Carafate (sucralfate) / AbbVie - LARVOL DELTA

A systematic review of therapeutic options for lymphocytic esophagitis. (PubMed, Dis Esophagus) - "For patients with LyE, topical steroids seem to provide greater symptomatic and histologic benefit compared to PPIs, although recurrence is more common. For patients not already on acid suppression therapy, PPIs may still be a reasonable first-line option, especially when prioritizing safety. Further prospective studies are needed to formally assess the comparative safety and efficacy of the various treatment modalities, including novel immunosuppressive therapies."

Journal • Review • Gastrointestinal Disorder

High-Throughput Screening Using the Self-Controlled Tree-Based Scan Statistic to Identify Medications Associated With Hospitalization for Severe Acute Liver Injury. (PubMed, Pharmacoepidemiol Drug Saf) - "High-throughput screening using tree-based scan statistics detected potentially hepatotoxic drugs for investigation in future pharmacoepidemiology studies."

Journal • CNS Disorders • Gastroenterology • Hepatology • Liver Failure • Pain

Prevention of Delayed Post-polypectomy Bleeding by Endoscopic Sucralfate Spray in High-risk Patients: A Randomized Controlled Trial (clinicaltrials.gov) - P4 | N=160 | Not yet recruiting | Sponsor: National Cheng-Kung University Hospital

New P4 trial

Severe Corrosive Gastritis Caused by Accidental Ingestion of Mildly Alkaline Calcium Chloride Desiccant: A Case Report. (PubMed, DEN Open) - "The patient was diagnosed with severe corrosive gastritis and was treated with omeprazole, sucralfate, and antibiotics (SBT/ABPC). However, as in this case, even mildly alkaline agents can cause severe injuries depending on the amount ingested, presence of solid components, and time elapsed after ingestion. Therefore, it is crucial to consider this possibility in clinical practice."

Journal • Alzheimer's Disease • CNS Disorders • Dementia • Gastrointestinal Disorder

Unmasking Hidden Threat of GI Tract: Duodenal Carcinoma (ACG 2025) - "He was started on Protonix and Carafate...Patient started on systemic therapy with modified FOLFIRINOX regimen (5-FU, irinotecan, oxaliplatin, leucovorin calcium)...Chemotherapy regimens include 5-fluorouracil, capecitabine, oxaliplatin or gemcitabine with radiation therapy less commonly used. Targeted immunotherapy is still investigational, and the prognosis depends on the spread of the disease. Those without lymph node involvement have a 65% 5-year survival rate and those with lymph node involvement have a 21% 5-year survival rate."

Addiction (Opioid and Alcohol) • Anemia • Celiac Disease • Colorectal Cancer • Crohn's disease • Fatigue • Gastric Cancer • Gastroenterology • Gastrointestinal Cancer • Gastrointestinal Disorder • Genetic Disorders • Hepatology • Hypertension • Immunology • Inflammatory Bowel Disease • Oncology • Pancreatic Cancer • Pulmonary Disease • Small Intestinal Carcinoma • Solid Tumor

Petersen's Hernia in the Setting of Gastrointestinal Bleeding: A Diagnostic Challenge After Roux-en-Y Gastric Bypass (ACG 2025) - "Three weeks prior, she had an upper endoscopy (EGD) performed which showed LA grade D esophagitis and a 4 cm gastrojejunostomy (GJ) large clean based ulcer which was treated with oral proton pump inhibitor (PPI) and sucralfate...Endoscopic evaluation. Upper endoscopy revealed clean based ulceration on the jejunal limb and inflamed, friable jejunal mucosa with subepithelial hemorrhage."

