title: Effect of cytochrome P450 2C19 polymorphisms on the Helicobacter pylori eradication rate following two-week triple therapy with pantoprazole or rabeprazole.
abstract: OBJECTIVE
  Cytochrome P450 2C19 (CYP2C19) polymorphisms play an important role in the metabolism of proton pump inhibitors. Rabeprazole is primarily metabolized via non-enzymatic pathways. In this study, we determined whether rabeprazole- and pantoprazole-based eradication treatments were influenced by CYP2C19 polymorphisms.
  
  
  METHODS
  A total of 200 patients infected with Helicobacter pylori were treated with either 40 mg of pantoprazole or 20 mg of rabeprazole plus 500 mg of clarithromycin, 1000 mg of amoxicillin twice daily for 2 weeks. CYP2C19 genotype status was determined by Polymerase Chain Reaction (PCR)-restriction-fragment-length polymorphism. The genotypes of cytochrome P450 2C19 were classified as homozigote extensive metabolizer (HomEM), heterozigote metabolizer (HetEM) and poor metabolizer (PM). The CYP2C19 genotype of all patients, the effectiveness of the treatment, the effect of the genotypic polymorphism on the treatment were assessed.
  
  
  RESULTS
  The frequencies of HotEM, HetEM, PM were 78%, 19.5% and 2.5%, respectively. 48% (n = 96) of the patients received treatment with rabeprazole and 52% (n = 104) with pantoprazole. The eradication rate was 64.7% for HomEM, 79.4% for HetEM, 100% for PM (p = 0.06). In HetEM, PM, are considered as a single group, the eradication rates were higher in patients with the HetEM and PM (HetEM+PM) genotypes than in those with the wild-type genotype (81.8 vs. 64.7% p = 0.031). Among the patients treated with rabeprazole, the eradication rates were significantly lower in those with the HomEM genotype than in those with the HetEM+PM genotypes (60% vs. 85.7% p = 0.023).
  
  
  CONCLUSIONS
  The genotypic polymorphism is effective on the rate of eradication. Eradication treatment rate with rabeprazole is influenced by CYP2C19 genotype.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey. kadirdmr@yahoo.com.
authors.forename: A
authors.initials: A
authors.lastname: Ormeci
authors.forename: Z
authors.initials: Z
authors.lastname: Emrence
authors.forename: B
authors.initials: B
authors.lastname: Baran
authors.forename: S
authors.initials: S
authors.lastname: Gokturk
authors.forename: O M
authors.initials: OM
authors.lastname: Soyer
authors.forename: S
authors.initials: S
authors.lastname: Evirgen
authors.forename: F
authors.initials: F
authors.lastname: Akyuz
authors.forename: C
authors.initials: C
authors.lastname: Karaca
authors.forename: F
authors.initials: F
authors.lastname: Besisik
authors.forename: S
authors.initials: S
authors.lastname: Kaymakoglu
authors.forename: D
authors.initials: D
authors.lastname: Ustek
authors.forename: K
authors.initials: K
authors.lastname: Demir
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage; D017291:Clarithromycin / Q000008:administration & dosage; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics*; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000235:genetics*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage; D000077402:Pantoprazole; D012150:Polymorphism, Restriction Fragment Length; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D064750:Rabeprazole / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D064750:Rabeprazole; D000658:Amoxicillin; D000077402:Pantoprazole; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D017291:Clarithromycin; D009853:Omeprazole