Influences of CYP2C19 polymorphism on recurrence of reflux esophagitis during proton pump inhibitor maintenance therapy.
OBJECTIVE
Patients with erosive gastroesophageal reflux disease (GERD) have rapid recurrence after treatment withdrawal. The aim is to study the influences of CYP2C19 polymorphism on recurrence of GERD during proton pump inhibitor maintenance therapy.


METHODS
Ninety-nine patients with initial healing of GERD (judged by endoscopy) after 8 wk of treatment with PPIs were enrolled into maintenance therapy for 6 mo with rabeprazole (10 mg/day), omeprazole (20 mg/day) or lansoprazole (15 mg/day). The recurrence of GERD symptoms in the maintenance therapy was assessed by a QUEST questionnaire.


RESULTS
The recurrence rate of GERD symptoms in the group of CYP2C19 homozygous extensive metabolizers (38.5%) was significantly greater than those in groups of heterozygous extensive metabolizers (10.9%) and poor metabolizers (5.6%). The recurrence rates in patients treated with omeprazole (25%) and lansoprazole (30.8%) were significantly greater than that with rabeprazole (4.4%). The gender, age and H. pylori did not significantly affect the rate.


CONCLUSIONS
The CYP2C19 genotypes affected the recurrence rate of GERD symptoms during PPI maintenance therapy. The reason for the low recurrence rate with 10 mg/day rabeprazole possibly is due to its sufficient acid suppression independent of CYP2C19 genotypes in Japanese patients.
Saitoh
Toshihito
T
Department of Internal Medicine, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan. saitohgm@dnh.twmu.ac.jp
Otsuka
Hiroko
H
Kawasaki
Takahiro
T
Endo
Hitoshi
H
Iga
Daijirou
D
Tomimatsu
Masahiko
M
Fukushima
Yasushi
Y
Katsube
Takao
T
Ogawa
Kenji
K
Otsuka
Kuniaki
K
D000328:Adult; D000367:Age Factors; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics*; D044466:Asian People / Q000235:genetics; D065731:Cytochrome P-450 CYP2C19; D004942:Esophagitis, Peptic / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics*; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics; D016480:Helicobacter pylori; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D012737:Sex Factors; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19