Pre-autism: Advancing early identification and intervention in autism

Autism spectrum disorder (ASD) is often diagnosed long after symptoms have become noticeable. This delay can make it difficult to provide early intervention, which can impact long-term outcomes. The concept of "pre-autism" highlights the phase before a formal diagnosis of ASD, providing an opportunity for earlier identification and intervention, which could be a turning point in ASD management. In a previous article, we explored different ways of diagnosing pre-autism, including historical records, physical markers, laboratory tests, and radiological evidence. This manuscript builds on that foundation by emphasizing the importance of early diagnosis and intervention in ASD. Recent research advancements have clarified that ASD presentations can be complex, and individualized support strategies are necessary. The significance of pre-autism lies in its potential to alter the trajectory of ASD through early detection and intervention despite challenges such as limited awareness and variability in symptom presentation. Biomarkers and diagnostic tools have shown promise as avenues for early detection, but it is essential to exercise caution and not rely too heavily on yet-to-be-established markers. Addressing these challenges requires a collaborative effort to increase awareness, improve access to diagnostic tools, and foster inclusive environments. Ultimately, this manuscript calls for ongoing research, advocacy, and resource allocation to enhance early detection and intervention efforts, ensuring optimal outcomes for individuals on the autism spectrum.

Characteristics and prognosis of small bowel tumors: A retrospective study

BACKGROUND

Small bowel tumors (SBTs) are a heterogeneous group of difficult-to-diagnose tumors that account for 2%-5% of all gastrointestinal tumors. Single-balloon enteroscopy greatly enhances the diagnosis and treatment of SBTs. However, few epidemiological studies have been conducted in Taiwan to determine the clinical profile of SBTs.

AIM

To investigate the clinical characteristics, managements and prognosis of SBTs in a medical center in Taiwan.

METHODS

The study enrolled 51 patients aged 58.9 ± 8.8 years (range, 22-93) diagnosed with SBTs from November 2009 to July 2021. We retrospectively recorded clinical characteristics, indications, endoscopic findings, pathological results, management, and outcomes for further analysis.

RESULTS

A male preponderance was observed (56.8%). The most common indications were suspected small intestinal tumors (52.9%) and obscure gastrointestinal bleeding (39.2%). The most common tumor location was the ileum (41.2%). The performance of imaging studies (P = 0.004) and the types of findings (P = 0.005) differed significantly between malignant and benign SBTs. The most frequent imaging finding was a small intestinal mass (43.1%). The top three malignant tumor types were gastrointestinal stromal tumors (GISTs), adenocarcinomas, and lymphomas. Moreover, the proportions of benign and malignant tumors were 27.5% and 72.5%, respectively. The survival rates of patients with malignant tumors in the GIST and non-GIST groups differed significantly (P = 0.015). Kaplan–Meier survival analysis showed a significant difference in survival between patients in the malignant and benign groups (P = 0.04). All patients with lymphoma underwent chemotherapy (n = 7/8, 87.5%), whereas most patients with GISTs underwent surgery (n = 13/14, 92.8%).

CONCLUSION

Patients with GISTs have a significantly higher survival rate than those with other malignant SBTs. Therefore, a large-scale nationwide study is warranted to evaluate the population-based epidemiology of SBTs.

Traumatic isolated bilateral gluteus minimus injuries misdiagnosed as lumbar radiculopathy: A case report

BACKGROUND

The tear of the gluteus medius and minimus tendons can cause chronic buttock pain, especially in middle-aged individuals; these tears occur mostly in association with degenerative changes in the muscles and tendons. Chronic injuries are more common than acute injuries, and concurrent injuries to the gluteus medius and minimus tendons without chronic pain are rare, especially isolated injuries to both sides of the gluteus minimus; such a case has not yet been reported.

CASE SUMMARY

The authors present a case of bilateral acute traumatic injuries to the gluteus minimus during buttock strengthening exercises in a 75-year-old male patient. The patient completely returned to his pre-injury lifestyle after 8 weeks of injury, with no limitations, but the diagnosis was initially delayed due to misdiagnosis as lumbar radiculopathy, resulting in unnecessary socio-economic burden on the patient.

CONCLUSION

When treating patients who complain of hip pain, it is important to consider various causes to make a correct diagnosis.

