First-line eradication for Helicobacter pylori-positive gastritis by esomeprazole-based triple therapy is influenced by CYP2C19 genotype

AIM: To evaluate the effect of first line esomeprazole(EPZ)-based triple therapy on Helicobacter pylori(H. pylori) eradication.METHODS: A total of 80 Japanese patients with gastritis who were diagnosed as positive for H. pylori infection by endoscopic biopsy-based or ^(13)C-urea breath tests were included in this study. The average age of the patients was 57.2 years(male/female, 42/38). These patients were treated by first-line eradication therapy with EPZ 40 mg/d, amoxicillin 1500 mg/d, and clarithromycin 400 mg/d for 7 d. All drugs were given twice per day. Correlations between H. pylori eradication, CYP2C19 genotype, and serum pepsinogen(PG) level were analyzed. This study was registered with the UMIN Clinical Trials Registry(UMIN000009642).RESULTS: The H. pylori eradication rates by EPZbased triple therapy evaluated by intention-to-treat and per protocol were 67.5% and 68.4%, respectively, which were similar to triple therapies with other first-generation proton pump inhibitors(PPIs). The eradication rates in three different CYP2C19 genotypes, described as extensive metabolizer(EM), intermediate metabolizer, and poor metabolizer, were 52.2%, 72.1%, and 84.6%, respectively. The H. pylori eradication rate was significantly lower in EM than non-EM(P < 0.05). The serum PG?Ⅰ?level and PG?Ⅰ/Ⅱ ratio were significantly increased after eradication of H. pylori(P < 0.01), suggesting that gastric atrophy was improved by H. pylori eradication. Thus, first-line eradication by EPZbased triple therapy for patients with H. pylori-positive gastritis was influenced by CYP2C19 genotype, and the eradication rate was on the same level with other firstgeneration PPIs in the Japanese population.CONCLUSION: The results from this study suggest that there is no advantage to EPZ-based triple therapy on H. pylori eradication compared to other firstgeneration PPIs.

Surveillance using trimodal imaging endoscopy after endoscopic submucosal dissection for superficial gastric neoplasia

AIM:To evaluate the effectiveness of trimodal imaging endoscopy(TME)to detect another lesion afterendoscopic submucosal dissection(ESD)for superficial gastric neoplasia(SGN).METHODS:Surveillance esophagogastroduodenoscopy(EGD)using a TME was conducted in 182 patients that had undergone ESD for SGN.Autofluorescence imaging(AFI)was conducted after white-light imaging(WLI).When SGN was suspicious,magnifying endoscopy with narrow-band imaging(ME-NBI)was conducted.Final diagnoses were made by histopathologic findings of biopsy specimens.The detection rates of lesions in WLI,AFI,and NBI,and the characteristics of lesions detected by WLI and ones missed by WLI but detected by AFI were examined.The sensitivity,specificity,and accuracy of endoscopic diagnosis using WLI,AFI and ME-NBI were evaluated.RESULTS:In 242 surveillance EGDs,27 lesions were determined pathologically to be neoplasias.Sixteen early gastric cancers and 6 gastric adenomas could be detected by WLI.Sixteen lesions were reddish and 6were whitish.Five gastric neoplasias were missed by WLI but were detected by AFI,and all were whitish and protruded gastric adenomas.There was a significant difference in color and pathology between the two groups(P=0.006).Sensitivity,specificity and accuracy in MENBI were higher than those in both WLI and AFI.Specificity and accuracy in AFI were lower than those in WLI.CONCLUSION:Surveillance using trimodal imaging endoscopy might be useful for detecting another lesion after endoscopic submucosal dissection for superficial gastric neoplasia.