Clarithromycin resistance and female gender affect Helicobacter pylori eradication failure in chronic gastritis

다국어 초록 (Multilingual Abstract)

Background/Aims: The eradication rate of the first-line triple therapy (a proton pump inhibitor, clarithromycin, and amoxicillin) for Helicobacter pylori infection has gradually decreased in Korea. We evaluated whether clinical parameters, clarithromycin resistance, and CYP2C19 genotype can affect the eradication failure.
Methods: A total of 203 patients with H. pylori-positive chronic gastritis were consecutively enrolled. They received clarithromycin-based triple therapy for 7 days. A clarithromycin resistance test was performed by detection of A2142G and A2143G point mutations in H. pylori 23S rRNA. The CYP2C19 genotype was examined for polymorphism G681A of exon 5 and G636A of exon 4 by polymerase chain reaction with restriction fragment length polymorphism. Eradication was assessed by a 13C-urea breath test 4 weeks after treatment.
Results: Of 203 patients, 190 completed the study. The eradication rate was 64.0% according to intention-to-treat analysis and 68.4% by per-protocol analysis. CYP2C19 genotypes were identified as follows: 75 poor metabolizers, 75 intermediate metabolizers, and 40 rapid metabolizers. Nonetheless, this polymorphism was not significantly associated with eradication failure (p = 0.682). Clarithromycin resistance was detected in 33/190 patients (17.4%), and their eradication rate was zero. Clarithromycin resistance (odds ratio [OR], 19.13; 95% confidence interval [CI], 9.35 to 35.09) and female gender (OR, 1.73; 95% CI, 1.15 to 4.25) were significantly associated with eradication failure. The other clinical parameters such as age, cigarette smoking, alcohol intake, the body mass index, hypertension, and diabetes were not significantly associated with eradication.
Conclusions: Clarithromycin resistance and female gender are factors affecting H. pylori eradication failure in patients with chronic gastritis.

참고문헌 (Reference)

1 김태윤, "제주 지역에서 23S rRNA 점 돌연변이와 관련된 Clarithromycin 내성 Helicobacter pylori" 대한소화기학회 61 (61): 252-258, 2013

2 Cai W, "Variables influencing outcome of Helicobacter pylori eradication therapy in South China" 14 : 91-96, 2009

3 Yoon JH, "Trends in the eradication rates of Helicobacter pylori infection for eleven years" 18 : 6628-6634, 2012

4 김성은, "Trends in Helicobacter pylori eradication rates by first-line triple therapy and related factors in eradication therapy" 대한내과학회 30 (30): 801-807, 2015

5 Namiot Z, "The effect of cigarette smoking and alcohol consumption on efficacy of Helicobacter pylori eradication" 104 : 569-574, 2000

6 Padol S, "The effect of CYP2C19 polymorphisms on H. pylori eradication rate in dual and triple first-line PPI therapies: a meta-analysis" 101 : 1467-1475, 2006

7 Suzuki T, "Smoking increases the treatment failure for Helicobacter pylori eradication" 119 : 217-224, 2006

8 Baena JM, "Relation between alcohol consumption and the success of Helicobacter pylori eradication therapy using omeprazole, clarithromycin and amoxicillin for 1 week" 14 : 291-296, 2002

9 Sjostedt S, "Prolonged and profound acid inhibition is crucial in Helicobacter pylori treatment with a proton pump inhibitor combined with amoxicillin" 33 : 39-43, 1998

10 De Francesco V, "Prevalence of primary clarithromycin resistance in Helicobacter pylori strains over a 15 year period in Italy" 59 : 783-785, 2007

11 Lee JW, "Prevalence of primary and secondary antimicrobial resistance of Helicobacter pylori in Korea from 2003 through 2012" 18 : 206-214, 2013

12 Lim SH, "Prevalence and risk factors of Helicobacter pylori infection in Korea : nationwide multicenter study over 13 years" 13 : 104-, 2013

13 Park CS, "Pretreatment antimicrobial susceptibility-guided vs. clarithromycin-based triple therapy for Helicobacter pylori eradication in a region with high rates of multiple drug resistance." 109 : 1595-1602, 2014