Bariatric surgery • Colon Cancer • Colorectal Cancer • Dermatology • Fatigue • Gastric Cancer • Gastroenterology • Gastrointestinal Disorder • Solid Tumor

Endoscopic Vacuum Therapy for Boerhaave Syndrome and Recurrent Esophageal Perforation: A Minimally Invasive Approach (ACG 2025) - "Repeat EGD revealed LA Grade D esophagitis and a cratered esophageal ulcer with active bleeding, which was managed with epinephrine injection, bipolar cautery, and Purastat...Follow-up endoscopy showed severe diffuse esophagitis with contact oozing, and sucralfate was added to promote mucosal healing...C) Upper GI Series with Small Bowel Follow Through demonstrating gastrografin contrast accumulation in right lung base consistent with recurrent EP. D) Benign-appearing, intrinsic severe stenosis approximately 25cm from the incisors."

Addiction (Opioid and Alcohol) • Anemia • CNS Disorders • Gastrointestinal Disorder • Hematological Disorders • Respiratory Diseases

When Crohn's Climbs Higher: Esophageal Crohn's Disease (ACG 2025) - "After the biopsy result, prednisolone and sucralfate were added, and the patient responded very well to corticosteroid therapy...Corticosteroids help manage acute inflammation; anti-tumor necrosis factor (anti-TNF) and immunomodulators remain the mainstay of therapy for esophageal Crohn's. In conclusion, clinicians should consider CD in atypical presentations of esophageal disease.Figure: Esophageal ulcersFigure: "Bamboo-joint-like junctions' at the esophagus."

Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Hepatitis B • Hepatitis C • Hepatology • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammatory Bowel Disease • CRP

A Case Report of Idiopathic Esophageal Ulcer in a Renal Transplant Patient Responsive to Steroid Therapy (ACG 2025) - "We describe a case of idiopathic esophageal ulceration ultimately responsive to steroid therapy in an immunosuppressed, HIV-negative renal transplant patient.Case Description/ A 59-year-old female with renal transplant in 2023 for ADPKD presented with odynophagia after a week-long course of doxycycline for outpatient pneumonia treatment...She was initially treated with daily pantoprazole, famotidine, sucralfate and an NG tube was placed for nutrition. Her odynophagia continued and a month later repeat EGD showed persistence of the ulcer for which Vonoprazan was started...Acyclovir was initiated and NG tube was transitioned to a PEG tube to facilitate healing...Due to suspicion for idiopathic giant esophageal ulcer, she was trialed on a prednisone taper of 40 mg, decreasing by 10 mg each week...Staining for CMV, HSV, VZV, EBV negative. No fungal organisms visualized."

Case report • Clinical • Autosomal Dominant Polycystic Kidney Disease • Fibrosis • Gastrointestinal Disorder • Human Immunodeficiency Virus • Immunology • Infectious Disease • Pneumonia • Polycystic Kidney Disease • Respiratory Diseases • Solid Organ Transplantation • Transplantation

Unmasking the Uncommon: A Case Report of Esophagitis Caused by Herpes Simplex Virus (ACG 2025) - "He was fluid resuscitated and started on empiric antibiotics, ceftriaxone and vancomycin...He was started on sucralfate four times daily for 14 days, and heparin was held as safely as possible, pending a repeat EGD in two months...Some studies suggest oral or IV acyclovir may ease symptoms, while others suggest the condition is self-limiting.Figure: 1A: Esophagus Mucosa Severe (LA Class D) ulcerative esophagitis with spontaneous bleeding seen throughout the esophagus starting at 25 cm and going up to 40 cm from the incisors. The GEJ appeared to be at 40 cm and the diaphragmatic pinch was at 45cm compatible with a 5cm hiatal hernia.Figure: 1B"

Case report • Clinical • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Heart Failure • Herpes Simplex • Infectious Disease • Nephrology • Renal Disease • Septic Shock • Thrombosis

Spontaneous Eosinophilic Esophagitis (EoE) Perforation: A Rare Presentation (ACG 2025) - "He had intermittently been taking pantoprazole, sucralfate, and viscous lidocaine without much improvement...However, given the duration of the perforation ( >7 days) and clinical stability, the decision was made to maintain a strict NPO diet, total parenteral nutrition (TPN), IV pantoprazole 40 mg twice daily, IV antibiotics, and initiate IM Dupilumab 300 mg once weekly...We wish to highlight this rare presentation of EoE and successful management using conservative measures in a condition known to have high morbidity and mortality. Figure: Image 1 (a)Green Arrow- Esophogram showing contained perforation (b)Yellow Arrow- Esophogram showing no extravasation of the contrast Figure: Image 2 (a) White arrow- Spontaneous perforation leading to a sinus tract (b)Black arrow- Concentric rings and strictures (c)Green arrow- Longitudinal furrows The total EoE endoscopic reference score (EREFS) of 8."

