Efficacy of low-dose proton pump inhibitor (PPI) in the eradication of Helicobacter pylori following combination PPI/AC therapy in Japan.
OBJECTIVE
In Japan, eradication regimens consisting of a proton pump inhibitor (PPI) + amoxicillin (AMPC) + clarithromycin (CAM) (PPI/AC) for 1 week have been conducted. In the present study, we assessed the eradication rates following treatment with low doses of various PPIs.


METHODS
135 patients were divided randomly into one of three 7-day regimens: (i) omeprazole (OPZ) 20 mg/day + AMPC 1500 mg/day + CAM 600 mg/day (OAC); (ii) lansoprazole (LPZ) 30 mg + AMPC 1500 mg/day + CAM 600 mg/day (LAC); and (iii) rabeprazole (RPZ) 10mg/day + AMPC 1500 mg/ day + CAM 600 mg/day (RAC). The genetic polymorphism of CYP2C19 was also examined.


RESULTS
The eradication rates according to the treatment regimen were as follows: 69.9% (31/45) for OAC, 62.2% (28/45) for LAC, and 71.1% (32/45) for RPZ. No significant differences were found among the regimens. Moreover, eradication rates, according to CYP2C19 phenotype (homozygous extensive metabolizer (EM), heterozygous EM, and poor metabolizer) were: 68.6% (35/51), 77.4% (41/53), and 82.4% (14/17), respectively.


CONCLUSIONS
In PPI/AC therapy, the eradication rate for each low-dose PPI was 60-70%, which is low. Based on previous reports, it is considered that doses greater than 40 mg/day OPZ, 60 mg/day LPZ, and 20 mg/day RPZ are required.
Kawai
Takashi
T
Endoscopy Center, Tokyo Medical University Hospital, Japan. t-kawai@tokyo-med.ac.jp
Kawakami
Kohei
K
Mikinori
Kataoka
K
Takei
Kazuo
K
Itoi
Takao
T
Moriyasu
Fuminori
F
Takagi
Yuu
Y
Aoki
Tatsuya
T
Watanebe
Kiyoshi
K
Matsumoto
Yuushuke
Y
Rimbara
Emiko
E
Noguchi
Norihisa
N
Sasatsu
Masanori
M
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D017291:Clarithromycin / Q000008:administration & dosage*; D065731:Cytochrome P-450 CYP2C19; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000235:genetics; D016480:Helicobacter pylori; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D006899:Mixed Function Oxygenases / Q000235:genetics; D009853:Omeprazole / Q000008:administration & dosage*; D010641:Phenotype; D011110:Polymorphism, Genetic / Q000235:genetics; D054328:Proton Pump Inhibitors; D064750:Rabeprazole; D019233:Retreatment; D013272:Stomach Diseases / Q000188:drug therapy* / Q000235:genetics; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D064750:Rabeprazole; D000658:Amoxicillin; D006899:Mixed Function Oxygenases; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D017291:Clarithromycin; D009853:Omeprazole