Search Results (917)

This study evaluated dietary sterol-rich yeast hydrolysate (SYH) at 0, 0.2, 0.5, and 0.8 g/kg in 720 yellow-feathered broiler breeder hens for 6 weeks. The tested SYH, supplied as a powder, contained 9.24% mannan, 3.1% total sterols, 2.0% amino nitrogen, and 3.64 g/kg nucleotides. Serum lipoproteins, intestinal morphology, digestive enzyme activities, barrier-related gene expression, and cecal microbiota were assessed. Low-density lipoprotein cholesterol was higher in J-C than in Control, J-A, and J-B, whereas high-density lipoprotein cholesterol did not differ among treatments. Duodenal lipase showed a significant overall treatment effect, but no Dunn–Holm pairwise comparison remained significant; ileal lipase was higher in J-C than in J-A. For barrier-related transcripts, J-A had higher ZO-1 than the Control and J-B and higher occludin and claudin-1 than all other groups, whereas MUC2 was higher in J-A and J-C than in the Control. These transcript changes are consistent with the modulation of molecular components associated with intestinal barrier integrity, but they do not by themselves demonstrate improved barrier function. Intestinal morphology showed selective, segment-specific differences rather than a consistent dose-related pattern. Alpha diversity did not differ, whereas Bray–Curtis PERMANOVA detected an overall difference among treatments (p = 0.017) despite overlapping PCoA distributions. Pairwise differential-abundance analysis using metagenomeSeq identified six family- or genus-level differences after false-discovery-rate correction, but these were specific to individual pairwise comparisons and showed no monotonic dose pattern. No exploratory microbiota–phenotype correlation remained significant after multiple-testing correction. Overall, SYH elicited inclusion-level- and trait-specific responses rather than a coordinated improvement across endpoints; therefore, the present data do not identify a single optimal inclusion level. Full article

Background: Peganum harmala L. stem ethanolic extract (PHL) has been scarcely evaluated as a ruminant feed component. We evaluated its effects on serum inflammatory and antioxidant biomarkers and duodenal and hepatic molecular responses in Hu sheep. Methods: Twelve male Hu sheep, approximately 120 days old, were randomly assigned to a control group or a PHL treatment group (n = 6 per group). After a 7-day adaptation period, the PHL group received 3 g/head/day of PHL (total flavonoid content: 65.7 mg rutin equivalents (RE)/g; approximately 197.1 mg RE/head/day) for 50 days. Serum markers, duodenal untargeted liquid chromatography–mass spectrometry (LC–MS) metabolomics, liver RNA sequencing, and alternative splicing were analyzed. Results: Serum interleukin-6 and malondialdehyde were lower, whereas interleukin-4 and glutathione peroxidase were higher, in the PHL group than in the control group (p < 0.05). Using variable importance in projection ≥ 1, fold change ≥ 1.2 or ≤0.83, and unadjusted p < 0.05 as screening criteria, 479 LC–MS features met these nominal screening criteria, of which 81 had database annotations. Following Benjamini–Hochberg correction, only two features remained significant (q < 0.05); however, only one was successfully annotated, rendering the pathway analysis exploratory. Liver RNA sequencing identified 279 differentially expressed genes (absolute log₂FC ≥ 1 and q ≤ 0.001) and 104 skipped-exon events (false discovery rate < 0.05). Functional enrichment analysis highlighted annotations related to bile secretion, ATP-binding cassette transport, nutrient metabolism, and glutathione metabolism. Conclusions: PHL supplementation was associated with selective changes in serum inflammatory and antioxidant biomarkers, accompanied by hepatic molecular responses. The duodenal metabolomic findings remain exploratory, and dose–response studies incorporating alkaloid quantification and targeted molecular validation are required before practical application can be considered. Full article

