Autoimmune pancreatitis (AIP) is a distinct subtype of pancreatitis, which is classified into type 1 and 2 based on the clinicopathological features. According to the international consensus diagnostic criteria, pancreas resection or core biopsy specimens are recommended to make an accurate histological evaluation. However, the usefulness of endoscopic ultrasonography (EUS) guided fine needle aspiration (FNA) for histological evaluation has also been reported. Furthermore, the simultaneous presentation of type 2 AIP and Crohn's disease (CD) is very rare, especially in the Asian population. Therefore, we herein report a case of type 2 AIP with CD, which was diagnosed using EUS guided FNA with a 22-gauge needle.

Expression of caveolin-1 (Cav-1) is frequently altered in many human cancers and both tumor suppression and promotion functions of Cav-1 have been suggested based on its expression status. However, it remains unanswered how Cav-1 provokes opposite effects in different cancers or different phases of tumor progression. To explore the implication of Cav-1 alteration in gastric tumorigenesis, the expression and mutational status of Cav-1 and its effects on tumor cell growth were characterized. A substantial fraction of primary tumors and cell lines displayed abnormally low or high Cav-1 mRNA expression, indicating the bidirectional alteration of Cav-1 in gastric cancers. While allelic imbalance and mutational alterations of the Cav-1 gene were rarely detected, aberrant promoter hyper- or hypo-methylation showed a tight correlation with bidirectional alteration of its expression. Abnormally low and high Cav-1 expression was more frequently observed in early and advanced cancers, respectively, suggesting the oncogenic switch of its function in tumor progression. Cell cycle progression, DNA synthesis, and colony forming ability were markedly decreased by Cav-1 transfection in low-expressing tumor cells but by its depletion in high-expressing cells. Interestingly, Cav-1 exerted opposite effects on MEK-ERK signaling in these two cell types through the reciprocal regulation of the RAF-ERK negative feedback loop. A feedback inhibition of RAF by ERK was stimulated by restoration of Cav-1 expression in low-expressing cells but by it depletion in high-expressing cells. As predicted, the opposite effects of Cav-1 on both tumor cell growth and inhibitory RAF phosphorylation were abolished if ERK is depleted. Bidirectional alteration of Cav-1 is linked to its opposite effects on gastric tumor cell growth, which stem from the reciprocal control on the RAF-ERK negative feedback loop.

Objectives: Tegoprazan, a novel potassium-competitive acid blocker with rapid and effective antisecretory activity, was approved for the treatment of Helicobacter pylori infections in Korea in March 2020. However, real-world data regarding tegoprazan-based therapies are scarce. We compared the efficacies of tegoprazan- and lansoprazole-based triple therapies (TTs).Methods: Between March 2020 and February 2023, this study enrolled patients diagnosed with H. pylori infections who were prescribed either 14-day tegoprazan- or lansoprazole-based TTs as first-line treatments. Their medical records were retrospectively reviewed to compare H. pylori eradication rates and the rates of patient adherence to the recommended therapy.Results: A total of 670 patients diagnosed with H. pylori infections were prescribed 14-day TT regimens between March 2020 and February 2023 at Ilsan Paik Hospital (Goyang, Korea). Of those enrolled in the study, 64 received tegoprazan-based TT and 295 received lansoprazole-based TT as their first-line treatment. The H. pylori eradication rates for tegoprazan- and lansoprazole-based TTs were 76.6% and 75.6%, respectively, in the intent-to-treat population; the rates were 88.9% and 88.4%, respectively, in the per-protocol population (non-inferiority test, p=0.03 and p=0.01 in the respective populations). No significant differences were observed between the two groups with regards to treatment adherence rates (84.4% vs. 85.1%, p=0.78).Conclusions: As a first-line treatment for H. pylori eradication, 14-day tegoprazan-based TT demonstrated non-inferior efficacy compared with 14-day lansoprazole-based TT.

Seokin Kang, Yoon Suk Lee, Nam-Hoon Kim, Jun Hyuk Son, Jong Wook Kim and Mee Joo. Korean J Gastroenterol 2023;82:25-9. https://doi.org/10.4166/kjg.2023.056