Proton Pump Inhibitor Switching Strategy after Failure of Standard Triple Therapy for Helicobacter pylori Infection

ABSTRACT

Background/Aims@#It is still unknown whether cytochrome P450 (CYP) 2C19 polymorphisms influence Helicobacter pylori (H. pylori) eradication, especially in eastern Asia. We aimed to evaluate how changes in proton pump inhibitor (PPI) strategies could be used to overcome the effects of CYP2C19 polymorphism on H. pylori eradication rate when it is used as the second-line regimen after the failure of standard triple therapy. @*Materials and Methods@#We performed a retrospective observation study of 675 patients in whom standard triple therapy for H. pylori infection was not effective between January 2009 to December 2018. All patients underwent a classic bismuth-containing quadruple therapy (10 to 14-day regimen), and their eradication rates were evaluated for several years. We compared the eradication rates in patients with or without the second-line PPI switch. Further, we assessed differences in eradication rates with or without the strategy using esomeprazole and rabeprazole, which are not influenced significantly by CYP2C19 genetic polymorphism. @*Results@#The eradication rate was 81.0% in individuals who received the second-line PPI switch, but it was 74.8% without switching (P=0.14). In the strategy using esomeprazole and rabeprazole, the eradication rate was 84.6%, compared to 76.5% in the control group (P=0.03). Finally, in the group of patients who switched to rabeprazole, the eradication rates were 85.6%, compared to 77.6% in the group who switched to pantoprazole (P=0.05). @*Conclusions@#Switching to PPI, which is not influenced by CYP2C19 genetic polymorphism, increases the efficiency of eradication after the failure of standard triple therapy.