Interobserver and intraobserver reliability of skull base angles measured on magnetic resonance images

BACKGROUND

Determination of platybasia and basilar kyphosis are significant parts of routine cranial magnetic resonance (MR) interpretations. These situations may explain a patient’s symptoms or may be associated with other anomalies.

AIM

To indicate the interobserver and intraobserver reliability of the skull base angles (SBA) (Koenigsberg standard) and modified SBA (mSBA) measurement techniques.

METHODS

In total, 391 patients who had undergone cranial MR imaging were re-assessed regarding the SBA measurements. The SBA and mSBA techniques were used on MR images. Two reviewers independently measured the same angles twice within a 15-day interval, using different monitors. Intraclass correlation coefficient (ICC) was calculated to reveal the intraobserver and interobserver agreements.

RESULTS

There was an excellent agreement between reviewers regarding both angle measurements (ICC was 0.998 for SBA and mSBA). Excellent agreement levels were also observed for intraobserver measurements. ICC was 0.998 for SBA and 0.999 for mSBA for reviewer 1. ICC was 0.997 for SBA and 0.999 for mSBA according to the measurement results of reviewer 2. Higher SBA and mSBA values were observed for females compared to males. There was no correlation between SBA and age for SBA. However, a negative and low-level correlation was observed between mSBA values and age for both reviewers.

CONCLUSION

SBA and mSBA measurements indicated excellent agreement regarding interobserver and intraobserver differences. The study results showed that SBA angles were reliable measurement techniques to be used on MR images.

Multimodal emotion recognition in the metaverse era: New needs and transformation in mental health work

This editorial comments on an article recently published by López del Hoyo et al. The metaverse, hailed as "the successor to the mobile Internet", is undoubtedly one of the most fashionable terms in recent years. Although metaverse development is a complex and multifaceted evolutionary process influenced by many factors, it is almost certain that it will significantly impact our lives, including mental health services. Like any other technological advancements, the metaverse era presents a double-edged sword for mental health work, which must clearly understand the needs and transformations of its target audience. In this editorial, our primary focus is to contemplate potential new needs and transformation in mental health work during the metaverse era from the perspective of multimodal emotion recognition.

Malignant melanoma: An important differential diagnosis for clear cell sarcoma of the gastrointestinal tract

A case report by Liu et al describes the characteristics of metastatic clear cell sarcoma (CCS) of the pancreas and provides valuable therapeutic insights for this rare malignancy. This case is interesting because of its rarity, suggesting that the pancreas may be a potential target organ for CCS, either primary or metastatic. At the same time, the authors also emphasize the importance of regular postoperative follow-up for timely detection of recurrent lesions, as CCS is characterized by a high degree of malignancy and a high rate of recurrent metastases. Considering that CCS of the gastrointestinal tract is easily confused with malignant melanoma (MM) of the gastrointestinal tract, here we compare the clinical features, histopathological and immunohistochemical characteristics, diagnosis, treatment, and prognosis of CCS and MM of the gastrointestinal tract, hoping to provide a reference for clinical work.

Influence of sarcopenia and frailty in the management of elderly patients with acute appendicitis

In developed countries, the average life expectancy has been increasing and is now well over 80 years. Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later age groups. Acute appendicitis is one of the most common surgical diseases, with a lifetime risk of 8%. A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups (> 80 years). Among patients > 50-year-old who present to the emergency department for acute abdominal pain, 15% have acute appendicitis. In these patients, emergency surgery for acute appendicitis is challenging, and some important aspects must be considered. In the elderly, surgical treatment outcomes are influenced by sarcopenia. Sarcopenia must be considered a precursor of frailty, a risk factor for physical function decline. Sarcopenia has a negative impact on both elective and emergency surgery regarding mortality and morbidity. Aside from morbidity and mortality, the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function maintenance. Therefore, prediction of function decline is critical. In emergency surgery, preoperative interventions are difficult to implement because of the narrow time window before surgery. In this editorial, we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.

Risk factors and risk prediction model for mucocutaneous separation in enterostomy patients: A single center experience

BACKGROUND

Mucocutaneous separation (MCS) is a common postoperative complication in enterostomy patients, potentially leading to significant morbidity. Early identification of risk factors is crucial for preventing this condition. However, predictive models for MCS remain underdeveloped.

AIM

To construct a risk prediction model for MCS in enterostomy patients and assess its clinical predictive accuracy.