Background/Objectives: Obesity is paradoxically associated with iron deficiency despite adequate dietary intake, driven by chronic inflammation and elevated hepcidin. Different dietary patterns may differentially affect iron metabolism in obese individuals, yet comparative evidence remains limited. Methods: We conducted a systematic literature review following PRISMA 2020 guidelines. Four databases (SciSpace, Google Scholar, PubMed) were searched through 2025 using terms related to obesity, iron deficiency, and three dietary patterns: Mediterranean diet, ketogenic diet, and intermittent fasting. Studies were screened using seven predefined criteria (three inclusion, four exclusion) with thresholds of ≥4.0/5.0 for abstract screening and ≥4.5/5.0 for full-text screening. Results: From 396 identified records (SciSpace n = 325, Google Scholar n = 57, PubMed n = 14), 38 studies were included after removing 62 duplicates and screening 334 unique records. Studies without accessible full text were excluded.The Mediterranean diet appears most protective for iron status due to its anti-inflammatory profile (omega-3 fatty acids, polyphenols, vitamin C) and bioavailable iron sources. Ketogenic diets may impair duodenal iron absorption through hepcidin-independent mechanisms and restrict dietary iron diversity. Intermittent fasting shows complex effects, remodeling iron metabolism with increased transferrin and decreased ferritin within physiological ranges. Weight loss per se consistently improves iron status by reducing adipose-driven inflammation and lowering hepcidin. Conclusions: Among the three dietary patterns examined, the Mediterranean diet appears most protective for iron status in obese individuals. The ketogenic diet may pose the highest risk due to restricted dietary iron diversity and potential hepcidin-independent absorption impairment. Direct comparative randomized controlled trials are urgently needed. Clinicians should routinely monitor iron biomarkers, including hepcidin, in obese patients undertaking any dietary intervention. Quantitative biomarker data from the 38 included studies showed serum ferritin reductions of 8–28%, hemoglobin levels remaining within clinically stable ranges, and IL-6 decreases of 15–42% across dietary patterns. Full article

Wle vanillin is widely used as a flavoring agent in food products, its potential as a non-antibiotic feed additive for broilers remains unexplored. This study primarily investigated the effects of dietary supplementation of vanillin on antioxidant activity, anti-inflammatory response, immune function, and gut microbiota composition in broilers. One-day-old male broilers were randomly assigned to five groups: a basal diet group, a positive control group (basal diet + 100 mg/kg chlortetracycline (CTC)), and three vanillin-supplemented groups (0.1%, 0.2%, or 0.4%) for 42 days. Results showed that vanillin improved antioxidant capacity, with elevated serum superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activity and reduced malondialdehyde (MDA) levels. Broilers receiving vanillin supplementation showed lower levels of pro-inflammatory cytokines (interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α)) and higher interleukin-10 (IL-10) expression compared with controls. Additionally, serum immunoglobulin A (IgA) and immunoglobulin M (IgM) levels were also greater in the vanillin group. It also enhanced intestinal health by increasing the duodenal villus height-to-crypt depth ratio, improving intestinal morphology, raising the Firmicutes-to-Bacteroidetes ratio, and promoting Lactobacillus proliferation compared with CTC. Notably, growth performance data were exploratory in nature; vanillin was associated with numerical improvements in average daily gain (ADG) and feed conversion (F/G) ratio. These preliminary findings suggest that vanillin requires further investigation as a potential feed additive. Full article

Background/Objectives: Three-dimensional (3D) reconstruction of contrast-enhanced computed tomography (CT) data has shown value in elective hepato-pancreato-biliary (HPB) surgery, but its role in complex abdominal emergencies remains poorly defined. Complex emergency HPB operations are high-acuity procedures in which precise preoperative anatomical knowledge directly influences outcome, because inadequate characterization of vascular relationships in these operations may lead to intraoperative catastrophe, unrecognized vascular injury, incomplete resection, or perioperative death. We report a retrospective proof-of-concept case series designed to test whether 3D reconstructions generated from preoperative CT datasets, when read by an operator blinded to the intraoperative findings, correspond to the intraoperative findings used as ground truth and provide anatomical information beyond the original conventional CT report. Methods: Single-center retrospective consecutive case series of five patients who underwent complex emergency HPB surgery at the Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor,” Cluj-Napoca, Romania, between July 2018 and July 2022. All operations were guided by conventional contrast-enhanced CT. Three-dimensional reconstructions were generated after surgery, from the archived preoperative CT datasets by a single reader who was blinded to the intraoperative findings, to the operative note, and to the histopathological diagnosis. The 3D reconstructions were compared qualitatively with the intraoperative findings (ground truth) and with the original radiological report. Results: Five patients (3 women, 2 men; mean age 62.2 years) were analyzed: a right colonic flexure tumor with duodenal invasion, a duodenal gastrointestinal stromal tumor (GIST), an aortoduodenal fistula, a complex bilioduodenal fistulization with right hepatic artery pseudoaneurysm, and a periampullary tumor in contact with the inferior vena cava (IVC). In all five cases the blinded 3D reconstruction corresponded closely with the intraoperative findings, whereas the original conventional CT report did not match the intraoperative ground truth as precisely—particularly with respect to the exact location, the longitudinal and circumferential extent, and the local topography of vascular involvement and of fistulous tracts. Conclusions: Under blinded retrospective comparison, post hoc 3D reconstructions—generated through independent reassessment of the archived CT imaging by a reader blinded to the intraoperative findings—corresponded more closely with intraoperative findings than the original same-day emergency CT report in depicting vascular topography across five complex emergency HPB operations. These hypothesis-generating findings motivate a prospective study of preoperative 3D reconstruction within the emergency imaging pathway. Full article

