Search Results (514)

For over three decades, Proton Pump Inhibitors (PPIs) have served as the established primary therapy for acid-suppressive therapy; however, their clinical utility is frequently compromised by their slow onset of action, meal-time dependency, and metabolic variability driven by CYP2C19 polymorphisms. Potassium-competitive acid blockers (P-CABs) represent a definitive pharmacological shift, offering rapid, reversible, and genotype-independent inhibition of the H⁺/K⁺-ATPase. This review outlines the emergence of South Korea as a global epicenter for P-CAB innovation, predicated upon a strategic partnership between a high domestic burden of Helicobacter pylori infection and a rising incidence of refractory gastroesophageal reflux disease (GERD). We analyze the clinical and structural developments of indigenous Korean agents, specifically tegoprazan and fexuprazan, the latter of which features an optimized 9-h elimination half-life engineered to mitigate nocturnal acid breakthrough. A critical evaluation of recent clinical evidence is provided, including the most recent 2024 prospective Phase III data, which demonstrate that 14-day P-CAB-based triple therapy achieves significantly improved eradication rates in high-clarithromycin-resistance environments. Furthermore, we explore the emerging 2025 trend toward personalized, on-demand maintenance therapy and address critical long-term safety considerations, including the duration-dependent risk of metachronous gastric cancer identified in recent multicenter longitudinal studies. Ultimately, the South Korean clinical framework is providing the foundational evidence for a global transition toward P-CAB-centered treatment algorithms, redefining the standards of care in modern gastroenterology. Full article

Gastrointestinal (GI) adverse drug reactions (ADRs) are common among glucagon-like peptide-1 receptor agonist (GLP-1 RA) users and frequently contribute to treatment discontinuation and reduced therapeutic benefit. This retrospective study aimed to develop and validate an explainable artificial intelligence (XAI) model to predict GI ADR risk among GLP-1 RA users using real-world clinical data from the NIH All of Us Research Program. Adults prescribed GLP-1 RAs were identified and classified according to the occurrence of GI ADRs following treatment initiation. Multiple supervised machine learning models, including logistic regression, random forest, extreme gradient boosting (XGBoost), support vector machine, neural network, LightGBM, and CatBoost, were evaluated using demographic, socioeconomic, clinical, medication, and laboratory variables. Model performance was assessed using area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, and F1-score. A total of 8697 participants were included, of whom 59.1% experienced GI ADRs. All models demonstrated reasonable predictive performance, with AUC values ranging from 0.82 to 0.84. The XGBoost achieved discrimination of (AUC: 0.84 ± 0.01). SHapley Additive exPlanations (SHAP) identified gastroesophageal reflux disease, hemorrhoids, and elevated HbA1c as important predictors of GI ADR risk. These findings demonstrate the potential utility of explainable machine learning approaches for predicting the safety of GLP-1 RA therapy. Full article

Backgroud: Pathologies of the trachea and large bronchi are a heterogeneous group of rare structural disorders of the airway wall that are frequently underdiagnosed because their symptoms overlap with common respiratory diseases. Methods: We present three patients with chronic cough and dyspnea lasting approximately three years who had previously received multiple incorrect diagnoses, including COPD, asthma, gastroesophageal reflux, and acute bronchitis. Case Description: Following hospitalization for acute respiratory failure, comprehensive differential diagnostic workups revealed Mounier–Kuhn syndrome (tracheobronchomegaly) in Case 1, idiopathic tracheobronchomalacia in Case 2, and tracheobronchopathia osteochondroplastica in Case 3. Tracheobronchomegaly involves marked dilatation of the trachea and main bronchi; tracheobronchomalacia is characterized by expiratory airway collapse due to loss of cartilage stability; and tracheobronchopathia osteochondroplastica is a disease of unknown etiology featuring abnormal submucosal chondrification and ossification with luminal obstruction. All three impair mucociliary clearance and predispose to recurrent infections and progressive respiratory dysfunction. Conclusions: Through these cases we underscore the diagnostic challenges, characteristic radiological findings, and diverse management strategies of these conditions, emphasizing the critical need to consider tracheobronchial anomalies in patients with chronic respiratory symptoms and the key role of computed tomography in establishing an accurate diagnosis. Full article

