprazole, sucralfate, and instructed to avoid NSAIDs...This case highlights the importance of suspecting uncommon bleeding sources and the effectiveness of endoscopic combination therapy. Figure: Diverticulum in third part of duodenum with adherent clot, endoclipped bleeding vessel"

Clinical • Dyslipidemia • Gastroenterology • Hematological Disorders • Inflammation

Marginal Ulcer With Hepatic Penetration Following Bariatric Surgery (ACG 2026) - "Case Description/ A 66-year-old woman with the history of gastric sleeve and a later duodenal switch, atrial fibrillation on Apixaban, Barrett's esophagus presented with two-week history of failure to thrive, nausea, vomiting, and severe anorexia...The patient was treated with proton pump inhibitors and sucralfate and discharged with outpatient surgical follow-up...This case highlights the need for vigilance for various presentations of marginal ulcers in post-bariatric patients presenting with possible gastrointestinal bleeding. Figure: Endoscopic view of the ulcer"

Bariatric surgery • Surgery • Anorexia • Atrial Fibrillation • Barrett Esophagus • Cardiovascular • Gastroenterology • Gastrointestinal Disorder • Peptic Ulcer

When the Esophagus Turns Black: A Lethal Presentation of Acute Esophageal Necrosis (ACG 2026) - "Despite initiating the patient on high dose PPI, sucralfate slurry and total parenteral nutrition, she soon developed odynophagia...Due to its high mortality rate and risk of acute complications, AEN requires prompt recognition and timely appropriate management. Figure: Figure A- Diffuse severe mucosal changes characterized by black esophagus and severe ulceration (index endoscopy) Figure B- Improved diffuse mucosal changes characterized by black esophagus, severe ulceration and stricture"

Addiction (Opioid and Alcohol) • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Inflammation • Peptic Ulcer

Acute Esophageal Necrosis (Black Esophagus) With Multisegment Upper Gastrointestinal Injury in Diabetic Ketoacidosis (ACG 2026) - "The patient was treated with twice-daily proton pump inhibitor therapy, sucralfate, insulin therapy, intravenous fluids, and gradual diet advancement...(C) Diffuse erythema and nodularity involving the second portion of the duodenum. Figure: Follow-up endoscopy 8 weeks after treatment demonstrating complete healing of the esophageal mucosa."

Cognitive Disorders • Diabetes • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Metabolic Disorders

Double Trouble: Contrasting Esophageal Injuries Following Shared Caustic Exposure (ACG 2026) - "She quickly improved with supportive care, PPI, and sucralfate...These cases emphasize the importance of maintaining suspicion for significant esophageal injury even in hemodynamically stable patients with uncertain toxic exposure. Figure: Figure 1: Lower Third of Esophagus Initial Findings of Case 1 Figure: Figure 2: Lower Third of Esophagus Initial Findings of Case 2"

Gastrointestinal Disorder • Otorhinolaryngology

When Protection Fails: Extensive Marginal and Jejunal Ulceration in a Post-Roux-en-Y Patient on Semaglutide With Helicobacter pylori Infection (ACG 2026) - "He received guideline-concordant H. pylori eradication therapy, acid suppression, and sucralfate...Figure: Proximal jejunal limb with extensive ulceration, Gray-white fibrinous/foul exudate, and inflamed mucosa. This appears more severe than a small clean-based marginal ulcer."

Clinical • Diabetes • Gastrointestinal Disorder • Infectious Disease • Metabolic Disorders • Peptic Ulcer • Type 2 Diabetes Mellitus

Duodenal Neuroendocrine Tumor Revealed by Escherichia coli Bacteremia: Possible Implication of Tirzepatide (ACG 2026) - "Case Description/ A 62-year-old female with known history of hypertension, hyperlipidemia and obesity, for which she was initially on liraglutide then switched to tirzepatide two months prior to admission...The Patient was diagnosed with sepsis and started immediately on piperacillin tazobactam...The patient received pantoprazole 40 mg twice daily and sucralfate, resulting in improvement of abdominal pain...In our patient, the ulcer likely contributed actively to the translocation, especially in the neoplastic conditions. Figure: Duodenal Bulbar Ulcer With Pigmented Material"

