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case_images: Upper gastrointestinal endoscopic findings in this patient 4 years prior to the current presentation, showing. Circumferential inflammation with accompanying ulcers in the thoracic esophagus. A ring-shaped ulcer in the antrum surrounding the pylorus.
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case_images: An upper gastrointestinal endoscopy performed 4 years earlier, at age 16 years, to investigate hematemesis revealed erosions and ulcers in the middle thoracic esophagus and a ring ulcer in the pyloric antrum (Figure 1a,b).
case_images: Initial upper gastrointestinal endoscopic findings in this patient at the time of initial presentation, showing. (a) Stenosis is associated with ulcers in the thoracic esophagus, with the mucosal epithelium exhibiting circumferential inflammatory changes. (b, c) Ischemic changes and pseudo-pylorus in the gastric antrum. The red arrow indicates the pseudo-pylorus, and the orange arrow indicates ischemic changes. (d) Membrane-like stenosis in the descending part of the duodenum. The membrane-like stenosis was located near the distal side of the duodenal papilla. The blue arrow indicates the duodenal papilla.
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case_images: An upper gastrointestinal endoscopy was conducted at age 20 due to episodes of repeated vomiting, black vomitus, and anemia, revealing an esophageal ulcer and stenosis in the middle thoracic esophagus (Figure 2a), ischemic changes, and a pseudo-pylorus in the gastric antrum (Figure 2b,c), and duodenal membrane-like stenosis (Figure 2d).
case_images: Histopathological findings at the margins of the esophageal ulcer. Hematoxylin and eosin staining showed enlargement of nuclei in the epithelial cells of the basal layer and homogeneous morphology and distribution of these cells.
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case_images: Heliobacter pylori infection by the gastric juice polymerase chain reaction method. Histological evaluation of the esophageal ulcer margins revealed only inflammatory cell infiltration and reactive changes, with no evidence of eosinophilic infiltration or malignancy (Figure 3).
case_images: Upper gastrointestinal endoscopic findings in this patient after treatment, showing. (a) Severe scar-induced stenosis in the thoracic esophagus 1 month after conservative treatment with acid secretion inhibitors. (b) Adequate esophageal expansion, following repeat balloon dilation of esophageal stenosis. (c) Dilation of the membrane-like stenosis of the duodenum using a scope bougie. (d) Recovery of ischemic changes, with no changes in the pseudo-pylorus of the stomach.
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case_images: An upper gastrointestinal endoscopy showed severe scar stenosis in the thoracic esophagus, rendering the passage of a small-diameter endoscope impossible (GIF 1200N, distal-end outer diameter 5.4 mm; Olympus Medical System; Figure 4a). System), whereas his esophageal stenosis was treated by balloon dilation (Figure 4b,c). Since then, the patient has been able to ingest food, but his esophageal stenosis has required regular repeated balloon dilation. Over time, the ischemic changes surrounding the pseudo-pylorus have healed (Figure 4d).