Middle East Journal of Digestive Diseases最新文献

{"title":"Fungal Pancolitis in an Immunocompetent Patient: A Case Report.","authors":"Coana Sukmagautama, Kenneth Tan, Christopher William Purnomo, Tivano Antoni, Alson Bryant Timotius Sinaga","doi":"10.34172/mejdd.2025.447","DOIUrl":"10.34172/mejdd.2025.447","url":null,"abstract":"<p><p>Normal gastrointestinal flora plays a crucial role in protecting against opportunistic pathogens, including bacteria and fungi. Fungal infection, in particular, may occur in patients whose commensal homeostasis is disrupted. Fungal colitis is a rare manifestation of fungal infection of the gastrointestinal tract, particularly in immunocompetent patients. This presents with a mortality rate of 50%, with <i>Candida</i> sp. being the most common causative agent. Evidence in this condition is lacking, and case reports can add to the collective information for generalizable information on this condition. This paper presents a rare case of a 63-year-old immunocompetent woman with fungal pancolitis, its presentation, examination, diagnosis, treatment, and response. Also discussed are the difficulties in diagnosing this rare condition, namely, its similar presentation to functional disorders.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"17 4","pages":"293-297"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Cohort Study on the Efficacy and Safety of Endoscopic Submucosal Dissection for Gastrointestinal Lesions: A Single-Center Experience.","authors":"Pedram Beigvand, Seyed Hassan Abedi, Saman Alhooei","doi":"10.34172/mejdd.2025.440","DOIUrl":"10.34172/mejdd.2025.440","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal (GI) lesions, including precancerous and early-stage cancerous lesions, are a significant global health concern. Endoscopic submucosal dissection (ESD) has emerged as a minimally invasive treatment option, offering complete en bloc resection with lower recurrence rates compared with traditional surgical methods. However, the efficacy and safety of ESD, particularly in diverse clinical settings, require further evaluation. This study aimed to assess the outcomes of ESD for GI lesions in a single-center cohort, focusing on complete resection rates, complications, and recurrence.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at Ayatollah Rouhani Hospital in Babol, Iran, from 2018 to 2023. The study included 45 patients with GI lesions who underwent ESD, with 39 patients receiving en bloc resection and six undergoing piecemeal resection. Data on patient demographics, lesion characteristics, resection outcomes, and complications were collected. Follow-up endoscopic examinations were performed every 3 to 6 months to monitor for recurrence or residual lesions. Statistical analysis was performed using SPSS software version 26, with descriptive statistics, <i>t</i>-tests, and chi-square tests used to evaluate outcomes.</p><p><strong>Results: </strong>The mean age of participants was 61.92 years (±11.19), with a male predominance (57.7%). Lesions were primarily located in the stomach (46.6%), rectum (26.6%), colon (20%), and esophagus (6.6%). The complete resection (R0) rate was 95.1%, with no significant differences based on lesion location. Complications included three cases of perforation (6.6%) and three cases of immediate bleeding (6.6%), all of which were managed endoscopically without surgical intervention. Recurrence occurred in two cases (4.4%), both in lesions larger than 2 cm. En bloc resection demonstrated lower recurrence (2.5%) and perforation rates (5.1%) compared with piecemeal resection (16.7% recurrence, 16.7% perforation).</p><p><strong>Conclusion: </strong>ESD is a safe and effective technique for the complete en bloc resection of GI lesions, with high success rates and low recurrence. En bloc resection is superior to piecemeal resection, particularly for larger lesions. While complications such as perforation and bleeding are rare, they can be managed endoscopically. These findings support the use of ESD as a viable alternative to surgery, especially for elderly patients or those with surgical contraindications. Further multicenter studies with long-term follow-up are needed to validate these results and optimize ESD techniques globally.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"17 4","pages":"253-260"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship between Carotid Artery Stenosis and the Severity of Fatty Liver in Patients with Coronary Artery Disease Who Are Candidates for Angiography.","authors":"Mehdi Pezeshgi Modarres, Ahmad Hormati, Mahdieh Memar, Alireza Shahhamzeh, Mostafa Vahedian, Mohammad Hosein Atarod","doi":"10.34172/mejdd.2025.439","DOIUrl":"10.34172/mejdd.2025.439","url":null,"abstract":"<p><strong>Background: </strong>Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder in developed societies, which can lead to inflammation, fibrosis, and even cirrhosis. Recent studies have also suggested an association between NAFLD and an increased risk of cardiovascular diseases through inflammatory mechanisms and insulin resistance. This study aimed to investigate the relationship between carotid artery stenosis and liver fibrosis severity in patients with coronary artery disease (CAD).