Clinical Trials Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2015; 21(48): 13548-13554
Published online Dec 28, 2015. doi: 10.3748/wjg.v21.i48.13548
First-line eradication for Helicobacter pylori-positive gastritis by esomeprazole-based triple therapy is influenced by CYP2C19 genotype
Yoshimasa Saito, Hiroshi Serizawa, Yukako Kato, Masaru Nakano, Masahiko Nakamura, Hidetsugu Saito, Hidekazu Suzuki, Takanori Kanai
Yoshimasa Saito, Hiroshi Serizawa, Yukako Kato, Masaru Nakano, Division of Gastroenterology, Kitasato Institute Hospital, Minato-ku, Tokyo 108-8641, Japan
Yoshimasa Saito, Hidetsugu Saito, Division of Pharmacotherapeutics, Keio University Faculty of Pharmacy, Minato-ku, Tokyo 105-8512, Japan
Yoshimasa Saito, Hidetsugu Saito, Hidekazu Suzuki, Takanori Kanai, Division of Gastroenterology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan
Masahiko Nakamura, School of Pharmaceutical Sciences, Kitasato University, Minato-ku, Tokyo 108-8641, Japan
Author contributions: Saito Y and Serizawa H designed the research; Saito Y, Serizawa H, Kato Y and Nakano M performed the clinical research; Nakamura M, Saito H, Suzuki H and Kanai T supervised the research; Saito Y and Serizawa H analyzed the data and wrote the paper.
Supported by Research Grant of Kitasato Institute Hospital.
Institutional review board statement: The study was reviewed and approved by the institutional review board of the Kitasato Institute Hospital.
Clinical trial registration statement: This study was registered with the UMIN Clinical Trials Registry, No. UMIN000009642.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have any conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yoshimasa Saito, MD, PhD, Division of Pharmacotherapeutics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan. saito-ys@pha.keio.ac.jp
Telephone: +81-3-54002692 Fax: +81-3-54002692
Received: June 3, 2015
Peer-review started: June 3, 2015
First decision: August 26, 2015
Revised: September 3, 2015
Accepted: October 17, 2015
Article in press: October 20, 2015
Published online: December 28, 2015
Processing time: 204 Days and 1.4 Hours
Abstract

AIM: 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 13C-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.

CONCLUSION: 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.

Keywords: CYP2C19; Esomeprazole; Helicobacter pylori; Pepsinogen; Proton pump inhibitor

Core tip: Esomeprazole (EPZ) is considered to be more effective for inhibition of gastric acid secretion than other first-generation proton pump inhibitors (PPIs) because its metabolism is not influenced by CYP2C19 genotype. In the present study, however, first-line eradication by EPZ-based triple therapy for patients with Helicobacter pylori (H. pylori)-positive gastritis was influenced by CYP2C19 genotype, and the eradication rate was on the same level with triple therapies with other first-generation PPIs in the Japanese population. Unlike previous studies, our results suggest that there is no advantage for EPZ-based triple therapy on H. pylori eradication in comparison with other first-generation PPIs.