Influences of CYP2C19 polymorphism on recurrence of reflux esophagitis during proton pump inhibitor maintenance therapy.

BACKGROUND/AIMS: Patients with erosive gastroesophageal reflux disease (GERD) have rapid recurrence after treatment withdrawal. The aim is to study the influences of CYP2C19 polymorphism on recurrence of GERD during proton pump inhibitor maintenance therapy. METHODOLOGY: Ninety-nine patients with initial healing of GERD (judged by endoscopy) after 8 wk of treatment with PPIs were enrolled into maintenance therapy for 6 mo with rabeprazole (10 mg/day), omeprazole (20 mg/day) or lansoprazole (15 mg/day). The recurrence of GERD symptoms in the maintenance therapy was assessed by a QUEST questionnaire. RESULTS: The recurrence rate of GERD symptoms in the group of CYP2C19 homozygous extensive metabolizers (38.5%) was significantly greater than those in groups of heterozygous extensive metabolizers (10.9%) and poor metabolizers (5.6%). The recurrence rates in patients treated with omeprazole (25%) and lansoprazole (30.8%) were significantly greater than that with rabeprazole (4.4%). The gender, age and H. pylori did not significantly affect the rate. CONCLUSIONS: The CYP2C19 genotypes affected the recurrence rate of GERD symptoms during PPI maintenance therapy. The reason for the low recurrence rate with 10 mg/day rabeprazole possibly is due to its sufficient acid suppression independent of CYP2C19 genotypes in Japanese patients.