The Effect of CYP2C19 Polymorphisms on H. pylori Eradication Rate in Dual and Triple First-Line PPI Therapies: A Meta-analysis

Padol, Sara; Yuan, Yuhong; Thabane, Marroon; Padol, Ireneusz T.; Hunt, Richard H.

doi:10.1111/j.1572-0241.2006.00717.x

Cited by 148 publications

(126 citation statements)

References 36 publications

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“…The majority of studies have come from Asia where poor metabolizers are relatively common. The frequency of poor metabolizers is low in Western populations and although some reports have suggested that CYP2C19 genotypes may not be important in Western populations 39,40 . However, others have confirmed the phenomena of improved results with poor metabolizers 41 .…”

Section: Host Factors Influencing Treatment Successmentioning

confidence: 95%

New concepts of resistance in the treatment of Helicobacter pylori infections

Graham

Shiotani

2008

Nat Rev Gastroenterol Hepatol

316

368

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SummaryThe prevalence of antimicrobial resistance is now such that all patients should be considered as having resistant infections. Ideally therapy is based on pretreatment susceptibility testing. Empiric therapies should assume antimicrobial resistance and use higher doses for 14 days. Acceptable results are 90-94% cure intention to treat (Grade B) or greater. Clarithromycin-containing triple therapies now typically produce ≤80% cure ITT (Grade F) and are no longer acceptable empiric therapy. Current initial therapy options are between sequential therapy, concomitant therapy, and bismuth containing quadruple therapy. Sequential therapy has the potential to be improved to ≥95% cure ITT (Grade A) by continuing the amoxicillin through the second and/or by increasing the duration. Better appreciation of the role of acidity in phenotypic resistance has resulted in high cure rates with high dose PPI plus amoxicillin dual therapy; additional studies to devise better dual-based multidrug regimes are still needed. Antimicrobial choices following treatment failure is best approached by susceptibility testing. If not available, we recommended a bismuth containing quadruple therapy substituting a new drug for metronidazole/tinidazole and/or clarithromycin if they have been used previously. The alternate would be to use a 14 day high dose PPI, amoxicillin-based triple therapy with rifabutin, a fluoroquinolone, or furazolidone. KeywordsHelicobacter pylori; therapy; resistance; antibiotics; anti-secretory drugs; phenotypic drug resistance; cytochrome P450 "To read without reflecting is like eating without digesting". -86-462-1111-86-462- , FAX 81-86-464-1195 Review criteria: We searched the relevant papers by using computer-assisted bibliographic searches of PubMed through November 30, 2007 using combinations of the following terms: H. pylori combined with resistance, therapy, eradication, second, triple, quadruple, sequential, or rescue. We also reviewed the recent literature on pharmacokinetics and pharmacodynamics in relation to the drugs used in H. pylori therapy and the relation to host cytochrome P450 genotypes to treatment outcome. We did not perform meta-analyses. We reviewed only articles published in English.

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Section: Host Factors Influencing Treatment Successmentioning

confidence: 95%

New concepts of resistance in the treatment of Helicobacter pylori infections

Graham

Shiotani

2008

Nat Rev Gastroenterol Hepatol

316

368

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“…In contrast, Caucasians have a higher prevalence rate of HomEM compared with Asians [142] . Accordingly, geographic differences should be considered in selecting doses or types of PPIs for H. pylori treatment since there is a significant difference between HetEM and HomEM (OR = 1.90; 95%CI: 1.38-2.60) in H. pylori eradication rate [143] . In additional subanalysis of individual PPIs revealed that omeprazole was influenced by the CYP2C19 genotype [143] .…”

Section: Is Tailored Therapy On the Horizon For H Pylori Treatment?mentioning

confidence: 99%

“…Accordingly, geographic differences should be considered in selecting doses or types of PPIs for H. pylori treatment since there is a significant difference between HetEM and HomEM (OR = 1.90; 95%CI: 1.38-2.60) in H. pylori eradication rate [143] . In additional subanalysis of individual PPIs revealed that omeprazole was influenced by the CYP2C19 genotype [143] . In another meta-analysis, successful eradication rates differed considerably between PM and HetEM (OR = 1.73, P = 0.002) and between PM and HomEM (OR = 2.79, P < 0.0001) and even between HetEM and HomEM (OR = 2.00, P < 0.0001) [144] .…”

Section: Is Tailored Therapy On the Horizon For H Pylori Treatment?mentioning

confidence: 99%

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Kim

Choi

Chung

2015

WJGPT

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Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori ) has been associated with gastroduodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Core tip: This article reviews the recent literature describing antibiotic resistance and trends in Helicobacter pylori (H. pylori ) treatment. As there is no effective conventional therapy, new treatments are being developed and bismuth quadruple, sequential, concomitant therapies are recommended as a first-line regimen in regions with high levels of clarithromycin resistance. Quinolones have also been used for H. pylori treatment, although the cure rate has gradually reduced with this approach. New therapeutic directions include probiotic supplementation, tailored therapy, novel agents, and nanotechnology.

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“…Several factors are reportedly associated with a decreased efficacy of H. pylori eradication therapy, including antibiotic resistance, CYP2C19 polymorphisms, MDR1 C3435T polymorphism, eradication duration, smoking, and probiotics. [23][24][25][26][27][28] Drug compliance was also found to be a risk factor of eradication failure. 12,29 To minimize the effects of these factors, we chose the same regimen with a 7-day duration in all the patients.…”

Section: Discussionmentioning

confidence: 99%

Helicobacter pylori Eradication in Patients with an Iatrogenic Ulcer after Endoscopic Resection and Peptic Ulcer

Ahn

et al. 2018

Korean J Helicobacter Up Gastrointest Res

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Background/Aims: We aimed to compare the outcomes and timing of Helicobacter pylori eradication in patients with iatrogenic and peptic ulcers. Materials and Methods: This was a retrospective study of 183 patients treated between 2012 and 2015 with 7-day standard triple therapy after endoscopic resection (ER). The patients were enrolled as the iatrogenic ulcer group and assigned to an early treatment group (n=139, H. pylori eradication initiated 2 days after ER) and a late treatment group (n=44, 8 weeks after ER). During the same period, 152 patients with peptic ulcer were assigned to the peptic ulcer group. Results: Successful H. pylori eradication was achieved in 141 patients (77.0%) in the iatrogenic ulcer group and 114 (75.0%) in the peptic ulcer group (P=0.661). Among the ER patients, the eradication rate was 79.9% (n=111) in the early treatment group and 68.2% (n=30) in the late treatment group (P=0.109). The adverse event rate was significantly higher in the peptic ulcer group than in the iatrogenic ulcer group (13.8% vs. 4.9%, P=0.005). Compliance and adverse events did not significantly differ between the early and late treatment groups. Conclusions: In iatrogenic ulcer, H. pylori eradication can be performed with a relatively lower adverse event rate, regardless of treatment timing, than that in peptic ulcer. (Korean J Helicobacter Up Gastrointest Res 2018;18:30-37)

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The Effect of CYP2C19 Polymorphisms on H. pylori Eradication Rate in Dual and Triple First-Line PPI Therapies: A Meta-analysis

Cited by 148 publications

References 36 publications

New concepts of resistance in the treatment of Helicobacter pylori infections

New concepts of resistance in the treatment of Helicobacter pylori infections

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Helicobacter pylori Eradication in Patients with an Iatrogenic Ulcer after Endoscopic Resection and Peptic Ulcer

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