Evaluation of the effectiveness of eradication therapy using cytochrome P450 2C19 genotyping

Relevance. Infection with Helicobacter pylori (НР), a class 1 carcinogen for gastric cancer development, is steadily increasing in the world population and reaches 50%. Currently, eradication therapy (ET) is considered the most relevant strategy for the prevention of gastric cancer. Due to the low eradication rates when using a triple regimen based on clarithromycin, the addition of bismuth salts and the use of double doses of proton pump inhibitors are recommended. Objective. To evaluate the effectiveness of double doses of esomeprazole and rabeprazole in ET in patients with different genotypes of cytochrome P450 2C19, infected with НР. Material and methods. 50 patients infected with Helicobacter pylori were recruited. All patients were prescribed triple therapy with a double dose of proton pump inhibitor (PPI) enhanced with bismuth preparations (clarithromycin 500 mg, amoxicillin 1000 mg, bismuth tripotassium dicitrate 240 mg, esomeprazole 40 mg/rabeprazole 40 mg.) All drugs were taken 2 times a day for 14 days. Depending on the PPI used, patients were randomized into two groups: esomeprazole 40 mg (group 1) and rabeprazole 40 mg (group 2).The genotype of cytochrome P450 2C19 was determined by PCR (test system Seeplex® CYP2C19 Genotyping Set.) Results. Genetic polymorphism of cytochrome P450 2C19 in patients infected with H. pylori in Crimea is represented by genotypes *1/*1 — 69.9% and *1/*2 — 30.1%. The eradication rate using regimens with esomeprazole and rabeprazole was 87,8% (95% confidence interval: 81.2–89.0%) and 85,7% (79.5–88.4%), respectively. The eradication rate using regimens with esomeprazole and rabeprazole did not differ significantly in patients with genotypes *1/*1 (p = 0.999) and *1/*2 (p = 0.286). On day 5, the mean intragastric pH was higher in the rabeprazole group compared with the esomeprazole group (5,7 vs. 5,4), but did not achieve a statistical difference (p = 0.308). Conclusion: The ET regimens used were equally effective in each group, regardless of the CYP2C19 genotype, and the intragastric pH profiles were comparable. 

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