{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T06:43:30Z","timestamp":1790405010283,"version":"4.1.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gastrointestinal (GI) amyloidosis is a rare disorder with nonspecific clinical and endoscopic features, often leading to misdiagnosis. Timely recognition is crucial to prevent diagnostic delays and systemic complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 64-year-old male initially presented with upper respiratory symptoms, and chest computed tomography (CT) performed for pneumonia evaluation incidentally revealed esophageal wall thickening. The first endoscopy showed diffuse redness with loss of the regular arrangement of collecting venules in the gastric body, and the findings were initially interpreted as Helicobacter pylori\u2013associated gastritis. However, both gastric histopathology and the \u00b9\u00b3C urea breath test were negative, and no clear cause of erythema was identified. The patient\u2019s symptoms resolved after taking anti-inflammatory medication, and he did not return for follow-up as instructed. One year later, the patient developed proteinuria and bilateral lower extremity edema and was diagnosed with systemic light-chain (AL) amyloidosis involving the kidneys and heart. Repeat endoscopy revealed disc- and linear-shaped gastric erythema with a submucosal tumor (SMT)-like protrusion. Congo red staining with polarized light confirmed amyloid deposition in the gastric biopsy. In addition, we compared the endoscopic features of gastric erythema from three different etiologies. On narrow-band imaging (NBI), amyloid-related erythema showed a grayish-green signal with a more layered, deeper-appearing distribution, whereas vonoprazan-associated and Helicobacter pylori\u2013associated erythema appeared more superficial with limited layering. Because absolute color intensity is not consistently comparable across panels, this observation should be considered hypothesis-generating rather than diagnostic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the diverse and potentially misleading endoscopic manifestations of GI amyloidosis. NBI may aid in visualizing the distribution pattern and apparent depth of amyloid-related mucosal signals and serve as a supportive diagnostic tool; however, histological confirmation via Congo red staining remains the gold standard. The combination of image-enhanced endoscopy, targeted biopsies, and multidisciplinary evaluation may facilitate earlier recognition and more comprehensive management of patients with atypical gastric erythema.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1683757","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T06:41:45Z","timestamp":1769668905000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Image-enhanced endoscopic characteristics of gastric amyloidosis with narrow-band imaging comparison"],"prefix":"10.3389","volume":"13","author":[{"given":"Xueman","family":"Wang","sequence":"first","affiliation":[{"name":"Endoscopy Center, Shaoxing People's Hospital (The First Affiliated Hospital, Shaoxing University)","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Lian","sequence":"additional","affiliation":[{"name":"Endoscopy Center, Shaoxing People's Hospital (The First Affiliated Hospital, Shaoxing University)","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quan","family":"Luo","sequence":"additional","affiliation":[{"name":"Endoscopy Center, Shaoxing People's Hospital (The First Affiliated Hospital, Shaoxing University)","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xintong","family":"Jiang","sequence":"additional","affiliation":[{"name":"Endoscopy Center, Shaoxing People's Hospital (The First Affiliated Hospital, Shaoxing University)","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Dong","sequence":"additional","affiliation":[{"name":"Endoscopy Center, Shaoxing People's Hospital (The First Affiliated Hospital, Shaoxing University)","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiannu","family":"Ding","sequence":"additional","affiliation":[{"name":"Endoscopy Center, Shaoxing People's Hospital (The First Affiliated Hospital, Shaoxing University)","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Forensic Center, Shaoxing University","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Tang","sequence":"additional","affiliation":[{"name":"Endoscopy Center, Shaoxing People's Hospital (The First Affiliated Hospital, Shaoxing University)","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lifeng","family":"Hu","sequence":"additional","affiliation":[{"name":"Endoscopy Center, Shaoxing People's Hospital (The First Affiliated Hospital, Shaoxing University)","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1056\/NEJMicm2403455","article-title":"AL Amyloidosis","volume":"391","author":"Mansilla Polo","year":"2024","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"425","DOI":"10.17235\/reed.2022.8656\/2022","article-title":"Clinical and endoscopic findings in gastrointestinal amyloidosis: a single-center experience","volume":"114","author":"Dias","year":"2022","journal-title":"Rev Esp Enferm Dig"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/s0016-5107(90)70913-3","article-title":"Endoscopic and biopsy findings of the upper digestive tract in patients with amyloidosis","volume":"36","author":"Tada","year":"1990","journal-title":"Gastrointest Endosc"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/joim.13169","article-title":"Systemic amyloidosis from a (AA) to T (ATTR): a review","volume":"289","author":"Muchtar","year":"2021","journal-title":"J Intern Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"A41","DOI":"10.1016\/j.cgh.2018.08.014","article-title":"A rare case of asymptomatic primary gastric localized amyloidosis","volume":"17","author":"Ding","year":"2019","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e85777","DOI":"10.7759\/cureus.85777","article-title":"Atypical presentation of systemic amyloid light chain (AL) amyloidosis","volume":"17","author":"Faraci","year":"2025","journal-title":"Cureus"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12872-024-04441-6","article-title":"Multimodality imaging features of systemic amyloidosis: a case report","volume":"25","author":"Yu","year":"2025","journal-title":"BMC Cardiovasc Disord"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"497","DOI":"10.15403\/jgld-5107","article-title":"Clinical, endoscopic, and histopathologic observations in gastrointestinal amyloidosis","volume":"32","author":"Krau\u00df","year":"2023","journal-title":"J Gastrointest Liver Dis"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1111\/jgh.13996","article-title":"Systemic amyloidosis with gastrointestinal involvement: diagnosis from endoscopic and histological views","volume":"33","author":"Iida","year":"2018","journal-title":"J Gastroenterol Hepatol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1016\/S2468-1253(21)00370-8","article-title":"Features