Background: Gastroesophageal reflux disease (GERD) is a common problem that affects patients. The constant irritation of the esophageal mucosa, in addition to the potential aspiration, has been suggested as a predisposing factor for lung cancer (LC). This study aims to investigate the association between GERD and LC. Methods: An electronic search was conducted on EMBASE, CENTRAL, and PubMed databases from inception through November 2025. Studies evaluating the association between GERD and lung cancer in adult populations were included. Reviews, non-English articles, pediatric studies, and non-human studies were excluded. Twelve studies involving 2,900,965 patients met the inclusion criteria. Three types of common and random effect meta-analyses were utilized, namely meta-analysis of proportion, log(HR) and log(OR) models. Included studies were examined for risk of bias using the Newcastle–Ottawa scale. Results: Twelve articles describing 2,900,965 patients were found to be fit for inclusion. Male and female sexes were equally represented. On average, patients were 57.67 ± 10.02 years of age. Pooled proportion of co-occurring LC and GERD in patients was estimated at 64% [95% C.I.: 15–95%; p = 0.02], with significant heterogeneity (I² = 96.8%, p < 0.01). Among studies calculating for hazard ratio (HR), an estimated pooled log(HR) of 1.01 [95% C.I.: 0.36–2.8; p = 0.98] with significant data heterogeneity (I² = 88%, p < 0.01) was found. In comparison, five studies included estimates of odds ratio (OR), which resulted in a pooled log(OR) of 1.32 [95% C.I.: 1.2–1.46; p < 0.01], with less heterogeneity (I² = 59.1%) which was marginally significant (p = 0.04). Conclusions: Our findings may suggest a possible association between LC and GERD; however, estimates were discordant across effect measures and heterogeneity was substantial, so this association should be interpreted with caution. Full article

Background/Objectives: Shift work is associated with circadian disruption, sleep disturbances, and psychological distress, all of which may influence both reflux-related symptoms and temporomandibular disorder (TMD)-related complaints. However, the relationships among reflux-related symptom burden, TMD severity, oral parafunctional behaviors, and psychological distress in healthcare professionals remain insufficiently understood. To evaluate the association between reflux-related symptom burden, assessed using the Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) questionnaire, and TMD severity among healthcare professionals, and to investigate the potential roles of shift work, oral parafunctional behaviors, and psychological distress in this relationship. Methods: This cross-sectional observational study included healthcare professionals working at a tertiary hospital. Data were collected using validated questionnaires, including the GERD-HRQL, Fonseca Anamnestic Index, Oral Behavior Checklist (OBC), Depression Anxiety Stress Scale-21 (DASS-21), and Epworth Sleepiness Scale (ESS). Participants were categorized as shift workers (≥4 night shifts/month) and non-shift workers. Correlation and multivariable regression analyses were performed. Results: A total of 240 participants were included. Higher GERD-HRQL scores were positively correlated with TMD severity (r = 0.31, 95% CI: 0.19 to 0.42, p < 0.001), oral parafunctional behavior scores (r = 0.28, 95% CI: 0.16 to 0.39, p < 0.001), and DASS-21 stress scores (r = 0.35, 95% CI: 0.23 to 0.46, p < 0.001). Shift workers demonstrated significantly higher GERD-HRQL scores and TMD severity scores than non-shift workers, with small-to-moderate effect sizes. In multivariable analysis, higher TMD severity, OBC score, stress score, and shift-work exposure showed adjusted associations with higher GERD-HRQL scores. The model explained 32% of the variance in reflux-related symptom burden (R² = 0.32; adjusted R² = 0.29). Conclusions: Higher GERD-HRQL scores, reflecting reflux-related symptom burden rather than objectively confirmed GERD, showed weak to small-to-moderate associations with TMD severity, oral parafunctional behaviors, psychological distress, and shift-work exposure among healthcare professionals. These findings indicate co-occurrence of gastrointestinal, temporomandibular, behavioral, and psychosocial symptom domains within this occupational population. Longitudinal studies using objective diagnostic methods are required to clarify the directionality and clinical significance of these associations. Full article

