An extensive metabolizer with recurrent ulcer responding to high dose of lansoprazole.
A 51-year-old man underwent surgery for duodenal ulcer in 1983. Ulcer recurred several times. Recently, the patient was receiving 30 mg/day of lansoprazole. On June 15, 2001 hemorrhagic recurrent ulcer was diagnosed. Analysis of CYP2C19 enzyme genotype indicated that the patient was a heterozygous extensive metabolizer, suggesting that 30 mg/day of lansoprazole did not produce effective concentrations of drug in the serum. The dose of lansoprazole was increased to 60 mg/day, and intragastric pH monitoring revealed that a pH > or = 3 was maintained for 99.8% of a 24-hour period, as compared with a previous value of 88.3%. After 3 weeks of treatment, endoscopic examination showed that a red scar had formed at the ulcer site.
Higuchi
Katsuhiko
K
Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Kanagawa, Japan. k.higu@kitasato-u.ac.jp
Tanabe
Satoshi
S
Koizumi
Wasaburo
W
Nakayama
Norisuke
N
Sasaki
Tohru
T
Nagaba
Shizuka
S
Saigenji
Katsunori
K
Katada
Natsuya
N
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D065731:Cytochrome P-450 CYP2C19; D004381:Duodenal Ulcer / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism; D005745:Gastric Acidity Determination; D005838:Genotype; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D006899:Mixed Function Oxygenases / Q000235:genetics; D009853:Omeprazole / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D012008:Recurrence
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D064747:Lansoprazole; D006899:Mixed Function Oxygenases; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D009853:Omeprazole