Journal of the Chinese Medical Association
Volume 73, Issue 4 , Pages 188-193, April 2010

Correlation of CYP2C19 Genetic Polymorphisms With Helicobacter pylori Eradication in Patients With Cirrhosis and Peptic Ulcer

  • Chii-Shyan Lay

      Affiliations

    • Division of Hepatology and Gastroenterology, Department of Internal Medicine, Lin Shin Hospital, Taichung, Central Taiwan University of Science and Technology, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Chii-Shyan Lay, Division of Hepatology and Gastroenterology, Department of Internal Medicine, Lin Shin Hospital, Central Taiwan University of Science and Technology, 36, Section 3, Whei-Chung Road, Taichung 408, Taiwan, R.O.C.
    • ,
  • Jiun-Rong Lin

      Affiliations

    • Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.

Received 19 October 2009; received in revised form 8 January 2010

Article Outline

Background

To investigate whether or not CYP2C19 genotype status is associated with cure rate for Helicobacter pylori infection in patients with cirrhosis and peptic ulcer, achieved with 2 weeks of triple therapy with rabeprazole, amoxicillin and clarithromycin.

Methods

We prospectively studied 95 consecutive patients with cirrhosis and H. pylori-infected active peptic ulcers. H. pylori infection was confirmed if any 2 of the following were positive: H. pylori DNA, histology, and rapid urease test. Patientswere assigned to an open-label 2-week course of oral amoxicillin 1,000 mg b.i.d., rabeprazole 20 mg b.i.d. and clarithromycin 500 mg b.i.d. Subsequently, all patients received oral rabeprazole 20 mg once daily until week 8. Three months and 1 year after therapy, all patients with cirrhosis were followed up endoscopically for peptic ulcer, rapid urease test, and 13C-urea breath test. The CYP2C19 genotype status for 2 mutations associated with the extensive metabolizer phenotype was determined by polymerase chain reaction and restriction fragment length polymorphism analysis.

Results

Cure rates for H. pylori infection were 80.9% (95% CI, 22.8–88.6%), 89.8% (95% CI, 50.8–90.2%), and 100% (95% CI, 62.8–100%) in the rapid-, intermediate-, and poor-metabolizer groups, respectively. Healing rates for duodenal and gastric ulcer in the 3 groups were roughly parallel with cure rates for H. pylori infection.

Conclusion

The results of the genotyping test for CYP2C19 seem to predict cure of H. pylori infection and peptic ulcer in patients with cirrhosis who receive triple therapy with rabeprazole, amoxicillin, and clarithromycin.

Key Words:  cirrhosis , CYP2C19 , Helicobacter pylori eradication , peptic ulcer

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PII: S1726-4901(10)70039-3

doi:10.1016/S1726-4901(10)70039-3

Journal of the Chinese Medical Association
Volume 73, Issue 4 , Pages 188-193, April 2010

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