Abstract
twofirst-lineproton pump inhibitor (PPI)-based triple therapy regimens were recom- mended. They are amoxicillin, clarithromycin, and PPI or metron- idazole, clarithromycin, and PPI. In Asia, where metronidazole resistance is high, 3 the regimen frequently selected is amoxicillin, clarithromycin, and PPI. With good compliance, the eradication outcome for Helicobacter pylori by this recommended first-line therapy is mainly determined by antimicrobial resistance to clarithromycin.Areport in 2005 suggested that host factor, namely extensivemetabolizers(EM)ofCYP2C19,couldresultinareduced eradication rate with triple therapy that combines clarithromycin, amoxicillin,andomeprazole,20 mgtwicedaily. 4 Inanarticleinthis issueoftheJournalofGastroenterologyandHepatology,aKorean group has confirmed that extensive metabolizers of CYP2C19 have aworseH.pylorieradicationratecomparedwithpoormetabolizers (PM) in a 7-day regimen using the same antibiotics combined with eitheresomeprazole20 mgtwicedailyorpantoprazole40 mgtwice daily. 5 In this head-to-head comparison, the H. pylori eradication rates were approximately 15% lower in the EM group than in the PMgroup.ThisisasignificantfindingforAsians,asPMaccountfor 15-23% or more of the population. 6
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