A comparative study of proton-pump inhibitor tests for chinese reflux patients in relation to the CYP2C19 genotypes
Journal
Journal of Clinical Gastroenterology
Journal Volume
43
Journal Issue
10
Pages
920-925
Date Issued
2009
Author(s)
Abstract
Background: The proton-pump inhibitor (PPI) test has been proposed as a valuable tool for diagnosing gastroesophageal reflux disease in Western populations. Goals: We aim to compare the diagnostic accuracy of the PPI test using rabeprazole and pantoprazole in a Chinese population with a higher prevalence of poor PPI metabolization. Study: After diagnostic endoscopy, patients with gastroesophageal reflux disease symptoms were randomly assigned to a 2-week test with rabeprazole (20 mg b.i.d.) or pantoprazole (40 mg b.i.d.). Therapeutic response was assessed with a 5-grade daily record. Genotypes of cytochrome P450 (CYP) 2C19 polymorphism were determined. Results: Of the 178 patients who completed the study, 92 (51.7%) had erosive esophagitis and 78 (48.3%) were endoscopy-negative reflux disease. On the basis of 50% reduction of symptoms, there was a nonsignificant difference of diagnostic performances between rabeprazole and pantoprazole. For the CYP2C19 genotypes, 138 (87.3%) were determined to be extensive metabolizers (EMs) and 20 (12.7%) were poor metabolizers (PMs). When comparing the EMs and PMs, the diagnostic specificity in the prediction of erosive esophagitis was higher in the EMs (57.6% vs. 20.0%, P=0.040), as was the accuracy (74.6% vs. 50.0%, P=0.023). There were no differences in the sensitivity, positive predictive value, or negative predictive value. Conclusions: CYP2C19 genotypic polymorphism was related to a higher possibility of false-positive results for patients who metabolized PPI poorly. High-dose rabeprazole and pantoprazole showed a similar diagnostic performance. ? 2009 by Lippincott Williams & Wilkins.
Other Subjects
cytochrome P450 2C19; pantoprazole; proton pump inhibitor; rabeprazole; 2 [[(2 pyridyl)methyl]sulfinyl]benzimidazole derivative; antiulcer agent; CYP2C19 protein, human; diagnostic agent; pantoprazole; proton pump inhibitor; rabeprazole; unspecific monooxygenase; adult; article; Chinese; comparative study; diagnostic accuracy; diagnostic procedure; disease severity; drug megadose; female; gastroesophageal reflux; gastrointestinal endoscopy; genetic polymorphism; genotype; human; major clinical study; male; priority journal; treatment outcome; China; clinical trial; controlled clinical trial; controlled study; gastroesophageal reflux; genetics; laboratory diagnosis; metabolism; middle aged; prediction and forecasting; randomized controlled trial; reflux esophagitis; sensitivity and specificity; 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Anti-Ulcer Agents; Aryl Hydrocarbon Hydroxylases; China; Esophagitis, Peptic; False Positive Reactions; Female; Gastroesophageal Reflux; Genotype; Humans; Male; Middle Aged; Predictive Value of Tests; Proton Pump Inhibitors; Sensitivity and Specificity
Type
journal article