title: First-line eradication for Helicobacter pylori-positive gastritis by esomeprazole-based triple therapy is influenced by CYP2C19 genotype.
abstract: OBJECTIVE
  To evaluate the effect of first line esomeprazole (EPZ)-based triple therapy on Helicobacter pylori (H. pylori) eradication.
  
  
  METHODS
  A total of 80 Japanese patients with gastritis who were diagnosed as positive for H. pylori infection by endoscopic biopsy-based or (13)C-urea breath tests were included in this study. The average age of the patients was 57.2 years (male/female, 42/38). These patients were treated by first-line eradication therapy with EPZ 40 mg/d, amoxicillin 1500 mg/d, and clarithromycin 400 mg/d for 7 d. All drugs were given twice per day. Correlations between H. pylori eradication, CYP2C19 genotype, and serum pepsinogen (PG) level were analyzed. This study was registered with the UMIN Clinical Trials Registry (UMIN000009642).
  
  
  RESULTS
  The H. pylori eradication rates by EPZ-based triple therapy evaluated by intention-to-treat and per protocol were 67.5% and 68.4%, respectively, which were similar to triple therapies with other first-generation proton pump inhibitors (PPIs). The eradication rates in three different CYP2C19 genotypes, described as extensive metabolizer (EM), intermediate metabolizer, and poor metabolizer, were 52.2%, 72.1%, and 84.6%, respectively. The H. pylori eradication rate was significantly lower in EM than non-EM (P < 0.05). The serum PG I level and PG I/II ratio were significantly increased after eradication of H. pylori (P < 0.01), suggesting that gastric atrophy was improved by H. pylori eradication. Thus, first-line eradication by EPZ-based triple therapy for patients with H. pylori-positive gastritis was influenced by CYP2C19 genotype, and the eradication rate was on the same level with other first-generation PPIs in the Japanese population.
  
  
  CONCLUSIONS
  The results from this study suggest that there is no advantage to EPZ-based triple therapy on H. pylori eradication compared to other first-generation PPIs.
authors.affiliation: Yoshimasa Saito, Hiroshi Serizawa, Yukako Kato, Masaru Nakano, Division of Gastroenterology, Kitasato Institute Hospital, Minato-ku, Tokyo 108-8641, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Yoshimasa Saito, Hiroshi Serizawa, Yukako Kato, Masaru Nakano, Division of Gastroenterology, Kitasato Institute Hospital, Minato-ku, Tokyo 108-8641, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Serizawa
authors.affiliation: Yoshimasa Saito, Hiroshi Serizawa, Yukako Kato, Masaru Nakano, Division of Gastroenterology, Kitasato Institute Hospital, Minato-ku, Tokyo 108-8641, Japan.
authors.forename: Yukako
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Yoshimasa Saito, Hiroshi Serizawa, Yukako Kato, Masaru Nakano, Division of Gastroenterology, Kitasato Institute Hospital, Minato-ku, Tokyo 108-8641, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Nakano
authors.affiliation: Yoshimasa Saito, Hiroshi Serizawa, Yukako Kato, Masaru Nakano, Division of Gastroenterology, Kitasato Institute Hospital, Minato-ku, Tokyo 108-8641, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Yoshimasa Saito, Hiroshi Serizawa, Yukako Kato, Masaru Nakano, Division of Gastroenterology, Kitasato Institute Hospital, Minato-ku, Tokyo 108-8641, Japan.
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Saito
authors.affiliation: Yoshimasa Saito, Hiroshi Serizawa, Yukako Kato, Masaru Nakano, Division of Gastroenterology, Kitasato Institute Hospital, Minato-ku, Tokyo 108-8641, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Yoshimasa Saito, Hiroshi Serizawa, Yukako Kato, Masaru Nakano, Division of Gastroenterology, Kitasato Institute Hospital, Minato-ku, Tokyo 108-8641, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics* / Q000378:metabolism; D004359:Drug Therapy, Combination; D064098:Esomeprazole / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005260:Female; D005756:Gastritis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D005838:Genotype; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D057194:Intention to Treat Analysis; D007564:Japan; D008297:Male; D008875:Middle Aged; D010597:Pharmacogenetics; D010641:Phenotype; D054328:Proton Pump Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D064098:Esomeprazole
keywords: CYP2C19; Esomeprazole; Helicobacter pylori; Pepsinogen; Proton pump inhibitor