METHODS

A total of 492 patients who underwent enterostomy from January 2019 to March 2023 were included in the study. Patients were divided into two groups, the MCS group (n = 110), and the non-MCS (n = 382) based on the occurrence of MCS within the first 3 weeks after surgery. Univariate and multivariate analyses were used to identify the independent predictive factors of MCS and the model constructed. Receiver operating characteristic curve analysis was used to assess the model’s performance.

RESULTS

The postoperative MCS incidence rate was 22.4%. Suture dislodgement (P < 0.0001), serum albumin level (P < 0.0001), body mass index (BMI) (P = 0.0006), hemoglobin level (P = 0.0409), intestinal rapture (P = 0.0043), incision infection (P < 0.0001), neoadjuvant therapy (P = 0.0432), stoma site (P = 0.0028) and elevated intra-abdominal pressure (P = 0.0395) were potential predictive factors of MCS. Suture dislodgement [P < 0.0001, OR: 28.0075 95%CI: (11.0901-82.1751)], serum albumin level (P = 0.0008, OR: 0.3504, 95%CI: [0.1902-0.6485]), BMI [P = 0.0045, OR: 2.1361, 95%CI: (1.2660-3.6235)], hemoglobin level [P = 0.0269, OR: 0.5164, 95%CI: (0.2881-0.9324)], intestinal rapture [P = 0.0351, OR: 3.0694, 95%CI: (1.0482-8.5558)], incision infection [P = 0.0179, OR: 0.2885, 95%CI: (0.0950-0.7624)] and neoadjuvant therapy [P = 0.0112, OR: 1.9769, 95%CI: (1.1718-3.3690)] were independent predictive factors and included in the model. The model had an area under the curve of 0.827 and good clinical utility on decision curve analysis.

CONCLUSION

The mucocutaneous separation prediction model constructed in this study has good predictive performance and can provide a reference for early warning of mucocutaneous separation in enterostomy patients.

Prothrombotic state and thrombotic events in COVID-19 pandemic period, including portal vein and splenic artery thromboses

This editorial article is intended to perform a discussion on the manuscript entitled “Simultaneous portal vein thrombosis and splenic vein thrombosis in a COVID-19 patient: A case report and review of literature” written by Abramowitz et al. The article focuses on the diagnostic processes in a 77-year-old-male patient with a simultaneous portal vein and splenic artery thrombosis accompanying coronavirus disease 2019 (COVID-19). The authors postulated that splanchnic thrombosis should be on the list of differential diagnoses in a patient presenting with abdominal pain in presence of a COVID-19 infection. The tendency for venous and arterial thrombosis in COVID-19 patients is encountered, largely attributed to hypercoagulopathy. In general, venous thromboembolism mostly manifest as deep vein thrombosis (DVT), pulmonary embolism (PE) or catheter-related thromboembolic events. Acute PE, DVT, cerebrovascular events and myocardial infarction are seen as the most common thromboembolic complications in COVID-19 patients. COVID-19-associated hemostatic abnormalities include mild thrombocytopenia and increased D-dimer level. Similar to other coagulopathies, the treatment of the underlying condition is the mainstay. Addition of antiplatelet agents can be considered in critically ill patients at low bleeding risk, not on therapeutic anticoagulation, and receiving gastric acid suppression Early administration of antithrombotic drugs will have a beneficial effect in both the prevention and treatment of thrombotic events, especially in non-ambulatory patients. Low molecular weight heparin (LMWH) should be started if there is no contraindication, including in non-critical patients who are at risk of hospitalization LMWH (enoxaparin) is preferred to standard heparin.

Integrating the health belief model into health education programs in a clinical setting

The article demonstrates that health belief model (HBM)-based health education in hypertensive patients effectively improves blood pressure control and medication adherence at 3 months and 6 months. The HBM addresses perceived barriers, benefits, susceptibility, severity, and self-efficacy, leading to better health behaviors. HBM-based education has been effective in various contexts, including managing chronic diseases, promoting cancer screenings, and preventing infectious diseases. However, the model has limitations, such as cultural applicability and addressing complex health behaviors influenced by environmental factors. Future research should integrate HBM with other theories and conduct longitudinal studies to assess long-term impacts. Despite these limitations, HBM-based education significantly improves patient outcomes, highlighting its potential in health education and promotion when appropriately adapted and implemented. This reinforces the model's value in designing effective health interventions and advancing public health.

