High-dose dual therapy and CYP2C19 polymorphism in Helicobacter pylori eradication

Background

Helicobacter pylori infect about 50% of the world's population. The efficacy of treatment using standard regimens has declined in recent years, mainly due to widespread development of antibiotic resistance. Use of enhanced acid suppression and antibiotics with lower risk to resistance, will shape the future of treatment for H pylori. High-dose dual therapy (HDDT) can overcome the effect of CYP2C19 polymorphism thus enhancing acid suppression and may become an option in H pylori eradication.

Objectives

To describe the eradication rate and side effects of HDDT in different metaboliser status relating to CYP2C19 polymorphism.

Method

This is a hospital-based cross-sectional analytic study. A total of 63 H pylori-infected patients diagnosed using rapid urease test and histology were given HDDT for 14 days. Urea breath test was done 4 weeks after cessation of HDDT. CYP2C19 polymorphism was tested using the PCR-RFLP method. The eradication rates of HDDT were compared according to CYP2C19 polymorphism status.

Results

Over all eradication rate of HDDT was 69.8% (95% CI 57%-80.8%). According to CYP2C19 polymorphism, 26.9% were homozygous extensive metabolisers (HomEM), 66.7% were heterozygous extensive metabolisers (HetEM) and 6.4% were poor metabolisers (PM). Eradication rate of HDDT was 82.4%, 69% and 25% in HomEM, HetEM and PM respectively. Only 16% of patients reported minor side effects.

Conclusion

Eradication rate of HDDT was fairly satisfactory for both homozygous and heterozygous extensive metaboliser states. This finding suggested that HDDT can overcome the effect of CYP2C19 polymorphism.