title: [Clarithromycin-resistant Helicobacter pylori associated with 23S rRNA point mutations in Jeju Island].
abstract: OBJECTIVE
  The point mutations in 23S rRNA gene accounts for the majority of the clarithromycin resistance of Helicobacter pylori. This study aimed to investigate the association between the clarithromycin-resistance of H. pylori and the failure of primary H. pylori eradication therapy in Jeju Island.
  
  
  METHODS
  Between April 2011 and October 2012, 6,937 patients underwent endoscopy, and H. pylori infection was evaluated in 2,287 patients (33.0%). Total of 110 patients with H. pylori infection were treated with proton pump inhibitor (PPI)-based triple therapy. The result of eradication was evaluated with urea breath test, histology and PCR which were conducted 4 weeks from the last dose of medicine.
  
  
  RESULTS
  The patients who had point mutations were 33 (26.0%). A2142G and A2143G mutations were observed in 10 patients (7.9%) and 23 patients (18.1%). Among 110 patients treated with PPI-based triple therapy, the success rate of the eradication therapy was 52.7% (58/110) and 70.7% (58/82) by intention-to-treat and per-protocol analysis, respectively. Fifteen of the 24 patients who failed the eradication therapy showed point mutations; 1 patient (4.2%) showed A2142G mutation and 14 patients (58.3%) showed A2143G mutation. Patients with A2143G mutation H. pylori showed higher failure rate of 87.5%. Patients with A2142G mutation H. pylori showed similar failure rate compared to those of the patients with wild type H. pylori.
  
  
  CONCLUSIONS
  In Jeju Island, the frequency of 23S rRNA point mutations is similar (26.0%) with other regions of Korea (15.8-31.3%). A2143G mutation is associated with the failure of H. pylori eradication.
authors.affiliation: Department of Internal Medicine, Jeju National University School of Medicine, National Biobank of Korea, Jeju National University Hospital, Jeju, Korea.
authors.forename: Taeyun
authors.initials: T
authors.lastname: Kim
authors.forename: Hyun Joo
authors.initials: HJ
authors.lastname: Song
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Shin
authors.forename: Jo-Heon
authors.initials: JH
authors.lastname: Kim
authors.forename: Soo-Young
authors.initials: SY
authors.lastname: Na
authors.forename: Sun-Jin
authors.initials: SJ
authors.lastname: Boo
authors.forename: Eun Kwang
authors.initials: EK
authors.lastname: Choi
authors.forename: Yoo-Kyung
authors.initials: YK
authors.lastname: Cho
authors.forename: Heung Up
authors.initials: HU
authors.lastname: Kim
authors.forename: Byung-Cheol
authors.initials: BC
authors.lastname: Song
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use*; D004269:DNA, Bacterial / Q000032:analysis; D024881:Drug Resistance, Bacterial; D005260:Female; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects / Q000235:genetics*; D006801:Humans; D062312:Islands; D008297:Male; D008875:Middle Aged; D017354:Point Mutation; D016133:Polymerase Chain Reaction; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012338:RNA, Ribosomal, 23S / Q000235:genetics*; D056910:Republic of Korea; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D054328:Proton Pump Inhibitors; D012338:RNA, Ribosomal, 23S; D017291:Clarithromycin