Infection with Listeria monocytogenes meningoencephalitis: A case report

BACKGROUND

Listeria meningitis is an infectious disease of the central nervous system caused by Listeria monocytogenes. This bacterium is widely present in the natural environment and can be transmitted through channels such as food and water. Patients usually show symptoms such as fever, headache, and neck stiffness. In severe cases, coma, convulsions, or even death may occur. Traditional diagnostic methods, such as cerebrospinal fluid (CSF) culture and serological tests, have certain limitations. Although CSF culture is the “gold standard” for diagnosis, it is time-consuming and has a relatively low positivity rate. Serological detection may also result in false positive or false negative results. The emergence of metagenomic sequencing (mNGS) technology has led to a significant breakthrough in diagnosing Listeria meningitis, allowing quick and accurate detection of various pathogens in samples.

CASE SUMMARY

Here, we present the case of a previously healthy 64-year-old woman diagnosed with Listeria meningitis using mNGS. She was successfully treated with intravenous ampicillin and meropenem, without any complications.

CONCLUSION

Listeria meningitis must be considered, especially in patients who fail to show improvement with first-line antibiotic treatments. mNGS significantly reduces the diagnosis time, supporting timely treatment of patients.

Evaluation of the mental health of COVID-19 patients discharged from the intensive care unit

In this editorial, I address the mental health status of patients who have been discharged from intensive care units (ICUs) after battling coronavirus disease 2019 (COVID-19). An ICU admission is generally a stressful experience, and for severe COVID-19 survivors prolonged treatment in the ICU can lead to significant psychological consequences. These individuals may experience psychiatric distress, including symptoms such as insomnia, anxiety, depression, and even post-traumatic psychological issues. Research indicates that during the first 6 months to 1 year following an ICU stay, nearly one-third of survivors exhibit symptoms similar to those of depression and post-traumatic stress disorder. Several factors may have contributed to the development of depressive and anxious symptoms during the COVID-19 pandemic, particularly for those who underwent an ICU stay. The ICU environment itself is inherently stressful, filled with the constant noise of various medical devices. Studies have provided strong evidence that the prolonged need for ventilation support and the loss of freedom of movement are key factors in the development of psychological problems among COVID-19 patients who had been treated in the ICU.

Advancements and challenges in gastrointestinal imaging

A recent review by Gulinac et al, provides an in-depth analysis of current clinical issues and challenges in gastrointestinal imaging. This editorial highlights the advancements in imaging techniques, including the integration of artificial intelligence and functional imaging modalities, and discusses the ongoing relevance of traditional nuclear medicine tests. The future of gastrointestinal imaging looks promising, with continuous improvements in resolution, enhanced ability to analyze color and texture beyond visual diagnosis, faster image processing, and the application of molecular imaging and nanoparticles expected to enhance diagnostic accuracy and clinical outcomes.

Tricuspid mass-curious case of Li-Fraumeni syndrome: A letter to the editor

We focus specifically on the rare occurrence of cardiac thrombi in Li-Fraumeni syndrome (LFS). LFS is a hereditary risk to a diverse range of specific, uncommon, malignancies. Children and young adults have a heightened susceptibility to many malignancies, particularly soft-tissue and bone tumors, breast malignancies, central nervous system malignancies, adrenocortical carcinoma, and blood cancers. Additionally, LFS patients may experience other cancer types such as gastrointestinal, lung, kidney, thyroid, and skin cancers, along with those affecting gonadal organs (ovaries, testicles, and prostate). An accurate diagnosis of LFS is crucial to enable affected families to access appropriate genetic counseling and undergo surveillance for early cancer detection.

Journey to diagnosis: An unfinished exploration of IgG4-related sclerosing cholangitis

IgG4-related sclerosing cholangitis (IgG4-SC) is an inflammatory disease that leads to bile duct stricture, characterized by the infiltration of IgG4-positive plasma cells into the bile duct wall, thickening of the bile duct wall, and narrowing of the lumen. The differential diagnosis of IgG4-SC mainly includes primary sclerosing cholangitis, cholangiocarcinoma, and pancreatic cancer. IgG4-SC is often associated with autoimmune pancreatitis and can be accurately diagnosed based on clinical diagnostic criteria. However, isolated IgG4-SC is difficult to distinguish from biliary tumors. Given the significant differences in biological behavior, treatment, and prognosis between these diseases, accurately identifying isolated IgG4-SC has very important clinical significance.