Eosinophilic Esophagitis • Gastrointestinal Disorder • Immunology

When Pancreatitis Turns Black: A Case Report of Acute Esophageal Necrosis (ACG 2025) - "The patient was managed conservatively with intravenous fluids, high-dose proton pump inhibitors, and oral sucralfate...Prompt recognition, exclusion of complications such as perforation, and early supportive care are essential for favorable outcomes, as demonstrated in this case.Figure: CT Abdomen revealing significant peripancreatic fat stranding compatible with acute pancreatitis. There is an area of decreased density at the body of the pancreas measuring 3.1 cm, suggestive of necrosis.Figure: Upper endoscopy before ERCP showing black necrotic mucosa with confluent and cratered ulcerations scattered in the entire esophagus"

Case report • Clinical • Cardiovascular • Dyslipidemia • Gastroenterology • Gastrointestinal Disorder • Hypertension • Immunology • Inflammation • Metabolic Disorders • Pancreatitis • Respiratory Diseases • Systemic Inflammatory Response Syndrome

Black Esophagus in Patients With Diabetic Ketoacidosis: Risk Factors, Diagnostic Challenges, and Outcomes of Acute Esophageal Necrosis (ACG 2025) - "Treatment involved treating DKA with insulin drip or infusion, IV fluids, high-dose PPI's, blood transfusions, and sucralfate. Among included studies, the majority of patients were middle-aged to elderly males with an average age of 56 and a range of 23-87. The most common comorbidities noted included coronary artery disease, renal failure, alcohol or substance use, malnutrition, and psychiatric illness. The majority of cases involved severe DKA with blood glucose above 800 mg/dL, acidosis with pH 20."

Clinical • Coronary Artery Disease • Gastrointestinal Disorder • Infectious Disease • Mental Retardation • Metabolic Disorders • Nephrology • Psychiatry • Renal Disease • Septic Shock

From Virtual to Procedural: A Case of Candy Cane Syndrome Diagnosed Through Hybrid GI Care (ACG 2025) - "She was placed on omeprazole 40 mg twice per day and sucralfate 1 g tablet three times per day due to prior peptic ulcer disease. Importantly, this case demonstrates how hybrid care models—integrating virtual multidisciplinary care with selective in-person procedural escalation— can enable accurate, timely diagnosis and comprehensive management of complex postoperative conditions. Virtual multidisciplinary models can enhance access to expert evaluation, coordinate diagnostic strategies, and support earlier recognition of complications like Candy Cane Syndrome, ultimately improving outcomes in complex GI presentations."

Clinical • Anemia • Cognitive Disorders • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Peptic Ulcer • Retinal Disorders • CRP

Giant Gastric Folds, Subtle Signs: Ménétrier-Like Disease in a Young Adult (ACG 2025) - "Stool PCR testing for enteric pathogens was also negative.He was managed symptomatically with scopolamine, sucralfate, PPI, and a high-protein diet...Continued surveillance is recommended due to the risk of recurrence or progression.Figure: Figure 1: Endoscopic view demonstrating circumferential hypertrophic rugae and hyperemic mucosa without ulceration or bleeding with abundant, thick mucus. Figure: Figure 2: Marked foveolar hyperplasia with elongation, tortuosity, and loss of mucin in the foveolae with active, chronic inflammation."

