The current tissue sampling techniques for subepithelial tumors (SETs) of the gastrointestinal (GI) tract have limited diagnostic efficacy. We evaluated the diagnostic yield and safety of forceps biopsies after small endoscopic submucosal dissection (SESD biopsies) in the diagnosis of gastric SETs. A total of 42 patients with gastric SETs > 10 mm were prospectively enrolled between May 2013 and October 2014. A dual knife was used to incise the mucosa and submucosa and forceps biopsies were then introduced deep into the lesion. To compare SESD biopsies with EUS-FNA, we used the retrospective data of 30 EUS-FNA cases. The diagnostic yield of SESD biopsies was comparable to that of EUS-FNA (35/42, 83.3% vs. 24/30, 80.0%, P = 0.717). The mean procedure time of SESD biopsies was shorter than that of EUS-FNA (10 vs. 37 minutes, P < 0.001). There were no procedure-related adverse events in the both group. The pathological diagnoses in SESD biopsies group included 15 leiomyomas, 7 GISTs, 10 heterotopic pancreases, 2 lipomas, and one other lesion. SESD biopsies are an easy, effective and safe technique for the diagnosis of gastric SETs and its diagnostic yield is comparable to that of EUS-FNA. This technique may be a reliable alternative to conventional EUS-FNA (Clinical trial registration No. KCT0000730).

Autonomic imbalance has been proposed to be a pathophysiological factor for irritable bowel syndrome (IBS). The aim of this study was to assess beta-adrenergic abnormalities in IBS and to evaluate their relationship to visceral hypersensitivity and other symptoms of IBS patients. Sixteen IBS patients and 16 control subjects were recruited into this study. Participants were asked to complete a questionnaire regarding bowel symptoms, and in order to study beta-adrenergic sensitivity, isoproterenol stimulation tests were performed and visceral hypersensitivity was evaluated by barostat test. Results showed that beta-adrenergic activity and rectal sensitivity were more pronounced in IBS patients than in normal control patients (P < 0.01). Although both IBS subgroups also exhibited more pronounced beta-adrenergic sensitivity than did the controls (P < 0.05), a significant correlation between beta-adrenergic activity and maximally tolerable pressures on the barostat test was found only in IBS-C patients (P = 0.03, R = 0.855). In addition, patients with "hard or lumpy" stools exhibited a higher degree of beta-adrenergic activity (P = 0.00). We conclude that increased beta-adrenergic activity significantly correlated with visceral hypersensitivity in constipation-predominant IBS and symptoms of hard or lumpy stools in IBS patients.

Background/Aims: Tegoprazan, a new, fast, and strong potassium-competitive acid blocker, has been approved for the treatment of gastric acid-related diseases in Korea. However, realworld clinical data regarding this drug are scarce. We aimed to compare the Helicobacter pylori eradication rates of tegoprazan-and rabeprazole-based triple therapy. Methods:We retrospectively reviewed data from patients who received first-line treatment for H. pylori infection using tegoprazan-or rabeprazole-based triple therapy for 2 weeks (50 mg tegoprazan or 20 mg rabeprazole+1,000 mg amoxicillin+500 mg clarithromycin twice daily). The primary endpoint was the eradication rate as determined by intention-to-treat analysis.Results: Of the 677 patients included in our study, 344 and 333 received tegoprazan-based and rabeprazole-based triple therapy, respectively. The eradication rate from intention-to-treat analysis was 76.7% (95% confidence interval [CI], 72.1% to 81.0%) for tegoprazan-based triple therapy and 75.4% (95% CI, 70.5% to 79.8%) for rabeprazole-based triple therapy. There was no significant difference in the eradication rates between the two groups (p>0.999). Per-protocol analysis also revealed no significant difference between the eradication rates of the two groups (tegoprazan 83.4% [95% CI, 79.0% to 87.2%] vs rabeprazole 83.5% [79.0% to 87.4%], p>0.999). Furthermore, there was no significant difference in adverse event rates between the two groups (tegoprazan, 27.6%; rabeprazole, 25.8%; p=0.604). Conclusions:The eradication rate of tegoprazan-based triple therapy was similar to that of rabeprazole-based triple therapy. Further studies on the dose-escalation effect of tegoprazan for H. pylori eradication and the efficacy of tegoprazan in regimens other than conventional triple therapy are needed.