Platelet-rich plasma treatment for chronic wounds: A case report and literature review

BACKGROUND

Wound healing is a complicated process that can be heavily influenced by patient comorbidities, in some cases leading to a chronic non-healing wound. Evidence presented in the medical literature supporting the clinical use of autologous platelet-rich plasma (PRP) in treatment of such wounds is becoming increasingly compelling. Mechanisms involved include complex interactions between the patient’s thrombocytes, cytokines, and growth factors.

CASE SUMMARY

We present a case of a 72-year-old male patient with a long-standing chronic wound and multiple comorbidities. Over the course of more than 7 months, the patient was unsuccessfully treated with all routinely used measures, including different dressing approaches. Multiple antibiotic regimens were administered for wound infection, with repeated evaluation of microbiological swab results. Finally, after three PRP applications, the wound showed clinical improvement with complete restitution of the epithelial layer of the skin.

CONCLUSION

PRP treatment may be beneficial to reduce healing time in chronic wounds.

Early screening to identify and diagnose primary nasal tuberculosis in patients with tumor necrosis factor inhibitors

In this editorial, we comment on the article by Liu et al. Based on our analysis of a case report, we consider that early screening and recognition of primary nasal tuberculosis are crucial for patients undergoing treatment with tumor necrosis factor inhibitor (TNFi). While TNFi therapy increases the risk of reactivating latent tuberculosis, primary nasal tuberculosis remains rare due to the protective mechanisms of the nasal mucosa. Risk factors for primary nasal tuberculosis include minimally invasive nasal surgery, diabetes, and human immunodeficiency virus. Patients with early symptoms such as nasal congestion, rhinorrhea, altered olfaction, epistaxis, or ulceration, and unresponsive to conventional antibiotics and antihistamines should undergo early rhinoscopy, possibly followed by repeated tissue biopsies and acid-fast bacilli culture when necessary. When diagnosis is challenging, it is essential to consider local tuberculosis epidemiology and the efficacy of diagnostic anti-tuberculosis treatment. The preferred method for tuberculosis screening is the Interferon Gamma Release Assay, with a general recommendation for screening at 3 and 6 months after initial treatment and then every six months. However, the optimal frequency is not yet consensus-driven and may be increased in economically viable settings.

Secondary diabetes due to different etiologies: A problem worthy of attention

There are many factors in the occurrence of diabetes, which can result in insufficient insulin secretion and insulin receptor resistance. Including pituitary tumors, can also lead to the occurrence of diabetes, if the primary disease can not be well controlled in time, such secondary diabetes control is more difficult. In the process of clinical diagnosis and treatment, these factors need to be taken into account, timely detection and treatment of primary diseases, so as to reduce the possibility of clinical missed diagnosis.

Flexner's legacy and the future of medical education: Embracing challenge and opportunity

This editorial comments on the article by Alzerwi. We focus on the development course, present challenges, and future perspectives of medical education. Modern medical education is gradually undergoing significant and profound changes worldwide. The emergence of new ideas, methodologies, and techniques has created opportunities for medical education developments and brought new concerns and challenges, ultimately promoting virtuous progress in medical education reform. The sustainable development of medical education needs joint efforts and support from governments, medical colleges, hospitals, researchers, administrators, and educators.

Targeting nuclear factor erythroid 2-related factor 2-regulated ferroptosis to treat nervous system diseases

By critically examining the work, we conducted a comprehensive bibliometric analysis on the role of nuclear factor erythroid 2-related factor 2 (NRF2) in nervous system diseases. We also proposed suggestions for future bibliometric studies, including the integration of multiple websites, analytical tools, and analytical approaches, The findings presented provide compelling evidence that ferroptosis is closely associated with the therapeutic challenges of nervous system diseases. Targeted modulation of NRF2 to regulate ferroptosis holds substantial potential for effectively treating these diseases. Future NRF2-related research should not only focus on discovering new drugs but also on designing rational drug delivery systems. In particular, nanocarriers offer substantial potential for facilitating the clinical translation of NRF2 research and addressing existing issues related to NRF2-related drugs.