Clinical • Cytomegalovirus Infection • Epstein-Barr Virus Infections • Gastric Cancer • Gastrointestinal Disorder • Herpes Simplex • Infectious Disease • Pediatrics • Renal Disease • Solid Tumor

Two H. pylori Are Not Better Than One (ACG 2025) - "He was treated with pantoprazole 40 mg twice daily and carafate 4 times daily. Early identification can aid in more accurate diagnosis and improved management. Additionally, heightened awareness can enhance the safety of EGDs in this setting with improved patient outcomes.Figure: This image depicts the progression of the double pylorus formation through subsequent EGDs"

Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Peptic Ulcer

Rare Case of Large Duodenal Ulcer From Immune Checkpoint Inhibitor Therapy (ACG 2025) - "Her treatment course included neoadjuvant chemotherapy with carboplatin, paclitaxel, and pembrolizumab, a left partial mastectomy with no residual carcinoma and subsequent adjuvant chemotherapy with cyclophosphamide, doxorubicin and pembrolizumab...Prior to ICI treatment, any GERD symptoms had been well-controlled with famotidine...Omeprazole dose was maximized, sucralfate was continued and she was recommended to discontinue her pembrolizumab treatment to avoid further ICI related complications. Immune checkpoint inhibitor related adverse effects (IrAEs) involving the upper GI tract are rare and lacking in a formal grading system and treatment algorithms, unlike ICI colitis...In order to recognize, diagnose and treat these rare side effects early and effectively there should be strong collaboration between oncologists and gastroenterologists. This case highlights the need for further research into the pathophysiology and guidance for management of ICI induced duodenitis..."

Checkpoint inhibition • Clinical • Dyspepsia • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Genetic Disorders • Hematological Disorders • Immunology • Neutropenia • Oncology • Pancreatitis • Peptic Ulcer • Solid Tumor • HER-2 • PMS2

Cannabinoid Hyperemesis Syndrome and Gastroparesis: A Complex Case Resolved with Endoscopic Pyloric Dilation (ACG 2025) - "Initial treatments included proton pump inhibitors (PPIs), sucralfate, and dietary modifications: low-fat, small-volume meals...Future research should explore long-term outcomes of pyloric dilation and better biomarkers to distinguish CHS from gastroparesis. Until then, adaptability remains key to bridging gaps between evidence and patient care.Figure: A) Pre-Dilation Pyloric StenosisB) Post-Dilation Pylorus is now normal sized"

Clinical • Cardiovascular • Diabetes • Gastrointestinal Disorder • Metabolic Disorders • Type 1 Diabetes Mellitus

A Rare Case of Immune Checkpoint Inhibitor Esophagitis Due to Pembrolizumab (ACG 2025) - "We describe a case of grade 3/4 pembrolizumab-induced esophagitis and mucositis in a patient receiving treatment for stage IIA breast adenocarcinoma.Case Description/ A 72-year-old female with triple-negative, poorly differentiated stage IIA breast adenocarcinoma achieved complete response to neoadjuvant therapy (doxorubicin, cyclophosphamide, and pembrolizumab)...Her symptoms proved refractory to empiric therapies including azithromycin, nystatin, fluconazole, micafungin, and saline gargles...Flexible laryngoscopy confirmed ulcerative mucositis with concomitant laryngopharyngitis.Pembrolizumab was discontinued, and she was initiated on prednisone 1 mg/kg, achieving significant pain improvement within one week...Treatment with fluconazole and pantoprazole was initiated...Management includes acid suppression (PPIs, H2 blockers), mucosal protectants (sucralfate), and corticosteroids for moderate to severe cases. This case highlights the need for clinician awareness of rare..."

Checkpoint inhibition • Clinical • Breast Cancer • Dermatology • Gastroenterology • Gastrointestinal Disorder • Immunology • Mucositis • Oncology • Triple Negative Breast Cancer

Gastric Mucormycosis in a Critically Ill Patient Who Survived: A Case Report (ACG 2025) - "The patient was on a proton pump inhibitor (PPI), sucralfate, and enteral nutrition...The patient was discharged home on supplemental oxygen, requiring home care, and on an extensive medication regimen, including apixaban, isavuconazonium, metformin, and pantoprazole...No background gastric mucosa was seen. Figure: EGD was performed which showed a necrotic mass."

