Background and Aims: The prevalence of clarithromycin resistant bacteria is increasing, and the effectiveness of Helicobacter pylori (H. pylori) triple therapy is gradually decreasing in Japan. Vonoprazan, a potassiumcompetitive acid blocker, has been reported for its effectiveness in eradicating H. pylori. We aimed to evaluate the efficacy of tailored vonoprazan-based triple therapy in patients with H. pylori. This study is the first to compare the efficacy of vonoprazan-based tailored triple therapy to that of vonoprazan-based conventional therapy. Method: This retrospective cohort study evaluated the treatment efficacy in 920 patients. Of these, 541 received conventional and 379 received tailored therapy. Successful eradication was confirmed by a negative 13C-urea breath test 6–8 weeks following completion of H. pylori eradication therapy, and the data were evaluated using the Chi-square test, or Fisher’s exact test, as appropriate. Results: The eradication rate of tailored therapy was 90% and 96.3% by intent-to-treat analysis and per protocol analysis, respectively, which was significantly higher than the 85% and 90.2% found for conventional therapy (p < 0.05 and p < 0.001, respectively). Amoxicillin- or clarithromycin-resistant bacteria did not affect treatment outcomes. By univariate and multivariate analysis, both amoxicillin- and clarithromycin-resistant bacteria and conventional therapy were detected as risk factors for eradication failure (odds ratio = 6.267, 95% CI [1.056–119.924], p < 0.05, and odd ratio =3.113, 95% confidence interval [1.688–6.160], p < 0.001, by multivariate analysis). Conclusion: Vonoprazan-based triple therapy could be a more effective treatment for H. pylori infection than conventional therapy when combined with a therapy regimen tailored according to bacterial antibiotic susceptibility.

Aseptic abscesses (AAs) are extraintestinal manifestations of inflammatory bowel disease (IBD). IBD-associated AAs are rare in Japan. We treated a 45-year-old man with ulcerative colitis (UC)-associated AAs. During remission, multiple progressive abscesses were detected in the spleen; he underwent splenectomy because an infectious disease was suspected. Although his condition improved temporarily after splenectomy, a large liver abscess was noted, and a diagnosis of UC-associated AAs was made. Granulocytapheresis (GCAP) and infliximab (IFX) administration resolved the abscess. This is the first reported case of UC-associated AAs in a Japanese patient treated by splenectomy, GCAP, and IFX.

Herein, we describe a case of olmesartan‐related sprue‐like enteropathy in which improvement in villous atrophy was confirmed by small‐bowel capsule endoscopy (CE). We successfully treated a 66‐year‐old man with a chief complaint of loose diarrhea. The patient had persistent watery diarrhea 10 times a day and experienced a weight loss of 9 kg in 3 months. An abdominal computed tomography scan showed fluid retention in the small intestine. Blood test results revealed no inflammatory reaction. Esophagogastroduodenoscopy detected villous atrophy in the stomach and duodenum. Moreover, small‐bowel CE showed villous atrophy in about two‐thirds of the small intestine. Based on other examinations, hyperthyroidism, intestinal tuberculosis, intestinal amyloidosis, and intestinal malignant lymphoma were ruled out. Therefore, the patient was suspected of having an olmesartan‐related sprue‐like disease. Early after discontinuation of medication, diarrhea symptoms improved, and a repeat CE indicated improvements in small intestinal villous atrophy. Since the patient had been administered olmesartan for a long time and CE showed villous atrophy throughout the small bowel, we suspected him of having the olmesartan‐associated sprue‐like disease. The findings of gastric mucosa atrophy on esophagogastroduodenoscopy may lead to an early diagnosis of this disease. Olmesartan‐related sprue‐like enteropathy should be considered as a differential diagnosis in patients with chronic severe watery diarrhea.

Background: Endoscopic submucosal dissection (ESD) is widely used for early gastric cancer (EGC) in patients without lymph node metastasis (LNM). Prediction of LNM after ESD is important to determine prognosis in patients with EGC. In this regard, the eCura system was applied to predict LNM after noncurative ESD for EGC. This study aimed to identify risk factors for LNM and improve the accuracy of the eCura system for predicting the risk of LNM after ESD. Methods: A total of 150 patients who underwent noncurative resection of EGC by ESD were retrospectively enrolled at five institutions in Japan. All patients underwent additional surgery with lymph node resection after ESD. The risk factors for LNM among clinicopathological parameters were examined and receiver operating characteristic curve (ROC) analysis was used to determine the optimal cutoff point for predicting high LNM risk using the modified eCura system. Results: Of 150 patients, 19 (13%) had LNM. In the multivariate analysis, lymphatic invasion, and tumor size >30 mm were independent risk factors for LNM. Using a cutoff score of ≥4 for predicting high risk based on the eCura system, the rate of LNM was significantly higher in the high-risk group (4–7 points) than in the low-risk group (0–3 points) (odds ratio 12.0, 95% confidence interval 3.7–54.2, p < 0.0001). Conclusions: An eCura score ≥4 may improve the prediction of LNM risk after ESD in patients with EGC in the intermediate-risk group (2–4 points) of the eCura system, suggesting better treatment strategies for patients. Further prospective and long-term follow-up studies are needed to validate the efficacy of the modified system.