Current evidence on artificial intelligence in regional anesthesia

The recent advancement in regional anesthesia (RA) has been largely attributed to ultrasound technology. However, the safety and efficiency of ultrasound-guided nerve blocks depend upon the skill and experience of the performer. Even with adequate training, experience, and knowledge, human-related limitations such as fatigue, failure to recognize the correct anatomical structure, and unintentional needle or probe movement can hinder the overall effectiveness of RA. The amalgamation of artificial intelligence (AI) to RA practice has promised to override these human limitations. Machine learning, an integral part of AI can improve its performance through continuous learning and experience, like the human brain. It enables computers to recognize images and patterns specifically useful in anatomic structure identification during the performance of RA. AI can provide real-time guidance to clinicians by highlighting important anatomical structures on ultrasound images, and it can also assist in needle tracking and accurate deposition of local anesthetics. The future of RA with AI integration appears promising, yet obstacles such as device malfunction, data privacy, regulatory barriers, and cost concerns can deter its clinical implementation. The current mini review deliberates the current application, future direction, and barrier to the application of AI in RA practice.

Managing uterine artery pseudoaneurysm post-hysteroscopic surgery: Clinical insights and future directions

This editorial discusses the case report by Kakinuma et al, which details a rare occurrence of uterine artery pseudoaneurysm following hysteroscopic surgery. The case highlights diagnostic challenges and management strategies for this uncommon complication. The editorial explores the implications for clinical practice, emphasizing the importance of early recognition and appropriate intervention to prevent potential severe outcomes. Future research directions to increase the understanding and management of uterine artery pseudoaneurysm in similar clinical settings.

Revisiting tuberculosis as a cause of gastric outlet obstruction: Insights from a case report

Gastroduodenal tuberculosis (GD-TB) is exceptionally rare. The clinical manifestations of gastrointestinal TB are diverse and non-specific, which makes diagnosis difficult, leading to delayed diagnosis and high mortality. As a peer-reviewer of World Journal of Clinical Cases, I would like to share my opinion on the article published by this journal. The patient had no family history of TB or contact with people with TB. Primary GD-TB presenting as gastric outlet obstruction and normal findings of thoracic computed tomography increased the difficulty of diagnosis and treatment in this patient. The diagnosis and treatment scheme of this typical case have reference value for the clinical treatment of GD-TB.

Virtual reality: The bridge between medical education and clinical practice

After perusing the paper by Kim et al, I discovered that this is an interesting manuscript and a successful study. Virtual reality (VR) is an emerging and promising technology employed in the domain of medical practice and medical education over the past decade. In the era of big data, VR is constantly progressing in the fields of medical education and clinical diagnosis and treatment. As a novel scientific and technological tool, VR not only overcomes multiple limitations of the traditional medical teaching mode but also reduces the reliance on personnel and equipment. VR can simulate the real clinical situation, stimulate the enthusiasm of young doctors and nurses for clinical study, and simultaneously safeguard and promote medical safety and doctor-patient harmony. Favorable outcomes have been attained in clinical teaching and diagnosis and treatment activities. While enhancing the training conditions of medical cosmetics and elevating the level of clinical practice and teaching, the risks resulting from improper clinical diagnosis and treatment have been circumvented. All of this is evident and comprehensible.

Foregut tuberculosis: Too close but miles apart

The worldwide burden of tuberculosis (TB) has increased and it can involve virtually any organ of the body. Intestinal TB accounts for about 2% of the cases of TB worldwide. The ileocecal region is the most commonly affected site, and the foregut is rarely involved. The reported incidence is approximately 0.5%. Esophageal TB presents with dysphagia, weight loss, and hematemesis in rare cases. Gastroduodenal TB usually manifests with symptoms such as nausea, vomiting, weight loss, and sometimes with gastric outlet obstruction. Gastroscopy may reveal shallow ulcers in stomach and duodenal deformity when underlying TB is suspected, therefore histopathology plays pivotal role. On computed tomography, duodenal TB typically manifests as duodenal strictures predominantly, accompanied by extrinsic compression, and occasionally as intraluminal mass. But their diagnosis can easily be missed if proper biopsies are not taken and samples are not sent for GeneXpert testing, TB polymerase chain reaction investigation and histopathological analysis. Despite being in close proximity to the lungs, the esophagus and stomach are rare sites of TB. The reasons could be low gastric pH and acidity which does not let mycobacterium grow. But there are various case reports of TB involving the foregut. We have summarized the rare cases of foregut TB in different sections and highlighted the importance of esophagogastroduodenoscopy, histopathology and advanced techniques like endoscopic ultrasound in establishing the diagnosis.