A Study About The Optimization Of Helicobacter Pylori Resistance Level, CYP2C19 Polymorphism Survey And Eradication Of Helicobacter Pylori Of Rural Population In Chongqing

Aim The aim of this multicenter study was to investigate the antibiotic resistance profile of H.pylori and the distribution of CYP2C19 gene polymorphisms in rural population of Chongqing, China. The results are expected to provide scientific basis for selecting appropriate treatment regimens for H. pylori infection.Methods 744 Patients infected with H.pylori were recruited from 11 hospitals in rural areas, and recruited 290 urban patients infected with H.pylori as control. All patients were subjected to gastroscopy and gastric tissue specimens were collected. H. pylori isolates were subjected to drug susceptibility tests by agar dilution method. 387 rural patients were determined CYP2C19 gene polymorphisms by Sanger way, and 116 urban patients were determined CYP2C19 gene polymorphisms as control; Selected two treatment regimans on the basis of above studies,A: esomeprazo Ie/rabeprazole + furazolidone + amoxicillin + bismuth potassium, B:pantoprazole/lansoprazole + furazolidone + amoxicillin+ bismuth potassium, and took standard therapy（esomeprazole/rabeprazole + clarithromycin + amoxicillin） as control group, 270 patients with H.pylori infection were collected and randomly divided into three groups. The course of treatment was 14 days.At least four weeks after the end of therapy and withdrawal the medicine,patients underwent fasting ¹³C-urea breath test or ¹⁴C-urea breath test, The negative result indicated as successful H.pylori eradication and the adverse effects were observed and recorded. Intension-totreat（ITT） and per protocol（PP） analyses were used to compare the eradication rates among these groups.Results 239 strains were isotated from rural patients, 99.6%,18.4%, and 22.2% of all isolates were found to be resistant to metronidazole, clarithromycin, levofloxacin, respectively. Resistance rate to metronidazole + clarithromycin / levofloxacin was 27.2%, while that to metronidazole + clarithromycin + levofloxacin was 6.7%. 111 strains were isolated from urban patients, 82.9%, 19.8%, and 24.3% of all isolates were found to be resistant to metronidazole, clarithromycin, and levofloxacin, respectively. Resistance to metronidazole + clarithromycin /levofloxacin was found in 13.5% isolates, while that to metronidazole +clarithromycin + levofloxacin was found in 15.3% isolates. And there was no strain found to be resistant to amoxicillin, gentamicin and furazolidone. Up to 39.8% 、 48.6% and 11.6% of rural patients were found to be extensive metabolizers（Ems）, intermediate metabolizers（Ims） and poor metabolizers（PMs）, respectively, while that were 33.3%,55.0% and 11.7% to urban patients, respectively; The intention-to-treat analysis of the H. pylori eradication rates in Groups A, B, and C were82.2%（74/90）, 74.4%（67/90） and 64.4%（58/90）, respectively, and according to PP analysis which were 88.1%, 80.7% and 68.2%,respectively. The H.pylori eradication rate in group A was the highest among the three groups, and there was a significant difference between groups A and C（P < 0.05）. The remission rate of clinical symptoms in A and B group were far better than C group（P < 0.05）. The number of adverse events was 16（17.8%）, 17（18.9%）, and 19（21.1%） in Groups A, B and C, respectively, including nausea, bitter taste, skin rash, itchy skin, and diarrhea, The symptoms were relieved without special treatment in all of the patients, there was no significant difference among three groups（P>0.05）.Conclusions The prevalence of H.pylori resistance to metronidazole,clarithromycin, levofloxacin and multiple antibiotics in rural area of Chongqing was high. Choice of therapy should be individualized based on a susceptibility test in this region. and didn’t find antibiotics resistance to amoxicillin, gentamicin and furazolidone, so, they can be recommended as the first-line empiric regimen, and there is no significant difference in distribution of CYP2C19 gene polymorphisms between rural and urban population. the eradication rate of standard triple therapy is low of 80%, so this regimen are not any more recommended for unconditional empiric use, the H.pylori eradication rate is high in esomeprazole/rabeprazole plus furanzolidone,bismuth and amoxicillin quadruple therapy and with good safety and low cost,which could be the first line treatment for H.pylori eradication.