Influence of CYP2C19 Polymorphism and Helicobacter pylori Genotype Determined From Gastric Tissue Samples on Response to Triple Therapy for H pylori Infection  Takahisa Furuta, Yukiko Sagehashi, Naohito Shirai, Mitsushige Sugimoto, Akiko Nakamura, Makoto Kodaira, Kazumi Kenmotsu, Makoto Nagano, Tohru Egashira, Koji Ueda, Masao Yoneyama, Kyoichi Ohashi, Takashi Ishizaki, Akira Hishida  Clinical Gastroenterology and Hepatology  Volume 3, Issue 6, Pages 564-573 (June 2005) DOI: 10.1016/S1542-3565(04)00779-7 Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 1 Median MIC values for clarithromycin in H pylori strains with different 23S rRNA mutations. Data were expressed as medians with ranges. The median MIC value of strains with the mutation from adenine to guanine at the position 2142 of 23S rRNA (A2142G) was highest, that with the mutation from adenine to guanine at the position 2143 of 23S rRNA (A2143G) was second highest, and that without mutation was lowest of the 3 groups. Clinical Gastroenterology and Hepatology 2005 3, 564-573DOI: (10.1016/S1542-3565(04)00779-7) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 2 Eradication rates of H pylori in different CYP2C19 genotype groups (A) and frequencies of CYP2C19 genotypes in patients with eradication and non-eradication of H pylori infection (B) by triple therapy with lansoprazole, clarithromycin, and amoxicillin. (A) The eradication rates in PM and IM groups were significantly higher than that of the RM group. (B) There was a significant difference in the frequency of CYP2C19 genotypes between the groups with and without eradication. The majority of patients in the non-eradication group had the RM genotype of CYP2C19. Note that most (>93%) patients with non-eradication of H pylori had EM genotype of CYP2C19 (RM or IM), whereas only 2 PM patients belonged to the non-eradication group. Clinical Gastroenterology and Hepatology 2005 3, 564-573DOI: (10.1016/S1542-3565(04)00779-7) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 3 Eradication rates of H pylori in clarithromycin-sensitive and -resistant strains of H pylori (A) and frequencies of clarithromycin-sensitive and -resistant strains of H pylori in patients with and without eradication of H pylori infection achieved with triple therapy with lansoprazole, clarithromycin, and amoxicillin. (A) The eradication rate in patients infected with clarithromycin-sensitive strains of H pylori was significantly higher than that with clarithromycin-resistant strains of H pylori. (B) There was a significant difference in the frequency of clarithromycin-sensitive or -resistant strain of H pylori between the groups with and without eradication. Note that more than half (51.7%) of patients without eradication of H pylori were infected with clarithromycin-resistant strains of H pylori, whereas only 12.6% of patients with eradication of H pylori were infected with clarithromycin-resistant strains of H pylori. Clinical Gastroenterology and Hepatology 2005 3, 564-573DOI: (10.1016/S1542-3565(04)00779-7) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 4 H pylori eradication rates achieved with triple lansoprazole/clarithromycin/amoxicillin therapy for clarithromycin-sensitive and -resistant strains of H pylori in the different CYP2C19 genotype groups. Bars indicate 95% CIs. There was a significant difference in eradication rates among the 3 genotype groups for both clarithromycin-resistant and -sensitive strains of H pylori. Difference in the eradication rates between clarithromycin-sensitive and -resistant strains of H pylori was most evident in the CYP2C19 RM patients. Clinical Gastroenterology and Hepatology 2005 3, 564-573DOI: (10.1016/S1542-3565(04)00779-7) Copyright © 2005 American Gastroenterological Association Terms and Conditions