A histopathologic study on how the common bile duct and main pancreatic duct open into the duodenum was performed on 72 autopsied cases of biliary tract carcinoma. Type IIIb which was considered to be an abnormal pancreatico–choledocho–ductal junction was identified in 8 of 34 cases in common bile duct carcinoma and in 4 of 24 cases in gallbladder carcinoma, while none of the control cases belonging to Type IIIb. In cases of Type IIIb, reflux of pancreatic juice may occur into the bile duct and produce the repeated inflammation on the biliary tract. Therefore, the abnormal pancreatico‐choledocho‐ductal junction was suggested to be one of the pathogenic factors which cause biliary tract carcinoma. Cancer 52:2086‐2088, 1983.

Background and study aims  Symptomatic capsule retention is a very rare adverse event following patency capsule, and the vast majority of cases are resolved without either surgical or endoscopic intervention. We herein describe a rare case of small bowel perforation after swallowing a patency capsule in a 37-year-old man suspected of having Crohn’s disease.

BackgroundProton pump inhibitors (PPIs) are affected by cytochrome P450 2C19 (CYP2C19) polymorphisms. This study compared the effect of two PPIs on early symptom relief in Japanese patients with reflux esophagitis, classified by the CYP2C19 phenotype.MethodsPatients with reflux esophagitis were randomised to treatment with omeprazole 20 mg or rabeprazole 10 mg once daily. The CYP2C19 phenotype [homozygous extensive metaboliser (homoEM), heterozygous extensive metaboliser (heteroEM) or poor metaboliser (PM)] of each patient was determined. The primary efficacy endpoint was early, sufficient (Global Overall Symptom scale score 1 or 2), sustained (maintained for ≥7 days) reflux symptom relief.ResultsOf the 199 patients included in this analysis, the proportion achieving sufficient, sustained reflux symptom relief was higher with omeprazole than with rabeprazole on day 1 (35.6 vs. 22.4 %; p = 0.041) and day 2 (43.6 vs. 28.6 %; p = 0.028); there was no significant difference between the two groups on days 3–7. Among patients with the CYP2C19 PM phenotype, sufficient, sustained reflux symptom relief was higher with omeprazole than with rabeprazole on days 4–7 (62.5–66.9 vs 31.6 %; p ≤ 0.03); differences were not significant on days 1–3, or among those with the homoEM or heteroEM phenotypes on days 1–7.ConclusionsIn Japanese patients with reflux esophagitis, omeprazole 20 mg is more effective than rabeprazole 10 mg at achieving early, sufficient, sustained reflux symptom relief in individuals with the CYP2C19 PM phenotype, and is similarly effective to rabeprazole 10 mg in those with heteroEM or homoEM phenotypes.

A 28-year-old woman visited our clinic with a chief complaint of epigastralgia. She had received successful Helicobacter pylori (H. pylori ) eradication therapy 5 years before. We repeated esophagogastroduodenoscopy, and a discolored depressed area with reddish spots and converging folds, 20 mm in size, was detected. No atrophic change including intestinal metaplasia or nodular gastritis was seen endoscopically. Two endoscopic biopsies revealed undifferentiated adenocarcinoma.No H. pylori was found, and the 13 C-urea breath test was also negative. Abdominal computed tomography demonstrated no nodal involvement, distant metastasis or fluid collection. She underwent a laparoscopyassisted distal gastrectomy. Histologically, the resected specimen revealed an early undifferentiated gastric cancer that had invaded deeply into the submucosal layer. Nodal involvement was histologically confirmed.No atrophic change or H. pylori infection was evident histologically. This is the youngest patient ever reported to have developed a node-positive early gastric cancer after eradication of H. pylori .

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