Background: The association between female reproductive factors and laryngopharyngeal reflux (LPR) remains poorly understood. This study investigated the relationship between reproductive history and LPR risk in women using a large nationally representative cohort. Methods: We conducted a nested case–control study using linked data from the Korean National Health and Nutrition Examination Survey and the National Health Insurance Service database (2007–2017). Among 57,559 participants, 1347 women diagnosed with LPR were matched 1:1 with 1347 controls without reflux disease using propensity score matching based on age, income, and education level. Multivariable logistic regression analyses were performed to evaluate the associations between reproductive factors and LPR risk after adjustment for metabolic and lifestyle variables. Results: Women with a first childbirth at age ≥27 years had a significantly higher risk of LPR than those with earlier childbirth (adjusted odds ratio [aOR] 1.33, 95% confidence interval [CI] 1.08–1.63; p = 0.007). A menarche-to-first-birth interval of ≥17 years was also associated with an increased risk of LPR (aOR 1.56, 95% CI 1.15–2.15; p = 0.005). In addition, breastfeeding for <12 months was independently associated with a higher risk of LPR (aOR 1.26, 95% CI 1.04–1.53; p = 0.019). These associations remained significant after adjustment for potential confounders. Conclusions: Female reproductive factors potentially reflecting cumulative hormonal exposure were independently associated with LPR risk in this nationally representative cohort. First delivery at age ≥27 years, a menarche-to-first-birth interval ≥17 years, and breastfeeding <12 months were associated with LPR, suggesting that reproductive history should be considered when evaluating women with reflux-related symptoms. Full article

Background/Objectives: The aim of this study was to show a standardized four-step technique that can offer individually personalized full-mouth therapy for each complex dental patient with erosive tooth wear resulting from bulimia nervosa, focusing on the individualized vertical dimension of occlusion (VDO), functional and aesthetic stability, and patient-reported outcomes, including dental symptoms, nutrition, self-perception, and quality of life. Methods: The following steps are proposed for structured full-mouth rehabilitation. Step 1: Intraoral diagnosis via a single computer-aided impression. Step 2: Determination of a new adequate vertical dimension of occlusion and soft tissue prediction. Step 3: Removable sample dentures—prototypes. Step 4: Non-prep/minimal-prep crowns as the long-term provisional/definitive treatment. Results: Nine adults (11% male) with dental erosion caused by bulimia nervosa (78%), gastro-esophageal reflux (11%), and soft drinks (11%) were part of this cohort. The novel digital workflow enabled restoration of an individualized vertical dimension of occlusion, stable occlusion, appropriate centric and eccentric contacts, biomimetic dental anatomy, harmonious tooth proportions, and optimized red–white aesthetics. Dental problems (hypersensitivity, dental pain), nutritional behavior, body perception, and quality of life improved after the full-mouth rehabilitation. Conclusions: The presented digital workflow offers a promising approach for full-mouth rehabilitation in patients with severe dental erosion, particularly associated with bulimia nervosa, enabling structured restoration planning and stepwise evaluation of the vertical dimension of occlusion and functional adaptation. Prospective studies with larger cohorts are needed to confirm long-term clinical outcomes and patient-reported benefits. Full article

Background/Objectives: The association between gastroesophageal reflux disease (GERD) and chronic rhinosinusitis (CRS) has been debated, with conflicting evidence regarding its magnitude and clinical significance. This systematic review and meta-analysis aimed to evaluate the epidemiological association between GERD and CRS, assess the potential pathophysiological mechanisms, and determine the impact of diagnostic methodology on the observed relationship. Methods: A literature search was conducted across PubMed, Embase, the Cochrane Library, and Web of Science for observational studies published up to January 2026. Studies reporting the prevalence or odds of GERD in adult patients with CRS compared with controls were included. Methodological quality was assessed using ROBINS-E, JBI, and Hoy et al. Data were pooled using random-effects models with Hartung–Knapp–Sidik–Jonkman adjustment. Heterogeneity was explored using subgroup and meta-regression analyses. The certainty of the evidence was graded using the GRADE approach. Results: Twenty-two studies, involving 45,618 participants, met the inclusion criteria. Patients with CRS had significantly higher odds of having GERD than controls (OR 5.39; 95% CI: 2.06–14.11; p < 0.001). This association was corroborated by longitudinal data (aOR, 1.77; 95% CI: 1.44–2.17; p < 0.0001) and genetic evidence from Mendelian randomization. Subgroup analysis revealed that the magnitude of association was significantly stronger in studies utilizing objective diagnostic tools, such as pepsin assays (OR 15.20) and pH monitoring (OR 6.94), compared to subjective questionnaires (OR 1.43). This association was significant for CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Meta-regression analysis indicated a stronger association in younger populations (p = 0.034). Moderate-certainty evidence supports a positive epidemiological association between GERD and CRS, although substantial between-study heterogeneity (I² = 69–89%) and wide 95% prediction intervals limit the precision and generalizability of the pooled estimates. Conclusions: An association between GERD and CRS is observed in studies using objective markers of extraesophageal reflux, whereas the association is attenuated and not statistically significant when reflux is assessed by subjective questionnaires. Objective reflux assessment may be considered in selected patients with medically and surgically refractory CRS, but routine reflux testing in unselected CRS patients is not yet supported by the available evidence. Full article