Cardiovascular • Dyslipidemia • Endocrine Cancer • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Hepatology • Hypertension • Immunology • Infectious Disease • Neuroendocrine Tumor • Obesity • Oncology • Peptic Ulcer • Septic Shock • Solid Tumor

Atypical Endoscopic Findings of HSV Esophagitis in an Immunocompetent Patient (ACG 2026) - "She is initially treated with famotidine without significant symptomatic relief...Patient is treated with pantoprazole and sucralfate and referred to infectious disease...Early recognition is important because antiviral therapy with acyclovir or valacyclovir may shorten symptom duration and accelerate recovery. Figure: Image 1: Upper endoscopy showing erosive esophagitis at the distal esophagus, with pathology later revealing HSV esophagitis. Figure: Image 2: Another endoscopic view of the HSV esophagitis."

Clinical • CNS Disorders • Epilepsy • Gastrointestinal Disorder • Herpes Simplex • Infectious Disease • Inflammation

Methotrexate-Induced Esophageal Dissecans Superficialis: A Rare Complication of Accidental Overdose in a Patient With Sarcoidosis (ACG 2026) - "Methotrexate was promptly discontinued, and the patient was started on a proton pump inhibitor twice daily and sucralfate four times daily, with subsequent clinical and laboratory improvement. This case not only adds to the exceedingly limited literature on methotrexate-induced EDS but also highlights the critical role of clear patient education regarding dosing regimens for weekly medications, particularly in patients with underlying mucosal vulnerability, to prevent potentially life-threatening toxicity. Figure: Upper endoscopy demonstrated whitish inflammation, mucosal friability, ulceration, and sloughing involving the middle and lower thirds of the esophagus Figure: Upper endoscopy demonstrated whitish inflammation, mucosal friability, ulceration, and sloughing involving the middle and lower thirds of the esophagus"

Clinical • Esophageal Cancer • Gastrointestinal Disorder • Immunology • Infectious Disease • Leukopenia • Sarcoidosis • Thrombocytopenia

Healing of Anastomotic Ulcer With Vonoprazan: A Case Report (ACG 2026) - "A pharmacodynamic study comparing vonoprazan 20 mg daily with lansoprazole 30 mg daily demonstrated more rapid, potent, and prolonged intragastric acid suppression with vonoprazan (2). Figure: Figure 2. Repeat EGD in 6 months following therapy with vonoprazan and sucralfate, showing complete healing of the previously seen esophagitis and marginal ulcer."

Case report • Clinical • Cardiovascular • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Peptic Ulcer • GAST

Case Report of Diagnostic Challenge in Eosinophilic Colitis (EC) With Indeterminate Initial Colonoscopy Findings (ACG 2026) - "Brief trial of Flagyl, Sucralfate provided no relief...The patient was diagnosed with EC, and was discharged with prednisone taper with follow-up to discuss further management options...Treatment options include allergen elimination, systemic corticosteroids, and alternative agents for steroid-sparing approaches. We believe this case will aid clinicians in identifying and managing this rare condition."

Case report • Clinical • Anorexia • Colorectal Cancer • Eosinophilia • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hematological Disorders • Immunology • Inflammation • Rare Diseases

Treating Ménétrier's Disease With Cetuximab (ACG 2026) - "She had no improvement in symptoms with?Omeprazole, Carafate, or?Vonaprazan.?Her?labs were notable for Hgb 13.8, albumin 4.5, lipase 40, negative CMV PCR, normal gastrin and ACE level, and negative H pylori stool antigen. Thickened Gastric Folds on Esophagogastroduodenoscopy in Gastric Body Figure: Figure 2. Marked Foveolar Hyperplasia on Pathology Slides from Full Thickness Biopsy"

Gastric Adenocarcinoma • Infectious Disease • Solid Tumor • EGFR • GAST

When Endoscopy Isn't Enough: Salvaging a Massive Esophageal Food Impaction With Enzymatic and Carbonated Irrigation (ACG 2026) - "She was extubated, advanced to a soft diet, and discharged on proton pump inhibitor therapy and sucralfate with planned follow-up endoscopy...Airway protection, multidisciplinary care, and persistence with adjunctive strategies were key to a favorable outcome. Further study is needed to assess safety and reproducibility."

Cardiovascular • Endocrine Disorders • Gastrointestinal Disorder • Hypertension