case_images: PMC11324263_01
case_images: Clinical course with endoscopic findings in the lesser curvature of the gastric angle between 20XX-6 and 20XX-4. a Esophagogastroduodenoscopy revealed a gastric ulcer in the lesser curvature of the gastric angle in 20XX-6. b The gastric ulcer still remained 2 months after Helicobacter pylori (HP) eradication. c The gastric ulcer became scarred in 20XX-5 after the start of vonoprazan treatment. d The gastric ulcer recurred in 20XX-4.
case_images: crg-2024-0018-0001-540185_F01.jpg
case_images: PMC11324263_01_crg-2024-0018-0001-540185_F01.jpg
case_images: F1
case_images: Clinical course with endoscopic findings in the lesser curvature of the gastric angle between 20XX-3 and 20XX + 1. a Esophagogastroduodenoscopy revealed a gastric ulcer in the lesser curvature of the gastric angle in 20XX-3. b The gastric ulcer still remained in 20XX-2. c The gastric ulcer still remained in 20XX. d The gastric ulcer became scarred in 20XX + 1 after the start of misoprostol treatment and changing daily vonoprazan to twice a day (linked color imaging).
case_images: crg-2024-0018-0001-540185_F02.jpg
case_images: PMC11324263_01_crg-2024-0018-0001-540185_F02.jpg
case_images: F2
case_images: In 20XX-3, polaprezinc was changed to 100 mg rebamipide, 3 times a day, but the gastric ulcer remained (Fig. 2a, b). In 20XX, the patient was admitted to the outpatient unit due to epigastric discomfort. An EGD revealed an ulcer (H1 stage) in the gastric angle (Fig. 2c). Subsequently, scarring of the ulcer was observed (Fig. 2d).
case_images: Twenty-four-hour intragastric pH monitoring. a The gastric pH was maintained between approximately pH 4 and pH 7 during the day. However, nocturnal gastric acid breakthrough was observed. b The gastric pH 1 year after the ulcer had healed indicated no improvement in acid suppression.
case_images: crg-2024-0018-0001-540185_F03.jpg
case_images: PMC11324263_01_crg-2024-0018-0001-540185_F03.jpg
case_images: F3
case_images: This showed that the pH was maintained between approximately pH 4 and pH 7 during the day; however, it was about pH 3 from midnight to 4:00 a.m., indicating nocturnal gastric acid breakthrough (Fig. 3a). Twenty-four-hour intragastric pH monitoring conducted in 20XX + 1 showed no improvement in acid suppression (Fig. 3b).