</p><p><strong>Methods: </strong>In this cross-sectional study, 200 patients referred for coronary angiography at Shahid Beheshti hospital, Qom, Iran, in 2019 were evaluated. Based on carotid Doppler ultrasonographic findings, patients were divided into two groups: with and without carotid stenosis. The severity of fatty liver was assessed using ultrasound, and fibrosis was evaluated using the fibrosis-4 (FIB-4) index. Demographic, laboratory, and imaging data were analyzed using SPSS software.</p><p><strong>Results: </strong>Among 200 patients (mean age 58.04 years, 50.5% female), 50% had carotid stenosis. Patients with carotid stenosis had a grade II and III fatty liver (44% with grade 2-3 vs. 19% in the non-stenosis group, <i>P</i>=0.001) and a higher FIB-4 score (40% vs. 8%, <i>P</i><0.001). Additionally, patients with high FIB-4 scores had more severe coronary artery involvement (62.5% with 2-3 vessel disease vs. 40.8%, <i>P</i>=0.003) and a higher prevalence of carotid stenosis (83.3% vs. 39.5%, <i>P</i><0.001).</p><p><strong>Conclusion: </strong>This study demonstrated that liver fibrosis severity (based on the FIB-4 index) is significantly associated with carotid artery stenosis and coronary artery involvement. Therefore, assessing liver fibrosis may serve as a predictive marker for cardiovascular risk in patients with NAFLD. The use of non-invasive methods such as FIB-4 alongside ultrasonography is recommended for fibrosis evaluation.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"17 4","pages":"247-252"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Draining Seton Insertion Followed by Ligation of the Intersphincteric Fistula Tract Versus Cutting Seton Insertion for Anal Fistula: A 5-Year Retrospective Cohort Study.","authors":"Siavash Masoumi, Ahmed Mohammed Ali Hussein Alhurry, Seyed Vahid Hosseini, Sara Shojaei-Zarghani, Mohammad Mostafa Safarpour, Zahra Ghanbarzadegan, Alimohammad Bananzadeh","doi":"10.34172/mejdd.2025.442","DOIUrl":"10.34172/mejdd.2025.442","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare healing time, recurrence rates, incidence of incontinence, and quality of life between the ligation of the intersphincteric fistula tract (LIFT) procedure (preceded by draining seton insertion) and cutting seton insertion for anal fistula over a 5-year period.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on patients with high-type perianal fistulas who underwent either LIFT (preceded by draining seton insertion) or cutting seton insertion between May 16, 2018, and April 17, 2024, at Shahid Faghihi and Ghadir mother and child hospitals. A comparative analysis was performed to evaluate healing time, recurrence rates, incidence of incontinence, and quality of life between the two surgical approaches.</p><p><strong>Results: </strong>The study included 51 patients who underwent LIFT surgery and 48 who received cutting seton insertion. There were no significant differences between the two groups in terms of demographic characteristics or behavioral factors. Additionally, no statistically significant differences were observed between the two groups regarding fecal incontinence, healing rates, recurrence, healing time, and quality of life (<i>P</i>>0.05). However, patients who underwent cutting seton insertion exhibited a non-significant lower recurrence rate compared with those who received the LIFT procedure (8.3% vs. 17.6%).</p><p><strong>Conclusion: </strong>This study provides valuable insights into the comparison of the efficacy of cutting seton insertion versus the LIFT procedure for managing anal fistulas. By evaluating key postoperative outcomes, the findings may help in clinical decision-making and enhance patient care strategies in colorectal surgery.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"17 4","pages":"269-274"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights into Non-Alcoholic Fatty Liver Disease and Non-Alcoholic Steatohepatitis: The Role of Fibrinogen and Pepsinogen.","authors":"Zahra Eslami, Alireza Norouzi","doi":"10.34172/mejdd.2025.438","DOIUrl":"10.34172/mejdd.2025.438","url":null,"abstract":"<p><strong>Background: </strong>Fibrinogen is a multifunctional protein that contributes to inflammatory processes. Elevated levels of fibrinogen have been associated with increased liver fibrosis and disease severity of non-alcoholic steatohepatitis (NASH). Fibrinogen appears to interact with other factors implicated in NASH pathophysiology, such as activation of immune cells to induce pro-inflammatory cytokines and cellular signaling pathways. Additionally, fibrinogen-mediated pathways may disrupt normal tissue repair processes. Pepsinogen, the inactive precursor of pepsin and a specific functional enzyme in the gastric mucosa, is a serological marker with subtypes closely related to different gastrointestinal diseases. Changes in pepsinogen levels in liver disease are not entirely understood and likely relate to many factors, including inflammation, altered gastrin levels, and <i>Helicobacter pylori</i> infection. The clinical implications of altered pepsinogen levels in liver disease are still under investigation, but they may have relevance in the diagnosis and monitoring of liver disease.