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease characterized by eosinophilic infiltration, epithelial barrier dysfunction, and progressive tissue remodeling. Increasing evidence identifies eosinophils as central drivers of inflammation and fibrosis, linking EoE to type 2 immune responses and allergic disorders. However, the molecular mechanisms underlying eosinophil-mediated esophageal damage and their interaction with gastroesophageal reflux disease (GERD) remain incompletely understood. Material and Methods: A comprehensive narrative review of the current literature was conducted, focusing on studies investigating eosinophil biology, inflammatory signaling pathways, epithelial remodeling, fibrosis, and therapeutic targets in EoE. Clinical, translational, and experimental studies evaluating the association between EoE, GERD, and allergic comorbidities were critically analyzed. Results: Available evidence demonstrates that eosinophils actively contribute to EoE pathogenesis through the release of cytotoxic granule proteins, cytokines, chemokines, and lipid mediators, leading to chronic inflammation and fibrostenotic remodeling. Dysregulation of type 2 cytokines, particularly IL-4, IL-5, and IL-13, plays a pivotal role in disease progression and immune cell recruitment. Significant overlap between EoE and GERD suggests shared inflammatory mechanisms and diagnostic challenges. Furthermore, EoE frequently coexists with systemic allergic diseases, supporting the concept of a broader atopic inflammatory phenotype. Emerging biologic therapies targeting eosinophilic and type 2 inflammatory pathways have shown promising efficacy in reducing symptoms and histologic activity. Conclusions: Eosinophils represent key regulators of EoE pathobiology and constitute promising biomarkers and therapeutic targets. A deeper understanding of eosinophil-driven inflammatory networks may improve diagnostic accuracy, patient stratification, and the development of personalized therapeutic strategies for EoE and related esophageal inflammatory disorders. Full article

Ataxia–telangiectasia is a rare, autosomal recessive primary immunodeficiency caused by mutations in the ATM gene on chromosome 11, which encodes a serine–threonine kinase essential for the recognition and repair of DNA double-strand breaks. The disease is characterized by progressive neurological impairment, immunological dysfunction, and an increased susceptibility to recurrent infections and malignancies. Pulmonary involvement represents a major source of morbidity and frequently arises from chronic infections, aspiration, and impaired airway clearance, ultimately leading to the development of bronchiectasis. The case of a 15-year-old adolescent with a history of recurrent aspiration pneumonias, neuropsychomotor developmental delay, and severe malnutrition is reported, who was admitted for evaluation of chronic productive cough, fever, and dysphagia. Comprehensive clinical assessment and ancillary investigations revealed recurrent respiratory infections, gastroesophageal reflux, and typical features of ataxia–telangiectasia, including cerebellar ataxia, oculomotor apraxia, and conjunctival telangiectasias. Additionally, bronchiectasis was identified as a secondary consequence of the underlying neurological and immunological impairment. This case highlights the diagnostic challenges posed by ataxia–telangiectasia in pediatric patients presenting with chronic respiratory symptoms and emphasizes the importance of early recognition of the underlying systemic disorder. A multidisciplinary approach is essential for accurate diagnosis and optimized management, aiming to address both the primary disease and its pulmonary complications. Full article

