Helicobacter Pylori Eradication Succes with High Dose Proton Pump Inhibitor in Extensive PPI Metabolizers

Aims Turkish population metabolizes proton pump inhibitors (PPI) rapidly. In helicobacter pylori eradication, intragastric PH should be>5 in 24 hour period. The reason for the low success in classical H. pylori eradication may be the insufficient acid inhibition with PPI twice daily dose and the insufficient increase of intagastric PH. In our study we aimed to show that the use of high dose PPI can increase treatment success in extensive acetylating societies such as Turkish people.

Methods Patients who were evaluated gastroscopically and found to be H.pylori positive in their endoscopic biopsies were evaluated by dividing them into two groups according to the eradication treatments they received. While both groups received Bismuth 2 tablets twice a day, Tetracycline 500 mg 3 times a day, Metronidazole 500 mg 3 times a day as common treatment, the 1^st group used pantaprozole 40 mg twice daily and the 2nd group used pantaprozole 40 mg 3 times a day as PPI. H.pylori antigens in the stool of the patients were evaluated 4 weeks after the treatment, including PPI treatment [1].

Results A total of 114 patients, 56 of whom (49.1%) were women, were included in our study. The average age of the patients was 49.69±15.65 years. Biopsies taken during gastroscopy of the patients revealed intestinal metaplasia in 30.7% and atrophic gastritis in 5.3%. H.pylori eradication rate was found to be 83.78% in the entire group. While 54 patients (47.4%) were in the 1st group (PPI twice daily), 60 patients were in the 2nd group (PPI 3 times a day). The H.pylori eradication rate was found to be 87.17% in the patients in the 2nd group, and the H.pylori eradication rate was 80% (p=0.001) in the patients in the 1st group. There was no difference between the treatment groups in terms of age, gender, atrophy on endoscopy, and the presence of intestinal metaplasia.

Conclusions In populations that extensive metabolizer, using a 3 times a day dose of PPI may increase the success of h pylori eradication compared to using a twice daily dose. However, more work is needed.

Publication History

Article published online:
27 March 2025

• References

• 1 Ormeci A, Emrence Z, Baran B. et al. Can Helicobacter pylori be eradicated with high-dose proton pump inhibitor in extensive metabolizers with the CYP2C19 genotypic polymorphism?. European Review for Medical and Pharmacological Sciences 2016; 20 (9): 1795-1797