</p><p><strong>Methods: </strong>Databases searched included PubMed, Google Scholar, and Scopus from 2005 to 2024, and the following keywords were used: fibrinogen, pepsinogen, non-alcoholic steatohepatitis, NASH, non-alcoholic fatty liver disease, NAFLD, and fibrosis.</p><p><strong>Results: </strong>As a potential biomarker for NASH, measuring fibrinogen levels could offer valuable insights into disease diagnosis and progression monitoring. On the other hand, pepsinogen is involved in gut health and liver function, contributing to liver inflammation and fibrosis through mechanisms like the gut-liver axis and signaling pathways.</p><p><strong>Conclusion: </strong>Overall, both fibrinogen and pepsinogen appear to have a more significant negative impact on liver health and the progression of NAFLD than beneficial effects. Integrating assessments of fibrinogen and pepsinogen into clinical practice could facilitate earlier intervention strategies aimed at slowing disease progression.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"17 4","pages":"240-246"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival Rate in Hepatocellular Carcinoma after Surgery and Its Association with Clinicopathological Factors: A Single-Center Report.","authors":"Masoomeh Safaei, Farid Azmoudeh-Ardalan, Ali Jafarian, Maede Hoseini, Amir Mohammad Azizpour","doi":"10.34172/mejdd.2025.441","DOIUrl":"10.34172/mejdd.2025.441","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) is the sixth most common cancer globally and the third leading cause of cancer-related deaths. Survival rate is a key health indicator that aids in assessing diagnostic and therapeutic approaches. This study aimed to evaluate the survival rate of patients with HCC and identify clinicopathological factors influencing survival in Iran, where data are limited.</p><p><strong>Methods: </strong>This cross-sectional retrospective study examined the medical records of 45 patients with HCC who underwent surgery at Imam Khomeini hospital, Tehran, from 2013 to 2019. Demographic, clinical, and histopathological data were collected, and survival rates were analyzed using the Kaplan-Meier method. Multivariate analysis was performed using Cox regression to identify independent prognostic factors.</p><p><strong>Results: </strong>The mean age of patients was 48.6±18.56 years, with 62.2% being male. The average follow-up period was 34.28 months, with a maximum of 102 months. The median overall survival was 26 months, with 1-year and 3-year survival rates of 66.7% and 46.7%, respectively. Multivariate analysis identified older age, tumor size>5 cm, presence of steatosis, history of recurrence, and non-transplantation treatment as independent risk factors for mortality. Other factors, such as tumor stage, histological subtype, and serum alpha-fetoprotein levels, were not significantly related to survival.</p><p><strong>Conclusion: </strong>Based on the results, mortality in patients with HCC is significantly influenced by factors such as advanced age, larger tumor size (>5 cm), presence of steatosis, prior recurrence, and absence of liver transplantation as a treatment. These findings underscore the limited prognostic value of variables such as tumor stage, histological subtype, and serum AFP levels. Emphasizing the importance of proactive management, regular follow-up of high-risk individuals, and timely detection to facilitate curative interventions appears to be an essential strategy for enhancing survival outcomes in patients with HCC.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"17 4","pages":"261-268"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophagus Impaction and Perforation by Jujube: A Tale of Double Trouble.","authors":"Ahmad Shukri Mohamad, Ikhwan Sani Mohamad, Michael Wong Pak Kai, Wan Mokhzani Wan Mokhter, Maya Mazuwin Yahya, Siti Rahmah Hashim Isa Merican","doi":"10.34172/mejdd.2025.446","DOIUrl":"10.34172/mejdd.2025.446","url":null,"abstract":"<p><p>Sharp foreign body ingestion may result in simple impaction to mucosal perforation along the gastrointestinal tract. We report a rare case of a 62-year-old woman with jujube ingestion, a fruit that contains sharp-edged seeds causing impaction in the esophagus. Contrast computed tomography (CT) confirmed the transverse lie of the seed at the esophageal wall with features of through-and-through perforation. Flexible endoscopy under local anaesthesia successfully retrieved the jujube seed, followed by application of endoscopic hemoclips for the esophageal perforation. The patient was discharged well within a few days with no fatal outcomes.