Open AccessEffect of proton pump inhibitors on cytochrome P450 2c19 activity in
patients with gastroesophageal reflux disease.
Author(s) -
Yuliya S. Rabotyagova,
I. L. Klyaritskaya,
Anil S Modak
Publication year - 2018
Publication title -
kliničeskaâ medicina
Language(s) - English
Resource type - Journals
eISSN - 2412-1339
pISSN - 0023-2149
DOI - 10.18821/0023-2149-2018-96-2-164-167
Subject(s) - cyp2c19 , rabeprazole , pantoprazole , esomeprazole , omeprazole , gerd , medicine , proton pump inhibitor , gastroenterology , reflux , pharmacology , lansoprazole , disease , cytochrome p450 , metabolism
Patients with gastroesophageal reflux disease (GERD) are routinely prescribed one of the six proton pump inhibitors (PPI). All of these PPI are inhibitors of CYP2C19 enzyme to varying degrees. The phenotype 13C-pantoprazole breath test (Ptz-BT) was used to identify patients who are poor metabolizers (PM) and the extent of phenoconversion of CYP2C19 enzyme activity caused by four PPI (omeprazole, esomprazole pantoprazole and rabeprazole) in 54 newly diagnosed GERD patients prior to initiating randomly selected PPI therapy and 30 days after PPI therapy. The phenoconversion after 30 days of PPI therapy in GERD patients was statistically significant (p = 0.001) with omeprazole/esomeprazole (n = 27) strong CYP2C19 inhibitors, while there was no change in CYP2C19 enzyme activity (p = 0.8) with pantoprazole/rabeprazole (n = 27), weak CYP2C19 inhibitors. The rapid, in vivo, and non-invasive phenotype Ptz-BT can evaluate CYP2C19 enzyme activity. More importantly, it can identify GERD patients with low CYP2C19 enzyme activity (PM), caused by PPI or other concomitant medications, who would benefit from dose adjustments to maintain efficacy and avoid toxicity. The existing CYP2C19 genotype tests cannot predict the phenotype nor can it detect phenoconversion due to nongenetic factors.