Case report • Clinical • Acute Respiratory Distress Syndrome • Anemia • Diabetes • Gastroenterology • Infectious Disease • Metabolic Disorders • Pneumonia • Renal Disease • Respiratory Diseases • Septic Shock

Diffuse Eosinophilic Gastrointestinal Disease Secondary to Strongyloides stercoralis (ACG 2025) - "Despite treatment with Reglan for concerns of esophageal dysmotility and Carafate, he lost 65lbs and intermittently required parenteral nutrition...Patient was placed on prednisone and colestipol, and although his weight stabilized, his diarrhea persisted with intermittent nocturnal incontinence...Colonic biopsy revealing extensive background eosinophilia1b. Evidence of rare parasitic microorganisms within crypts"

Eosinophilia • Gastroenterology • Gastrointestinal Disorder • Infectious Disease

Shocked by a Bleeding Duodenal Polyp: A Case of Stress-Related Mucosal Disease (ACG 2025) - "He completed a course of ceftriaxone and azithromycin, was weaned off pressors, extubated, and downgraded until his nurse noted melena. The patient was readmitted to the ICU for hemorrhagic shock in the setting of UGIB and was given 2U of packed red blood cells, IVF, IV pantoprazole, and sucralfate...We highlight the importance of including duodenal polyps in the differential for an UGIB, particularly in the setting of septic shock with vasopressor use, due to the bleeding risk associated with exacerbation of SRMD. This case demonstrates that duodenal polyps, specifically those with a visible and actively bleeding vessel, may be amenable to therapeutic options currently used in the setting of ulcerations with actively bleeding vessels.Figure: Figure 1: The actively bleeding duodenal polyp as visualized on EGDFigure: Figure 2: Cessation of bleeding observed from the visible vessel within the duodenal polyp after (a) the local injection of epinephrine and (b) application..."

Clinical • Asthma • Cardiovascular • Gastrointestinal Disorder • Hematological Disorders • Hypotension • Immunology • Infectious Disease • Pneumonia • Respiratory Diseases • Septic Shock

Emergent Management of a Bleeding Posterior Duodenal Ulcer: A Case for Early Surgical Involvement (ACG 2025) - "High-dose intravenous proton pump inhibitors and sucralfate were initiated...Here, surgery was both appropriate and life-saving. This case supports a collaborative strategy: begin with endoscopy, but escalate early to surgery when clinically indicated to ensure the best outcomes."

Clinical • Gastroenterology • Gastrointestinal Disorder • Hypotension • Peptic Ulcer

Formaldehyde Fix: A Novel Approach to Management of Radiation Proctitis Ulcers (ACG 2025) - "He was also managed with hyperbaric oxygen as well as Carafate enemas, which unfortunately failed to control rectal bleeding...In the study by Yeoh et al, comparing APC and formaldehyde application, complete bleeding cessation was achieved in 100% of the patients in the formaldehyde group compared to 94% in the APC group. As clinicians, it is important to prioritize research and evidence-based practices to enhance patients' outcomes with minimal adverse effects when faced with challenges of managing complex cases without a gold standard treatment.Figure: Fig 1.1 Radiation Proctitis UlcerFigure: Pre- and Post-Formaldehyde use"

Anemia • Genito-urinary Cancer • Prostate Cancer • Solid Tumor

Vonoprazan as Salvage Therapy in Recalcitrant Gastro-Jejunal Marginal Ulcer (ACG 2025) - "The patient had a known history of gastrojejunal anastomotic ulcer two years prior that had responded to open capsule esomeprazole 40 mg twice daily, sucralfate 1 gram four times dailiy, and was healed as of eight months prior...Of note, patient had recently been taking meloxicam as needed for chronic back pain...After 2 days of medical therapy with pantoprazole 40 mg IV twice daily, no further bleeding was noted...Figure: Figure 2. The previous area of marginal ulceration has healed."

Back Pain • Cardiovascular • Hypotension • Musculoskeletal Pain • Peptic Ulcer