Background: Inferior vena cava (IVC) graft–enteric fistula is an exceptionally rare but potentially fatal complication of caval reconstruction. Case Presentation: A 22-year-old woman with previous IVC and right renal vein reconstruction presented with an 18-month history of intermittent abdominal pain, diarrhea, and progressive anemia. On admission, contrast-enhanced computed tomography demonstrated a thrombosed IVC graft with perigraft gas and fluid, loss of the fat plane between the graft and adjacent bowel, and a multiloculated right psoas abscess. Escherichia coli was isolated from blood and drainage cultures. Upper gastrointestinal endoscopy directly visualized prosthetic graft material protruding into the descending duodenum, confirming a graft–enteric fistula. After targeted antimicrobial therapy and stabilization, the patient underwent complete graft explantation, resection of the involved duodenal and jejunal segments, duodenojejunal reconstruction, and extensive retroperitoneal debridement. She remained free of recurrent infection, fistula, and gastrointestinal bleeding at 5-year follow-up. Conclusions: In patients with previous caval reconstruction, persistent gastrointestinal symptoms, unexplained anemia, bacteremia, or retroperitoneal infection should raise suspicion for a graft–enteric fistula. Computed tomography may identify suggestive perigraft changes, whereas endoscopy can provide direct confirmation of luminal erosion. Full article

The study evaluated the effects of dietary compound enzyme preparations (CEPs) supplementation on antioxidant capacity, immune response, and intestinal health of pigeons. A total of 288 White King parent pigeons were randomly assigned to four treatments, with six replications of 12 pigeons each. The control (CK) group received a basal diet, whereas the CEP groups were fed a basal diet with 0.25 g/kg (low compound enzyme preparation group, LCEP), 0.5 g/kg (middle compound enzyme preparation group, MCEP), and 1.0 g/kg (high compound enzyme preparation group, HCEP) CEPs. Results showed that supplementation with 0.25 g/kg of CEPs significantly increased duodenal crypt depth (CD), as well as jejunal villus height (VH) and the villus height-to-crypt depth ratio (VCR) (p < 0.05). It also increased the immunoglobulins of serum, such as IgA, IgG, and IgM, as well as enhanced antioxidant capacity by increasing superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities of serum (p < 0.05). Furthermore, we found that CEPs altered ileum content microbiota composition, increasing the relative abundance of p_Bacteroidota and g_Bifidobacterium (p < 0.05). In addition, untargeted metabolomics analysis identified 92 upregulated and 95 downregulated metabolites. Pathway enrichment analysis of these differential metabolites revealed that CEP supplementation altered the metabolomic profile of the ileum contents, with differential metabolites mainly enriched in alanine, aspartate and glutamate metabolism, fatty acid biosynthesis, and unsaturated fatty acid biosynthesis pathways. These results demonstrated that dietary supplementation with CEPs at different doses improved antioxidant capacity to varying degrees and maintained intestinal immune balance by modulating microbiota, which provides a theoretical basis for the rational application of compound enzyme preparations in breeding pigeon feed. Moreover, this study provides mechanistic evidence that CEPs can improve intestinal health, immunity, and antioxidant capacity. It also fills a key knowledge gap in pigeon nutrition by linking enzyme use with gut microbiota and metabolic regulation. Full article

