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kinase and represents the standard treatment for metastatic and unresectable gastrointestinal stromal tumor (GIST) [1, 2]. Imatinib is orally administered and generally well tolerated; cases of severe toxicity have rarely been described [3]. We report the first case of severe esophagitis occurring during imatinib administration. A 56-year-old man with a high-risk GIST underwent gastric resection and liver metastasectomy. He was started on treatment with imatinib 400 mg/day, which was prematurely suspended because of grade 3 dyspepsia. The patient restarted the treatment with imatinib when metastasis recurred in the liver and showed a good response (l" Fig. 1). However, during the treatment the patient reported severe dysphagia and retrosternal burning pain that was aggravated by food and water intake, and he experienced a weight loss of 11 kg in 2 months. Proton pump inhibitors, antacids, and prokinetics were ineffective. The only identifiable responsible agent was imatinib. We suggested splitting the drug intake into two administrations and performed esophagogastroduodenoscopy shortly afterwards. This showed erosive–ulcerative lesions of the esophageal mucosa starting at 27 cm from the dental arches and ending at the gastroesophageal anastomosis (l" Fig. 2). Some biopsies were taken and a diagnosis was made of grade III esophagitis with granulation tissue and necrotic material at the bottom of the ulcerative lesion (l" Fig. 3). Two months after treatment suspension, the patient’s clinical condition is greatly improved. In our patient, severe esophagitis occurred during treatment with imatinib. This case demonstrates that in clinical practice it is necessary to pay attention to every symptom reported by patients before irreversible damage appears: firstly, in orSevere esophagitis in a patient with gastrointestinal stromal tumor treated with imatinib