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.