What happened, in summary

This 71-year-old woman had a prior history of invasive ductal and lobular carcinoma of the right breast. Her breast cancer had been treated with surgery followed by chemoradiotherapy. About 16 weeks after completing treatment, she developed progressive difficulty swallowing solid food, along with nausea and epigastric discomfort. Because she had received thoracic radiation, doctors performed esophagogastroduodenoscopy to evaluate both dysphagia and dyspepsia. The first EGD showed radiation-related changes in the esophagus, including strictures in the upper esophagus, as well as diffuse erosive gastritis in the stomach. Multiple gastric biopsies were taken, but initial rapid urease testing and histopathology were negative for H. pylori. She underwent endoscopic dilation of the esophageal strictures and started proton pump inhibitor therapy. Despite this, nausea and dyspepsia continued for 2 months. A repeat EGD showed persistent redness and erosions in the stomach. New biopsies from the antrum and body revealed numerous tightly coiled, spiral-shaped organisms consistent with H. heilmannii. This infection can be harder to detect than H. pylori because the inflammatory response may be less obvious. She was treated with a 2-week bismuth-based quadruple regimen: bismuth, a proton pump inhibitor, metronidazole, and tetracycline. She tolerated treatment well. Her dysphagia, nausea, and dyspepsia resolved completely. When dysphagia recurred 4 weeks later, repeat EGD with biopsy and dilation found no Helicobacter organisms. On later evaluations, she remained asymptomatic without further complications. The breast cancer story remains a completed-treatment survivorship context, while the active clinical issue in this case was management of radiation-related esophageal stricture and H. heilmannii gastritis.