14 Andersson T, "Polymorphic hydroxylation of S-mephenytoin and omeprazole metabolism in Caucasian and Chinese subjects" 2 : 25-31, 1992

15 Malfertheiner P, "Peptic ulcer disease" 374 : 1449-1461, 2009

16 Osato MS, "Pattern of primary resistance of Helicobacter pylori to metronidazole or clarithromycin in the United States" 161 : 1217-1220, 2001

17 Moayyedi P, "Patient factors that predict failure of omeprazole, clarithromycin, and tinidazole to eradicate Helicobacter pylori" 32 : 24-27, 1997

18 McNicholl AG, "Meta-analysis: esomeprazole or rabeprazole vs. first-generation pump inhibitors in the treatment of Helicobacter pylori infection" 36 : 414-425, 2012

19 Malfertheiner P, "Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report" 66 : 6-30, 2017

20 Occhialini A, "Macrolide resistance in Helicobacter pylori : rapid detection of point mutations and assays of macrolide binding to ribosomes" 41 : 2724-2728, 1997

21 Murray LJ, "Inverse relationship between alcohol consumption and active Helicobacter pylori infection : the Bristol Helicobacter project" 97 : 2750-2755, 2002

22 Kim N, "Institutional difference of antibiotic resistance of Helicobacter pylori strains in Korea" 40 : 683-687, 2006

23 Pratha VS, "Inhibition of pentagastrin-stimulated gastric acid secretion by pantoprazole and omeprazole in healthy adults" 51 : 123-131, 2006

24 조동근, "Helicobacter pylori 제균율 변화와일차 제균에 영향을 미치는 임상 인자" 대한소화기학회 55 (55): 368-375, 2010

25 Aydemir S, "Helicobacter pylori infection in hemodialysis patients : susceptibility to amoxicillin and clarithromycin" 11 : 842-845, 2005

26 Megraud F, "Helicobacter pylori and antibiotic resistance" 56 : 1502-, 2007

27 Dickson EJ, "Genetics of response to proton pump inhibitor therapy : clinical implications" 3 : 303-315, 2003

28 Lee JY, "Factors affecting first-line triple therapy of Helicobacter pylori including CYP2C19genotype and antibiotic resistance" 59 : 1235-1243, 2014

29 Mitchell H, "Epidemiology, clinical impacts and current clinical management of Helicobacter pylori infection" 204 : 376-380, 2016

30 Sugimoto M, "Efficacy of tailored Helicobacter pylori eradication treatment based on clarithromycin susceptibility and maintenance of acid secretion" 19 : 312-318, 2014

31 Jung SW, "Efficacy of Helicobacter pylori eradication therapy in chronic liver disease" 41 : 134-140, 2009

32 Tang HL, "Effects of CYP2C19loss-of-function variants on the eradication of H. pylori infection in patients treated with proton pump inhibitor-based triple therapy regimens: a meta-analysis of randomized clinical trials" 8 : e62162-, 2013

33 Kang JM, "Effect of the CYP2C19polymorphism on the eradication rate of Helicobacter pylori infection by 7-day triple therapy with regular proton pump inhibitor dosage" 23 (23): 1287-1291, 2008

34 Franchini M, "Effect of Helicobacter pylori eradication on platelet count in idiopathic thrombocytopenic purpura : a systematic review and meta-analysis" 60 : 237-246, 2007

35 Zheng Q, "Comparison of the efficacy of triple versus quadruple therapy on the eradication of Helicobacter pylori and antibiotic resistance" 11 : 313-318, 2010

36 McColl KE, "Clinical practice. Helicobacter pylori infection" 362 : 1597-1604, 2010

37 Francavilla R, "Clarithromycin-resistant genotypes and eradication of Helicobacter pylori" 157 : 228-232, 2010

38 Hwang TJ, "Change in antibiotic resistance of Helicobacter pylori strains and the effect of A2143G point mutation of 23S rRNA on the eradication of H. pylori in a single center of Korea" 44 : 536-543, 2010

39 Treiber G, "Age-dependent eradication of Helicobacter pylori with dual therapy" 11 : 711-718, 1997