Stereotactic body radiotherapy (SBRT) is an effective and increasingly utilized treatment modality for abdominal tumors, offering high rates of local control with generally acceptable toxicity profiles. Nevertheless, rare but severe late gastrointestinal complications, including radiation-induced ulceration, may occur and significantly impair patients’ quality of life, as well as continuation of oncologic treatment. Hyperbaric oxygen therapy (HBOT) has shown potential benefit in the management of chronic radiation-induced tissue injury, although evidence regarding its role following SBRT remains limited. We report the case of a 75-year-old woman with cholangiocellular carcinoma who developed severe radiation-induced duodenal ulceration following liver SBRT, presenting with persistent postprandial pain, nausea, vomiting, and substantial weight loss despite standard supportive treatment. Helicobacter pylori testing was negative, non-steroidal anti-inflammatory drug use was excluded, and histopathology showed chronic inflammatory and fibrotic mucosal injury with reactive epithelial changes. Despite high-dose proton pump inhibition, bismuth subcitrate, and nutritional support, symptoms and endoscopic ulceration persisted. HBOT was administered at 2.4 atmospheres absolute for 60 min over 30 sessions. Clinical improvement was noted after three sessions, and treatment was completed without adverse effects. Follow-up endoscopy demonstrated almost complete ulcer regression, with complete symptom resolution, improved oral intake, and a 10 kg weight gain. To the best of our knowledge, this represents the first reported case describing the successful use of HBOT as a potentially effective adjunctive treatment for severe radiation-induced duodenal ulceration following liver SBRT in a patient with cholangiocarcinoma. Although encouraging, this observation should be interpreted cautiously, and prospective clinical studies are needed to further evaluate the efficacy, safety, and optimal timing of HBOT in this setting. Full article

Background: Eosinophilic jejuno-duodenitis is a rare inflammatory disorder characterized by eosinophilic infiltration of the gastrointestinal tract, with highly variable clinical presentations. Mucosal eosinophilic duodenitis and jejunitis associated with ascites is uncommon and may mimic inflammatory or neoplastic conditions. Case Presentation: A 26-year-old male presented with persistent left-sided abdominal pain without bowel habit changes. Laboratory investigations revealed only slight inflammatory syndrome and peripheral eosinophilia. Contrast-enhanced abdominopelvic computed tomography demonstrated minimal ascites and circumferential wall thickening with contrast enhancement of duodenal and jejunal loops in the left flank. Given the nonspecific imaging findings, differential diagnoses included Crohn’s disease, intestinal lymphoma, and infectious enteritis. Endoscopic evaluation with histopathological analysis confirmed dense eosinophilic infiltration of the duodenal and jejunal mucosa, establishing the diagnosis of eosinophilic jejuno-duodenitis after exclusion of secondary causes. Management and Outcome: The patient was treated with budesonide, with rapid clinical improvement and resolution of inflammatory markers. Follow-up magnetic resonance enterography performed three months after initiation of treatment demonstrated complete resolution of bowel wall thickening and disappearance of the minimal ascites. Conclusions: Eosinophilic jejuno-duodenitis should be considered in young patients presenting with small bowel thickening, ascites, and peripheral eosinophilia. Awareness of this entity is essential to avoid misdiagnosis and unnecessary invasive procedures. Full article

Background: The Braak hypothesis proposes that α-synuclein (α-syn) pathology may originate in the gastrointestinal tract and propagate to the central nervous system along the gut–brain axis; however, the precise propagation routes and the factors influencing this process remain controversial. Methods: A gut-originating Parkinson’s disease model was established by injecting α-syn preformed fibrils (PFF) into the duodenal muscularis of C57BL/6J and A53T transgenic mice. Phosphorylated α-synuclein (p-α-syn) pathology, motor behavior, and gut microbiota were assessed, with truncal vagotomy included to evaluate its association with gut-to-brain propagation. Results: In C57BL/6J mice, at 4 months post-injection, p-α-syn deposition was observed in both the duodenal muscular layer and the striatum, accompanied by gut microbiota alterations and motor behavioral deficits. Truncal vagotomy was associated with reduced p-α-syn levels in the brain and alterations in the gut microbiota. In A53T transgenic mice, p-α-syn pathology and neurodegenerative changes were also observed following α-syn PFF injection, though the lack of a genetically matched wild-type control precludes definitive attribution of these phenotypes solely to the A53T transgene. Conclusions: These results align with the Braak hypothesis, showing that gut-derived p-α-syn pathology and associated functional impairments are intimately linked to vagal pathways during their propagation to the brain. Additionally, this gut-origin PD mouse model may serve as a useful tool for future mechanistic investigations. Full article