Background/Objectives: Zastaprazan (JP-1366) is a novel potassium-competitive acid blocker (P-CAB) used for the treatment of gastroesophageal reflux disease (GERD). To date, its metabolic pathways and metabolism-related drug–drug interactions (DDIs) in humans remain incompletely elucidated. This study aimed to determine the relative contributions (f_m) of cytochrome P450 isoforms to JP-1366 elimination and assess its DDI potential. Methods/Results: In vitro metabolic studies using human liver microsomes (HLMs) revealed that JP-1366 was first metabolized to M1, which subsequently underwent further oxidation, glucuronidation, and N-dealkylation. Mono-oxidation was estimated to contribute more than 46% to the overall metabolic clearance of JP-1366. Reaction phenotyping identified CYP3A as the major enzyme (f_m = 96.1%), followed by CYP1A2 (1.49%) and CYP2C9 (2.41%). By integrating in vitro data, clinical pharmacokinetic data and clarithromycin coadministration DDI data, a physiologically based pharmacokinetic (PBPK) model was developed and validated. Simulations predicted significant DDIs with strong CYP3A inhibitor (ketoconazole), with AUC ratios of 3.80. Moderate inhibitors (fluconazole and fluvoxamine) caused mild increases (AUC ratios: 1.14–1.74). Conversely, strong and moderate CYP3A inducers, rifampicin and efavirenz, produced pronounced DDIs, with AUC ratios of 0.22 and 0.50, respectively. Furthermore, simulations predicted that although JP-1366 functions as a CYP enzyme inhibitor, it would not cause clinically meaningful changes in the plasma exposure of corresponding CYP substrate drugs; however, potential interactions with CYP3A substrates still warranted consideration. Conclusions: JP-1366 is predominantly cleared via a CYP3A-dominated metabolic pathway. The PBPK simulations suggest that JP-1366 may be a moderately sensitive CYP3A substrate and a moderate inhibitor of sensitive CYP3A substrates, while its perpetrator DDI risk toward other major CYP pathways appears limited. These findings support caution or monitoring when JP-1366 is co-administered with strong CYP3A modulators or sensitive CYP3A substrates. Full article

Background: Gastroesophageal reflux symptoms (GERSs) represent the most prevalent phenotype of gastroesophageal reflux disease and frequently overlap with the symptoms of functional dyspepsia, posing diagnostic and therapeutic challenges. Limitations of long-term acid suppression have prompted interest in alternative mucosa-protective approaches. This study was conducted to evaluate the effectiveness of a novel multicomponent formulation (Tamacid-Pro^®) in patients with reflux-like symptoms and negative endoscopy. Methods: In this prospective observational study, consecutive adult patients undergoing upper gastrointestinal endoscopy at a tertiary centre between January 2025 and February 2026 were screened. Patients with upper gastrointestinal symptoms lasting ≥2 months, negative endoscopy, and no evidence of Helicobacter pylori infection were enrolled. Participants received Tamacid-Pro^® three times daily for 3 months. Symptom frequency and intensity were assessed at baseline and after treatment using the Reflux Disease Questionnaire (RDQ). Changes over time were analyzed using paired t-tests, and multivariable linear regression was performed to identify response predictors. Results: A total of 1035 patients were included. After 3 months of treatment, all RDQ items showed a statistically significant improvement in both frequency and intensity (p < 0.0001). Significant reductions were observed in the GERD composite score, as well as in heartburn, regurgitation, and dyspepsia dimensions (all p < 0.0001). In a multivariable analysis, female sex was independently associated with greater improvement across multiple symptom domains, whereas alcohol consumption was negatively associated with improvement in the heartburn dimension. Conclusions: In this large real-world cohort of endoscopy-negative patients, treatment with Tamacid-Pro^® was associated with significant improvement in both typical reflux and dyspeptic symptoms. These findings support the role of multicomponent, mucosa-protective formulations as a valuable therapeutic option in patients with GERSs and overlapping functional gastrointestinal disorders. Full article

