Korean J Gastroenterol.  2013 May;61(5):252-258. 10.4166/kjg.2013.61.5.252.

Clarithromycin-resistant Helicobacter pylori Associated with 23S rRNA Point Mutations in Jeju Island

Affiliations
  • 1Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea. songhj@jejunu.ac.kr
  • 2National Biobank of Korea, Jeju National University Hospital, Jeju, Korea.
  • 3Department of Pathology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea.

Abstract

BACKGROUND/AIMS
The point mutations in 23S rRNA gene accounts for the majority of the clarithromycin resistance of Helicobacter pylori. This study aimed to investigate the association between the clarithromycin-resistance of H. pylori and the failure of primary H. pylori eradication therapy in Jeju Island.
METHODS
Between April 2011 and October 2012, 6,937 patients underwent endoscopy, and H. pylori infection was evaluated in 2,287 patients (33.0%). Total of 110 patients with H. pylori infection were treated with proton pump inhibitor (PPI)-based triple therapy. The result of eradication was evaluated with urea breath test, histology and PCR which were conducted 4 weeks from the last dose of medicine.
RESULTS
The patients who had point mutations were 33 (26.0%). A2142G and A2143G mutations were observed in 10 patients (7.9%) and 23 patients (18.1%). Among 110 patients treated with PPI-based triple therapy, the success rate of the eradication therapy was 52.7% (58/110) and 70.7% (58/82) by intention-to-treat and per-protocol analysis, respectively. Fifteen of the 24 patients who failed the eradication therapy showed point mutations; 1 patient (4.2%) showed A2142G mutation and 14 patients (58.3%) showed A2143G mutation. Patients with A2143G mutation H. pylori showed higher failure rate of 87.5%. Patients with A2142G mutation H. pylori showed similar failure rate compared to those of the patients with wild type H. pylori.
CONCLUSIONS
In Jeju Island, the frequency of 23S rRNA point mutations is similar (26.0%) with other regions of Korea (15.8-31.3%). A2143G mutation is associated with the failure of H. pylori eradication.

Keyword

23S rRNA; Point mutation; Clarithromycin; Resistance; Helicobacter pylori

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents/*therapeutic use
Clarithromycin/*therapeutic use
DNA, Bacterial/analysis
Drug Resistance, Bacterial
Female
Gastroscopy
Helicobacter Infections/*drug therapy
Helicobacter pylori/drug effects/*genetics
Humans
Islands
Male
Middle Aged
Point Mutation
Polymerase Chain Reaction
Proton Pump Inhibitors/therapeutic use
RNA, Ribosomal, 23S/*genetics
Republic of Korea
Young Adult
Anti-Bacterial Agents
Clarithromycin
DNA, Bacterial
Proton Pump Inhibitors
RNA, Ribosomal, 23S

Figure

  • Fig. 1. Detection of point mutation at A2143G and A2142G in 23S rRNA gene by polymerase chain reaction products. M, marker; NC, negative control; PC1, PC2, clarithromycin resistance (PC1: A2143G, PC2: A2142G). Lane 28, A2143G mutation; lane 29, wild type; lane73, A2142G mutation.

  • Fig. 2. Results of Helicobacter pylori eradication with primary triple theraphy. PPI, proton pump inhibitor.


Reference

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