Hye-Kyung Jung, Chung Hyun Tae, Kyung Ho Song, Seung Joo Kang, Jong Kyu Park, Eun Jeong Gong, Jeong Eun Shin, Hyun Chul Lim, Sang Kil Lee, Da Hyun Jung, Yoon Jin Choi, Seung In Seo, Joon Sung Kim, Jung Min Lee, Beom Jin Kim, Sun Hyung Kang, Chan Hyuk Park, Suck Chei Choi, Joong Goo Kwon, Kyung Sik Park, Moo In Park, Tae Hee Lee, Seung Young Kim, Young Sin Cho, Han Hong Lee, Kee Wook Jung, Do Hoon Kim, Hee Seok Moon, Hirota Miwa, Chien-Lin Chen, Sutep Gonlachanvit, Uday C Ghoshal, Justin C Y Wu, Kewin T H Siah, Xiaohua Hou, Tadayuki Oshima, Mi-Young Choi, and Kwang Jae Lee; The Korean Society of Neurogastroenterology and Motility. J Neurogastroenterol Motil 2021;27:453-81. https://doi.org/10.5056/jnm21077

Summary: Background: Tegoprazan is a novel potassium‐competitive acid blocker that has a fast onset of action and can control gastric pH for a prolonged period, which could offer clinical benefit in acid‐related disorders.Aim: To confirm the non‐inferiority of tegoprazan to esomeprazole in patients with erosive oesophagitis (EE).Methods: In this multicentre, randomised, double‐blind, parallel‐group comparison study, 302 Korean patients with endoscopically confirmed EE (Los Angeles Classification Grades A‐D) were randomly allocated to either tegoprazan (50 or 100 mg) or esomeprazole (40 mg) treatment groups for 4 or 8 weeks. The primary endpoint was the cumulative proportion of patients with healed EE confirmed by endoscopy up to 8 weeks from treatment initiation. Symptoms, safety and tolerability were also assessed.Results: The cumulative healing rates at week 8 were 98.9% (91/92), 98.9% (90/91) and 98.9% (87/88) for tegoprazan 50 mg, tegoprazan 100 mg and esomeprazole 40 mg, respectively. Both doses of tegoprazan were non‐inferior to esomeprazole 40 mg. The incidence of adverse events was comparable among the groups, and tegoprazan was well‐tolerated.Conclusion: Once daily administration of tegoprazan 50 or 100 mg showed non‐inferior efficacy in healing EE and tolerability to that of esomeprazole 40 mg.

Although many case reports have described patients with proton pump inhibitor (PPI)-induced hypomagnesemia, the impact of PPI use on hypomagnesemia has not been fully clarified through comparative studies. We aimed to evaluate the association between the use of PPI and the risk of developing hypomagnesemia by conducting a systematic review with meta-analysis. We conducted a systematic search of MEDLINE, EMBASE, and the Cochrane Library using the primary keywords “proton pump,” “dexlansoprazole,” “esomeprazole,” “ilaprazole,” “lansoprazole,” “omeprazole,” “pantoprazole,” “rabeprazole,” “hypomagnesemia,” “hypomagnesaemia,” and “magnesium.” Studies were included if they evaluated the association between PPI use and hypomagnesemia and reported relative risks or odds ratios or provided data for their estimation. Pooled odds ratios with 95% confidence intervals were calculated using the random effects model. Statistical heterogeneity was assessed with Cochran’s Q test and I² statistics. Nine studies including 115,455 patients were analyzed. The median Newcastle-Ottawa quality score for the included studies was seven (range, 6–9). Among patients taking PPIs, the median proportion of patients with hypomagnesemia was 27.1% (range, 11.3–55.2%) across all included studies. Among patients not taking PPIs, the median proportion of patients with hypomagnesemia was 18.4% (range, 4.3–52.7%). On meta-analysis, pooled odds ratio for PPI use was found to be 1.775 (95% confidence interval 1.077–2.924). Significant heterogeneity was identified using Cochran’s Q test (df = 7, P<0.001, I² = 98.0%). PPI use may increase the risk of hypomagnesemia. However, significant heterogeneity among the included studies prevented us from reaching a definitive conclusion.

Background and study aims: Intestinal Behçet’s disease and Crohn’s disease are chronic inflammatory bowel diseases that are difficult to distinguish from each other. We investigated their colonoscopic features and identified simple and valuable strategies for differential diagnosis. Patients and methods: Between 1995 and 2006, 250 consecutive patients with ulcers on colonoscopy (115 Behçet’s, 135 Crohn’s cases) were reviewed. All patients with Behçet’s fulfilled the criteria of the International Study Group for Behçet’s Disease or of the Behçet’s Disease Research Committee of Japan, while Crohn’s disease was confirmed by clinicopathological data. Patients were randomly allocated to a training set (70 %) or a validation set (30 %). Ulcer shapes, distributions, numbers, margins, and border contours, and the presence of aphthous, cobblestone, perianal, and strictured lesions were compared, in the training set. Univariate and multivariate analysis were performed, using the x2-test and logistic regression. In addition, a classification and regression tree (CART) was then used to generate simplified algorithms for differential diagnosis. Results: Round shape, five or fewer in number, focal distributions, and absence of aphthous and cobblestone lesions were significantly dominant features in Behçet’s disease, according to multivariate analysis of the training set. The CART-generated algorithms proposed sequential use of shape (round, irregular/geographic, or longitudinal) and distribution (focal single/focal multiple, or segmental/diffuse). Diagnosis of Behçet’s disease in the validation set produced sensitivity, specificity, and negative and positive predictive values of 94.3 %, 90.0 %, 94.7 %, and 89.2 %, respectively. Using the CART model, we made the correct diagnosis of intestinal Behçet’s disease or Crohn’s disease in 69 of 75 patients (92 %). Conclusion: It was determined that round and longitudinal ulcers are suggestive of Behçet’s disease and Crohn’s disease, respectively. Irregular/geographic-shaped ulcers and focal distributions are suggestive of Behçet’s disease, while segmental/diffuse lesions suggest Crohn’s.