It has been Palbociclib in vivo proposed that pretreatment with PPI decreases the efficacy of H. pylori eradication treatment. With so many patients being treated with PPI for a period prior to being investigated for dyspepsia, this could have obvious negative

clinical implications. Two studies published on this topic this year, however, failed to support this hypothesis nor does it appear to have any impact on symptom severity and quality of life [38,39]. There is a cohort of patients, however, for whom the use of a PPI for H. pylori eradication might be undesirable, for instance those on dual antiplatelet therapy with coronary stents or patients with allergies and intolerances. A trial was published this year on a new-generation histamine-2 click here receptor antagonist, lafutidine, that has antisecretory properties. This study suggested that as part of a standard

triple-therapy regimen, similar rates of eradication could be achieved with lafutidine as with lansoprazole with no increase in adverse events [40]. It may be possible to tailor the eradication regime offered to individual patients to maximize its efficacy. There are a number of options available to achieve this, which have been examined in the past such as examining bacterial virulence factors and pretesting for antibiotic susceptibility,

but in the last year, some new developments have been made. One of the more interesting targets for this aim lies in understanding the role of the cytochrome P450 2C19 (CYP2C19) genotype in H. pylori eradication. The effect here is exerted via the PPI component of therapy with polymorphisms of the CYP2C19 leading some individuals to metabolize more extensively than others. The studies carried Morin Hydrate out in the last year have mainly involved Chinese patients. One study divided subjects receiving a standard triple-therapy regime with omeprazole into extensive (EM), intermediate (IM), and poor (PM) metabolizers according to their CYP2C19 phenotype: 33% for the EM group, 92% for the IM group, and 100% for PM [41]. CYP2C19 polymorphisms can be overcome somewhat in EM by increasing PPI dose with one study showing significantly higher eradication rates in EM when 40 mg rather than 20 mg of omeprazole is used in a dual-therapy regime [42]. It may also be the case that not all PPIs are the same. In another Chinese study where esomeprazole was used, no significant difference was observed when 40 mg was used as opposed to 20 mg in either rate of eradication or side effects [43]. Similarly, in another study where rabeprazole and lansoprazole were used, a dose-dependent effect was not seen [44].