Background: Otitis media with effusion (OME) is a highly prevalent pediatric condition and a leading cause of conductive hearing loss in children. Its pathogenesis remains uncertain, and diagnostic and therapeutic challenges make management difficult. Objectives: This review evaluates current evidence on the middle ear microbiome in pediatric OME, focusing on the diagnostic value of 16S ribosomal ribonucleic acid (16S rRNA) gene sequencing and its potential clinical implications. Methods: A literature review was conducted using the PubMed database, including studies published between 2006 and 2026. Eligible studies involved pediatric patients with OME and examined the sources and characteristics of microbiota potentially involved in disease pathogenesis. Microbiome analysis was performed using next-generation sequencing (NGS) techniques. Results: Growing evidence indicates that OME is associated with microbial dysbiosis and biofilm formation rather than a sterile inflammatory process. The most frequently detected genera include Haemophilus, Moraxella, Streptococcus, and Alloiococcus, although substantial variability exists between studies. Pathogens are believed to reach the middle ear through the Eustachian tube from two main reservoirs: the nasopharynx and the adenoids. The potential role of Helicobacter pylori infection and gastroesophageal reflux disease (GERD) in OME pathogenesis remains uncertain and requires further investigation. NGS methods, including 16S rRNA sequencing, demonstrate higher sensitivity than conventional culture techniques, enabling the detection of fastidious and previously unrecognized microorganisms. Evidence also highlights the limited effectiveness of antibiotic therapy in OME, the persistent issue of antibiotic overuse, and the relative advantages of conservative management and microbiome-modulating approaches compared with antibiotics and surgical interventions. Conclusions: Current evidence suggests that OME is closely associated with microbiota dysbiosis and bacterial biofilm formation. Given the limited efficacy of antibiotics, microbiome-focused strategies—particularly probiotics—should be further explored. Molecular diagnostic methods, especially NGS, show clear advantages over traditional culture-based techniques. Future research should further evaluate microbiome modulation as a potential adjunctive or preventive strategy. Full article

Background/Objectives: Despite increasing GERD prevalence worldwide, the role of gastroduodenal microbiota in GERD phenotypes and symptom severity remains poorly understood. This study profiled mucosa-associated microbiota from the gastric antrum and duodenum across phenotypes and examined site-specific associations with symptom severity. Methods: In this cross-sectional study, forty individuals, including 26 with erosive reflux disease (ERD), 10 with non-erosive reflux disease (NERD), and 4 participants in the endoscopically normal comparator group, underwent 16S rRNA gene sequencing. Community differences were assessed using Bray–Curtis dissimilarity, differential taxa were explored by linear discriminant analysis effect size (LEfSe), and correlations with validated symptom questionnaires were evaluated. Results: Microbial community structure differed significantly between the antrum and duodenum, with Proteobacteria and Firmicutes predominating at both sites. LEfSe suggested enrichment of Streptococcus, Haemophilus, and Enterobacter in the duodenum, whereas Sphingobium, Acinetobacter, and Aquabacterium were more abundant in the antrum. The genus Helicobacter was relatively enriched in the antrum of ERD samples, whereas Streptococcus-dominant signatures were more prominent in the duodenum. Symptom severity showed stronger associations with duodenal taxa, including Fusobacterium with odynophagia, early satiety, and globus; Aquabacterium with postnatal drip and dyspnea, whereas gastric associations were fewer. Conclusions: In this small exploratory cross-sectional cohort, gastroduodenal microbiota exhibited both site-specific and phenotype-associated differences, with phenotype-related microbial variation being more evident in the duodenum than in the antrum. These hypothesis-generating findings highlight the importance of considering both anatomical context and GERD phenotype in upper gastrointestinal host–microbe interactions, and require confirmation in larger, phenotypically well-characterized cohorts. Full article

A 65-year-old man with type 2 diabetes presented with abdominal pain. Although he had no typical reflux symptoms such as heartburn or acid regurgitation, esophagogastroduodenoscopy (EGD) showed findings suggestive of reflux esophagitis, and proton pump inhibitor therapy was initiated. Two months later, he was admitted with intractable vomiting. EGD demonstrated diffuse circumferential mucosal injury without black discoloration, predominantly in the distal esophagus. These findings were interpreted as severe reflux esophagitis (Los Angeles grade D; RE-D). Symptoms improved with supportive care, glycemic control, and continued PPI therapy; follow-up EGD showed marked improvement. Six months later, he re-presented with identical symptoms and endoscopic findings. Laboratory testing confirmed diabetic ketoacidosis (DKA), with ketonuria, elevated total ketone bodies (2469 µmol/L), and high-anion gap metabolic acidosis (anion gap 17.2 mEq/L). The diagnosis was revised to DKA-associated acute esophageal mucosal lesion (AEML). He improved with fluid resuscitation and insulin therapy, and medication adherence was reinforced. Follow-up EGD showed complete healing without recurrence. AEML has been proposed as a spectrum that includes acute esophageal necrosis (AEN; “black esophagus”) and esophagitis without black-appearing mucosa. This case highlights a diagnostic pitfall in which DKA-associated AEML without black discoloration may be misattributed to severe reflux esophagitis. When the clinical presentation or endoscopic appearance is severe or atypical, clinicians should consider AEML and evaluate for underlying systemic precipitants. Full article