Can Helicobacter pylori be eradicated with high-dose proton pump inhibitor in extensive metabolizers with the CYP2C19 genotypic polymorphism?

ORMECI A., Emrence Z., BARAN B., SOYER O., GOKTURK S., EVIRGEN S., ...More

EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES, vol.20, no.9, pp.1795-1797, 2016 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 20 Issue: 9
  • Publication Date: 2016
  • Journal Name: EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.1795-1797
  • Keywords: CYP2C19, Homozygote extensive metabolizers, Proton pump inhibitors, High dose proton pump inhibitors, TRIPLE THERAPY, S-MEPHENYTOIN, GASTRIC-JUICE, OMEPRAZOLE, CLARITHROMYCIN, METRONIDAZOLE, AMOXICILLIN, INFECTION
  • Istanbul University Affiliated: Yes

Abstract

Proton pump inhibitors (PPI) metabolism and pharmacokinetics are regulated by cytochrome P450 enzymes in the liver. Cytochrome P450 2C19 (CYP2C19) polymorphism plays an import role in the metabolism of PPIs. The three possible genotypes for CYP2C19 each has a distinct effect on the pharmacodynamics of PPIs. Homozygote extensive metabolizers (HomEM) are the most frequent genotype and have two wild-types (non-mutant) (*1/*1) alleles. HomEM is associated with increased enzyme activity, which increases the rate of PPI metabolism. Intragastric pH, which is required for eradication, is lowest in HomEM. In HomEMs, an insufficient increase in intragastric pH results in decreased anti-Helicobacter pylori (HP) efficacy of the antibiotics and, therefore, lower eradication rates. We determined whether the HP eradication rate would increase after high-dose PPI treatment of extensive PPI metabolizers who had been treated unsuccessfully with a standard PPI dose.