This study evaluated the effects of dietary Zanthoxylum armatum DC. ‘Jiuyeqing’ leaf extract (ZBLE) in laying hens. A total of 1024 healthy 41-week-old Lohmann Pink layers were assigned to four treatments with eight replicates of 32 hens and fed diets containing 0, 2, 4, or 6 g ZBLE/kg for 8 weeks. The results showed that laying rate significantly increased linearly during weeks 1–4 and 1–8 (p = 0.009 and 0.005, respectively), and the 6 g/kg group had a higher laying rate than the control group (CON) over weeks 1–8 (p = 0.026). Yolk color score increased (p < 0.001), and serum immunoglobulin M concentration increased significantly (p = 0.007), whereas serum biochemical parameters remained unchanged. Serum total antioxidant capacity and total superoxide dismutase activity and hepatic total antioxidant capacity and catalase activity increased significantly, whereas serum malondialdehyde decreased. Intestinal responses were segment-specific, with increased duodenal villus height, alongside greater jejunal crypt depth and a lower jejunal villus-to-crypt ratio at 6 g/kg. Hepatic metabolomic comparison between the CON and 6 g/kg groups indicated that glycerophospholipid metabolism was the most strongly enriched pathway. Overall, 6 g ZBLE/kg produced the most favorable response among the tested levels and may serve as a plant-based feed additive for laying hens. Full article

Whipple disease is a rare systemic infection caused by Tropheryma whipplei that often presents with nonspecific gastrointestinal symptoms and may mimic other disorders. We report the case of a 75-year-old woman with type 2 diabetes mellitus who presented with chronic diarrhoea and a 15 kg unintentional weight loss over 6 months despite preserved appetite. Laboratory investigations revealed iron-deficiency anaemia, hypoproteinaemia, mild inflammatory and liver function abnormalities, and peripheral eosinophilia. Extensive infectious, autoimmune, and gastrointestinal investigations were unrevealing. Abdominal computed tomography demonstrated mesenteric lymphadenopathy, raising suspicion for lymphoma. Histopathological examination of duodenal biopsies revealed numerous foamy macrophages containing periodic acid–Schiff-positive, diastase-resistant granular material, consistent with Whipple disease. Ziehl–Neelsen staining additionally demonstrated acid-fast bacilli, and subsequent investigations confirmed concomitant Mycobacterium szulgai infection. The significance of this finding remains uncertain, as it may represent either true coinfection or incidental colonisation. A potential explanation is that T. whipplei-induced macrophage dysfunction creates a permissive intracellular niche for nontuberculous mycobacteria, although supporting evidence is lacking. Following antimicrobial therapy, the patient experienced marked clinical improvement with resolution of symptoms and an 8 kg weight gain. This case highlights the diagnostic challenges of Whipple disease and the need to consider concomitant mycobacterial infection when acid-fast organisms are identified. Full article

In this study, we investigated the protective effects of CPP-C3M4 against Salmonella-induced hepatic injury in lambs. Thirty 72-day-old Hu sheep were randomly divided into five groups: the control group (CON), the Salmonella-infected group (ST), and three CPP-C3M4 pretreatment groups at low, medium and high doses (CPP-C3M4-L, CPP-C3M4-M, and CPP-C3M4-H). The results showed that administration of CPP-C3M4 via duodenal fistula significantly alleviated liver enlargement and histopathological damage caused by Salmonella infection. CPP-C3M4 improved liver function by reducing alanine aminotransferase (ALT), aspartate aminotransferase (AST), and triglyceride (TG) levels. It enhanced the liver antioxidant capacity by increasing glutathione peroxidase (GSH-Px), catalase (CAT), and superoxide dismutase (SOD) activities. It also alleviated inflammatory responses by downregulating the mRNA expression of interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2), toll-like receptor 2 (TLR2), and toll-like receptor 9 (TLR9). Transcriptomic Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis further confirmed that CPP-C3M4 exerts its protective effects by suppressing multiple inflammatory pathways, with the interleukin-17 (IL-17) signaling axis being a key target of regulation. These results indicate that CPP-C3M4 is a promising alternative antimicrobial substance for preventing and alleviating Salmonella-induced liver injury in lambs. Full article