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"17 4","pages":"290-292"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Diarrheal Celiac Disease in Iraq: A Multicenter study.","authors":"Abdullah Zuhair Alyouzbaki, Ahmed Abdul Hussein Alhilly, Samar Saad Abdulhussein, Azhar Khalaf Alazawi, Kamal Breesam Lafta, Khalid N M Alkheroo","doi":"10.34172/mejdd.2025.443","DOIUrl":"10.34172/mejdd.2025.443","url":null,"abstract":"<p><strong>Background: </strong>Non-diarrheal celiac disease (NDCD) is increasingly recognized in Iraq, but many cases are often missed or underdiagnosed because of its non-classical presentation. This study aimed to determine the clinical features and relevant investigations for patients with NDCD in Iraq.</p><p><strong>Methods: </strong>This is a prospective study that includes 117 cases of NDCD collected from different centers across Iraq. The study evaluated presenting symptoms, associated features, serological markers, endoscopic findings, and histopathological features. Patients with classical diarrhea were excluded from the study.</p><p><strong>Results: </strong>90 patients (77%) were women, and 94 patients (80%) were younger than 40 years. More than half had a normal body mass index, while a quarter of patients were classified as overweight and obese. Only 22% of patients with NDCD received a diagnosis within one year of the onset of symptoms, and 99 patients (84.6%) were suspected of having celiac disease during gastroscopy. Common symptoms among patients with NDCD included epigastric pain and anemia reported by 78.6% and 86.3% of patients, respectively. Endoscopic features suggestive of celiac disease were present in 94% of cases, and Marsh grade 3 histopathological features were observed in 75% of patients.</p><p><strong>Conclusion: </strong>NDCD is more prevalent in young, normal-weight, and obese female patients. Due to non-classical presentations such as epigastric pain or anemia, there is often a delay of more than one year in receiving a diagnosis. A gastroscopy performed by an experienced doctor yields a high diagnostic success rate in identifying NDCD. Furthermore, most patients with NDCD exhibit advanced histopathological features of celiac disease in their duodenal biopsies.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"17 4","pages":"275-281"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Gastric Hodgkin Lymphoma: A Case Report.","authors":"Hana Ben Hammamia, Dorra Jabr, Raoudha Mansouri, Malek Sayadi, Karima Kacem, Raihane Ben Lakhal, Ghada Sahraoui, Karima Mrad","doi":"10.34172/mejdd.2025.448","DOIUrl":"10.34172/mejdd.2025.448","url":null,"abstract":"<p><p>Hodgkin lymphoma is among the most frequent hematologic malignancies that affects the lymphatic system. Primary extranodal involvement in Hodgkin disease is unusual. We report the case of primary gastric Hodgkin lymphoma in a 50-year-old man, who complained about epigastralgia and poor appetite. An upper gastrointestinal endoscopy, biopsy, and immunohistochemical exam confirmed the diagnosis of Hodgkin lymphoma. Primary gastric Hodgkin lymphoma is a very rare entity; clinicians and anatomopathologists should be sensitized to its uncommon extranodal localization.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"17 4","pages":"298-300"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unusual Cause of Dysphagia in a 16-Year-Old Girl.","authors":"Samira Saeian, Saeedeh Esmaeili, Mohammad Hossein Anbardar, Alireza Dehghan, Kamran B Lankarani","doi":"10.34172/mejdd.2025.445","DOIUrl":"10.34172/mejdd.2025.445","url":null,"abstract":"<p><p>This report presents the case of a 16-year-old girl with progressive dysphagia and weight loss over 6 months. Initial examinations, laboratory findings, and upper endoscopy were unremarkable. High-resolution esophageal manometry was suspicious of achalasia, but subsequent imaging revealed the presence of a non-homogeneous mass in the esophageal wall, identified as esophageal leiomyoma through histopathological and immunohistochemical analyses. Despite the rarity of this tumor in adolescents, our findings emphasize the importance of considering esophageal leiomyoma in the differential diagnoses of intramural esophageal lesions. The patient was advised of surgical treatment, which she and her family refused. This case underscores the need for accurate tissue diagnosis via endoscopic ultrasonography (EUS)-guided biopsies to guide treatment decisions, especially in young patients presenting with significant esophageal symptoms.</p>","PeriodicalId":18517,"journal":{"name":"Middle East Journal of Digestive Diseases","volume":"17 4","pages":"287-289"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}