Influence of CYP2C19 on Helicobacter pylori eradication in Brazilian patients with functional dyspepsia

Abstract

ABSTRACT. The aim of this study was to examine the effect of polymorphisms in the cytochrome P450 (CYP) 2C19 gene (CYP2C19) on the Helicobacter pylori eradication rate in Brazilian patients with functional dyspepsia. Adults diagnosed with functional dyspepsia based on the ROME III criteria and infected with H. pylori were recruited to this study. The patients were subjected to gastrointestinal endoscopy and the H. pylori status was defined when both urease test and histopathology results were negative or positive. The patients were treated with proton pump inhibitor-based triple therapy (omeprazole, amoxicillin, and clarithromycin). CYP2C19*2 and CYP2C19*3 were genotyped by polymerase chain reaction-restriction fragment length polymorphism. One hundred and forty-eight patients (81.8% women) with a mean (± SD) age of 46.1 (12.2) years were included in this study. Based on the CYP2C19 genotypes, the patients were classified as homozygous extensive metabolizer (HomEM; 67.6%), heterozygous extensive metabolizer (HetEM; 26.3%), or poor metabolizer (PM; 6.1%). The H. pylori eradication rates in patients with HomEM, HetEM, and PM were 85.0, 89.7, and 100.0% (P = 0.376), respectively. The included study population comprised a high frequency of patients carrying the HomEM genotype. Although the genotypes of CYP2C19 variants were not statistically significant, the results of this study suggest a possible effect of the PM genotype on the efficacy of H. pylori eradication.

Ivth Brazilian Consensus Conference on Helicobacter Pylori Infection

“…The recommended alternatives to 14-day standard triple therapy include quadruple bismuth regimens (PPIs, bismuth, tetracycline, and metronidazole) for 10-14 days or concomitant therapy (PPI, amoxicillin, clarithromycin, and metronidazole or tinidazole) for 14 days (385) (TABLE 2). The use of metronidazole in both regimens may be problematic because of the high levels of resistance of HP to this medication.…”

Helicobacter pylori eradication therapy in an area of southeastern Brazil: a cohort study

“…A second meta-analysis, published in 2013(TANG, LI, HU, XIE, AND ZHAI, 2013 ), involving 16 randomized and controlled studies and 3680 patients, without significant heterogeneity, reached conclusions similar to those described in the previously mentioned study, with the polymorphisms of CYP2C19 (homozygous or heterozygous rapid metabolizer and slow metabolizer) having a significant impact on the efficacy of triple therapies for the eradication of H. pylori when the chosen PPI was omeprazole or lansoprazole, but not when using rabeprazole or esomeprazole. In a Brazilian study derived from the HEROES (MAZZOLENI et al, 2011) trial, originally designed to evaluate the impact of H. pylori eradication on the treatment of patients with functional dyspepsia recruited in Porto Alegre, RS, involving 149 patients selected by randomized sampling, the prevalence of CYP2C19 polymorphisms was described in a Brazilian population: homozygous rapid metabolizer (100 patients or 67.6%), heterozygous rapid metabolizer (39 patients or 26.3%), and slow metabolizer (9 patients or 6.1%) (NABINGER et al, 2016).…”

Efficacy of compatible acupoints and single acupoint versus sham acupuncture for functional dyspepsia: study protocol for a randomized controlled trial

“…Currently, the treatment for FD mainly includes lifestyle adjustment [4], eradication of Helicobacter pylori [5], antacid drugs [6], and prokinetic drugs [7]. However, a standard management for FD has not yet been established, and satisfactory pharmacotherapy is also unavailable [8].…”