of gastrointestinal amyloidosis","volume":"6","author":"Hokama","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2630","DOI":"10.3390\/biomedicines12112630","article-title":"Digestive amyloidosis trends: clinical, pathological, and imaging characteristics","volume":"12","author":"Bucurica","year":"2024","journal-title":"Biomedicine"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.3748\/wjg.v27.i12.1132","article-title":"Primary localized gastric amyloidosis: a scoping review of the literature from clinical presentations to prognosis","volume":"27","author":"Lin","year":"2021","journal-title":"World J Gastroenterol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"476","DOI":"10.5946\/ce.2015.48.6.476","article-title":"Narrow band imaging: technology basis and research and development history","volume":"48","author":"Gono","year":"2015","journal-title":"Clin Endosc"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1117\/1.1695563","article-title":"Appearance of enhanced tissue features in narrow-band endoscopic imaging","volume":"9","author":"Gono","year":"2004","journal-title":"J Biomed Opt"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4253\/wjge.v13.i1.1","article-title":"Gastrointestinal amyloidosis: a focused review","volume":"13","author":"Dahiya","year":"2021","journal-title":"World J Gastrointest Endosc"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1016\/S2468-1253(21)00222-3","article-title":"Endoscopic features of gastrointestinal amyloid light-chain amyloidosis","volume":"6","author":"Latorre","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"592","DOI":"10.5009\/gnl240383","article-title":"Endoscopic features of gastrointestinal amyloidosis: a proposed endoscopic classification","volume":"19","author":"Song","year":"2025","journal-title":"Gut Liver"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1097\/PAS.0000000000002173","article-title":"Characterization of amyloidosis in the gastrointestinal tract with an emphasis on histologically distinct interstitial patterns of deposition and misinterpretations","volume":"48","author":"Harris","year":"2024","journal-title":"Am J Surg Pathol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1002\/ajh.25149","article-title":"Immunoglobulin light chain amyloidosis: 2018 update on diagnosis, prognosis, and treatment","volume":"93","author":"Gertz","year":"2018","journal-title":"Am J Hematol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1016\/j.gie.2007.11.049","article-title":"Narrow-band imaging system with magnifying endoscopy for rectal amyloidosis","volume":"68","author":"Hui","year":"2008","journal-title":"Gastrointest Endosc"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"E275","DOI":"10.1055\/s-0032-1309750","article-title":"Endoscopic features of primary amyloidosis of the stomach","author":"Sawada","year":"2012","journal-title":"Endoscopy"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s12328-016-0651-x","article-title":"Localized amyloidosis of the stomach mimicking a superficial gastric cancer","volume":"9","author":"Kagawa","year":"2016","journal-title":"Clin J Gastroenterol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"507","DOI":"10.2169\/internalmedicine.3715-19","article-title":"Vonoprazan-associated gastric mucosal redness: a report of four cases","volume":"59","author":"Kubo","year":"2020","journal-title":"Intern Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e71325","DOI":"10.7759\/cureus.71325","article-title":"Vonoprazan-associated mucosal redness: a report of two cases","volume":"16","author":"Iwamuro","year":"2024","journal-title":"Cureus"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1111\/j.1443-1661.2012.01357.x","article-title":"Research Group for Establishment of endoscopic diagnosis of chronic gastritis. Endoscopic diagnosis of gastric mucosal activity and inflammation","volume":"25","author":"Nomura","year":"2013","journal-title":"Dig Endosc"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1002\/ajh.26569","article-title":"Immunoglobulin light chain amyloidosis: 2022 update on diagnosis, prognosis, and treatment","volume":"97","author":"Gertz","year":"2022","journal-title":"Am J Hematol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1097\/CM9.0000000000000623","article-title":"Artificial intelligence in gastrointestinal endoscopy: general overview","volume":"133","author":"El Hajjar","year":"2020","journal-title":"Chin Med J"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1055\/a-1950-5694","article-title":"Expected value of artificial intelligence in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) position statement","volume":"54","author":"Messmann","year":"2022","journal-title":"Endoscopy"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"852","DOI":"10.3390\/bioengineering12080852","article-title":"Integrating AI with advanced hyperspectral imaging for enhanced classification of selected gastrointestinal diseases","volume":"12","author":"Chou","year":"2025","journal-title":"Bioengineering"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"2732","DOI":"10.3390\/diagnostics15212732","article-title":"Transforming endoscopic image classification with spectrum-aided vision for early and accurate cancer identification","volume":"15","author":"Fang","year":"2025","journal-title":"Diagnostics"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1111\/den.13890","article-title":"Current status and future perspective of artificial intelligence applications in endoscopic diagnosis and management of gastric cancer","volume":"33","author":"Hirasawa","year":"2021","journal-title":"Dig Endosc"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1111\/den.13317","article-title":"Artificial intelligence and upper gastrointestinal endoscopy: current status and future perspective","volume":"31","author":"Mori","year":"2019","journal-title":"Dig Endosc"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1645","DOI":"10.1016\/S1470-2045(19)30637-0","article-title":"Real-time artificial intelligence for detection of upper gastrointestinal cancer by endoscopy: a multicentre, case-control, diagnostic study","volume":"20","author":"Luo","year":"2019","journal-title":"Lancet Oncol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1080\/13506129.2025.2463678","article-title":"Supportive care for systemic amyloidosis: International Society of Amyloidosis (ISA) expert panel guidelines","volume":"32","author":"Muchtar","year":"2025","journal-title":"Amyloid"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1683757\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:26:02Z","timestamp":1771925162000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1683757\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":34,"alternative-id":["10.3389\/fmed.2026.1683757"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1683757","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]},"article-number":"1683757"}}