An accessory spleen is splenic tissue located separately from the anatomical location of the spleen and is a rare phenomenon. It can be found within the gastrointestinal tract. Clinically, accessory spleens are benign but can be misidentified as reactive lymph nodes or malignant gastrointestinal tumors. They are often diagnosed via endoscopy or imaging. We report the case of a woman presenting with iron deficiency anemia who was incidentally noted to have a gastric submucosal lesion with pathology significant for accessory spleen. As this case illustrates, when submucosal lesions are present in the stomach, especially in patients with a history of splenectomy, the endoscopic ultrasound (EUS) operator should consider the possible presence of an accessory spleen to minimize invasive removal procedures.

Background: Achalasia is characterized by aperistalsis with poor relaxation of the lower esophageal sphincter (LES). We aimed to systematically assess whether LES metrics on high-resolution manometry (HRM) correlate with the symptomatic or endoscopic presentation of patients with achalasia. Methods: A retrospective study was performed at two tertiary medical centers. All cases of newly diagnosed, untreated achalasia were reviewed for demographics, symptoms, and endoscopic findings. These were correlated with HRM metrics, including LES basal pressure (LESP), integrated relaxation pressure (IRP), percent LES relaxation, and esophagogastric junction (EGJ) morphology. Results: 108 achalasia patients were included; 56 (51.9%) were men, with a mean overall age of 55.6 ± 17.9 years old. Achalasia subtypes included 23.1% with Type I, 65.7% Type II, and 11.1% Type III. Mean LESP was 40.9 ± 13.7 mmHg, IRP 26.8 ± 11.5 mmHg, with 36% ± 20% LES relaxation. On univariate analyses, a higher IRP was associated with age < 50 (p = 0.028), female sex (p = 0.030), Arab ethnicity (p < 0.001), weight loss (p = 0.016), a tortuous esophagus (p = 0.036), and resistance at the EGJ (p = 0.033). However, on multivariate regression analyses, only ethnicity remained significantly associated with IRP. No unique variables were associated with either LESP or percent LES relaxation. Achalasia subtype and Eckardt score were not associated with any LES metrics. Non-Type 1 EGJ morphology was associated with a lower LESP. Conclusions: LES metrics on HRM do not appear to correlate with the clinical or endoscopic presentation of patients with untreated achalasia.

Goals: A systematic review was conducted to evaluate the efficacy and safety of proton pump inhibitor (PPI) therapy in relieving nocturnal reflux symptoms and sleep disturbances. Background: Nocturnal gastroesophageal reflux disease (GERD) is commonly associated with sleep disturbances. The benefits of PPI therapy for GERD-related nocturnal reflux and sleep disturbance remain unclear. Study: We searched the MEDLINE, EMBASE, and Cochrane CENTRAL databases from inception to March 1, 2026, for randomized controlled trials (RCTs) in adults with GERD and sleep disturbances that compared any PPI to placebo or an alternative therapy. The primary outcome was the proportion of patients experiencing relief from nighttime heartburn. Secondary outcomes included relief from GERD-related sleep disturbances, changes in subjective sleep quality, work productivity, and treatment-emergent adverse events (TEAEs). Results: Five RCTs involving 1495 patients met the inclusion criteria. Three placebo-controlled trials consistently showed that PPI therapy improved nighttime heartburn relief and GERD-related sleep disturbances compared with placebo. Subjective sleep quality and sleep-related daytime functioning also generally improved with PPI therapy. However, the findings were more heterogeneous across trials because of differences in study populations, comparators, and outcome measures. Across the placebo-controlled studies, TEAEs were generally similar between the PPI and placebo groups. Conclusions: PPI therapy was associated with improvement in nighttime heartburn and reflux-related sleep disturbances, especially in patients with reflux-driven nocturnal symptoms. The available evidence also suggests potential improvement in subjective sleep quality and sleep-related daytime functioning.

Background/Objectives: Eosinophilic esophagitis (EoE) is an increasingly recognized chronic immune-mediated inflammatory disease of the esophagus. Data on the real-world diagnosis and management practices among gastroenterologists in Israel is scarce. This study aimed to describe current diagnostic and treatment practice patterns for eosinophilic esophagitis among Israeli gastroenterologists, and to identify areas of concordance with, and variability relative to, international recommendations. Methods: A nationwide, cross-sectional, internet-based survey was conducted among gastroenterologists from the Israeli Gastroenterology Association (IGA) and the Israeli Society of Pediatric Gastroenterology, Hepatology and Nutrition between February and April 2024. We used a structured 28-item questionnaire covering physician demographics, diagnostic practices and treatment strategies of EoE. Responses were analyzed for the entire cohort and compared across subgroups based on physician characteristics. Results: Of the 540 eligible gastroenterologists, 114 (22%) completed the survey. Almost all responders (97%) would obtain esophageal biopsies in the case of dysphagia even without typical endoscopic findings. Similarly, 94% of the responders would obtain esophageal biopsies in the case of typical endoscopic findings even without dysphagia. About 86 (75%) were familiar with the Endoscopic Reference Score (EREFS) system. Proton pump inhibitors were the most prescribed first-line treatment (92%), followed by dietary interventions (40%) and topical steroids (17%). As compared with adult gastroenterologists, pediatric gastroenterologists were more likely to obtain biopsies, use the EREFS and initiate treatment before histologic confirmation was obtained. Overall, practices showed broad concordance with international recommendations (>75% of respondents). Conclusions: In this cross-sectional survey, it was demonstrated that diagnostic and treatment practices for EoE among Israeli gastroenterologists were broadly concordant with international recommendations. However, several areas of inconsistency across different provider subgroups were identified. These gaps can be managed through educational programs that will improve standardization of management in EoE.