Background/Objectives: Congenital gastrointestinal malformations (CGIMs) remain a significant cause of pediatric mortality, particularly during the neonatal period in resource-limited settings. Mortality varies widely, across conditions and healthcare systems, yet data from Eastern European centers remain limited. We aimed to determine mortality during index admission and identify baseline factors associated with death among children with CGIMs treated at our tertiary surgical center, including the COVID-19 pandemic years. Methods: We conducted a single-center retrospective study (January 2020–December 2024) of all consecutive children admitted with congenital gastrointestinal malformations. The primary outcome was death during index admission. Secondary mortality outcomes included death within 30 days of admission and 30-day postoperative mortality. Comparisons were performed between survivors and non-survivors. Data were extracted from medical records and potential risk factors of mortality were evaluated using univariable analyses and multivariable logistic regression. Statistical analysis was performed using SPSS version 31 (IBM) and a p-value of <0.05 was considered statistically significant. Results: Overall, index-admission mortality was 11.7% (27/231), with 55.6% of deaths occurring within 30 days from admission and 85.2% occurring postoperatively. Mortality was highest among patients with cloacal malformations, duodenal atresia/stenosis, and esophageal atresia ± tracheoesophageal fistula. Deaths occurring during the neonatal period accounted for 85% of all deaths. Compared with survivors, non-survivors had significantly lower birth weight, gestational age, and Apgar scores, increased ASA score, and higher rates of prematurity, syndromic conditions, associated anomalies, and sepsis. In multivariable analysis, prematurity remained independently associated with index-admission mortality (adjusted OR 3.20, 95% CI 1.23–8.31; p = 0.017). In an exploratory multivariable analysis including in-hospital complications, sepsis was strongly associated with mortality (adjusted OR 8.63, 95% CI 3.16–23.55, p < 0.001). Conclusions: Mortality during index admission remained substantial among children with congenital gastrointestinal malformations. Prematurity was the only baseline characteristic independently associated with mortality. In an exploratory analysis, sepsis identified from retrospective clinical documentation was associated with mortality. Improved care for preterm infants and prevention of severe infection may improve outcomes. Larger multicenter studies are needed to validate these findings and refine risk stratification strategies for high-risk patients. Full article

Background and Clinical Significance: Enfortumab vedotin combined with pembrolizumab has emerged as an effective first-line therapy for advanced urothelial carcinoma. While immune checkpoint inhibitors are associated with digestive tract toxicities, upper gastrointestinal involvement such as esophagitis remains rare, and its presentation in combination with enfortumab vedotin is not well characterized. Case Presentation: A 72-year-old man with metastatic urothelial carcinoma presented with generalized weakness, poor oral intake, odynophagia, dysphagia, anemia, and systemic symptoms following the second cycle of combination therapy of enfortumab vedotin and pembrolizumab. Endoscopic evaluation revealed diffuse circumferential ulcerative esophagitis involving the entire esophagus, with associated duodenitis. Infectious workup, including Clostridioides difficile, cytomegalovirus, and human immunodeficiency virus testing, was negative, and HSV-1 IgG was positive, consistent with prior exposure rather than active infection; however, tissue-based testing for active HSV infection was not performed. Lower gastrointestinal evaluation demonstrated nonspecific rectal inflammation. The patient was treated with high-dose intravenous corticosteroids (intravenous methylprednisolone 1 mg/kg/day) with rapid clinical improvement within 48–72 h, followed by a steroid taper and supportive care. Conclusions: This case represents a severe and diffuse manifestation of esophagitis associated with enfortumab vedotin and pembrolizumab therapy. While immune-mediated esophagitis is rare, the combination of antibody–drug conjugate therapy with immune checkpoint inhibition may contribute to synergistic mucosal injury. Early recognition and prompt initiation of immunosuppressive therapy are critical for favorable outcomes. Clinicians should be aware of severe esophagitis as a potential complication of enfortumab vedotin and pembrolizumab therapy. Timely diagnosis and management with corticosteroids can lead to rapid symptom resolution and may prevent serious complications. Full article