Rabeprazole and CYP2C19 with Quadruple Therapy

Rabeprazole and CYP2C19 with Quadruple Therapy -...

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Rabeprazole Can Overcome the Impact of CYP2C19 Polymorphism on Quadruple Therapy Chao-Hung Kuo,* ,†,‡ Sophie S.W. Wang, Wen-Hung Hsu,* Fu-Chen Kuo, § Bi-Chuang Weng, Chia-Jung Li, Ping-I Hsu, Angela Chen,** ,†† Wen-Chun Hung,** ,†† Yuan-Chieh Yang, ‡‡ Wen-Ming Wang* †,‡ and Deng-Chyang Wu †,‡,†† *Division of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan, Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, § Department of Gynecology and Obstetrics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan, Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan, **Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan, †† National Sun Yat-Sen Univeristy- Kaoshiung Medical University Joint Center, Kaohsiung, Taiwan, ‡‡ Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan According to Maastricht III Consensus Report, indi- cations for anti- Helicobacter pylori therapy include gastroduodenal ulcer disease, gastric low-grade mucosa- associated lymphoid tissue lymphoma, atrophic gastritis, and early gastric cancer following endoscopic resection [1]. Seven-day triple therapy (proton-pump inhibitor (PPI), amoxicillin, and clarithromycin) has been the recommended Frst-line therapy for H. pylori infection in Taiwan, Europe, and many other countries [2,3]. Currently available Frst-line anti- H. pylori therapies may fail in up to 30% of patients [4,5] leading to a signiFcant increase of antimicrobial resistance, particu- larly against the key antibiotics clarithromycin and or metronidazole [6,7]. Therefore, the standard strategy of Keywords CYP2C19 genotype, quadruple therapy, Helicobacter pylori. Reprint requests to : Deng-Chyang Wu, Chief of Gastroenterology, Kaohsiung Medical University Hospital, 100 Tz-You 1st Road, Kaohsiung City, 807 Taiwan. E-mail: dechwu@ yahoo.com Abstract Objectives: The prospective study was designed to clarify the impact of CYP2C19 on quadruple therapies and survey the efFcacies of rabeprazole- based quadruple therapy for Helicobacter pylori infection after failure of standard triple therapies. Patients and Methods: ±rom January 2007 to March 2009, 1055 H. pylori- infected patients received standard triple regimens (proton-pump inhibitor (PPI), clarithromycin, and amoxicillin). Helicobacter pylori eradication was achieved in 865 (81.9%) subjects. One hundred ninety eradication-failure patients were enrolled and randomly assigned to receive a 7-day eradication therapy. Ninety-six patients were treated with esomeprazole-based quadru- ple rescue therapies (EB), while 94 patients were treated with rabeprazole- based quadruple rescue therapies (RB). ±ollow-up endoscopy was done 16 weeks later to assess the treatment response. Patients’ responses, CYP2C19 genotypes, and antibiotics resistances were also examined.
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Rabeprazole and CYP2C19 with Quadruple Therapy -...

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