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Master of Public Health

Host genetic determinants associated with Helicobacter pylori eradication treatment failure: A systematic review and meta-analysis

AUTHORS

Shah SC , Tepler A , Chung CP , Suarez G , Peek RM , Hung A , Roumie C , Narula N , . Gastroenterology. 2021 8 3; ().

ABSTRACT

BACKGROUND/AIM: Helicobacter pylori infects approximately 50% of individuals worldwide. Successful H. pylori eradication is associated with reduced risk of gastric cancer and peptic ulcer disease, among other conditions. We hypothesized that host genetic determinants, especially those affecting gastric pH, might contribute to eradication therapy failure, particularly when treatment adherence and antibiotic susceptibility are confirmed. We aimed to conduct a meta-analysis of host genetic variants associated with H. pylori eradication failure.

METHODS: We searched the literature for studies comparing post-treatment H. pylori eradication failure vs success (outcome) according to host genetic polymorphisms (exposure). Reference groups were defined according to genotypes (or corresponding phenotypes) hypothesized to be associated with successful eradication. We pooled estimates using a random-effects model, and performed comprehensive sensitivity analyses.

RESULTS: We analyzed 57 studies from 11 countries; the vast majority analyzed CYP2C19 polymorphisms. Among individuals prescribed eradication regimens with PPIs predominantly CYP2C19-metabolized, enhanced vs poor metabolizer phenotypes were associated with a 2.52-fold significantly higher likelihood of eradication failure, and 4.44-fold significantly higher likelihood when treatment adherence and H. pylori clarithromycin susceptibility (if relevant) were confirmed. There was no association between CYP2C19 variants and eradication failure if PPIs less metabolized by or which bypass CYP2C19 metabolism were used. IL-1B polymorphisms that are vs. are not associated with less gastric acid suppression were associated with 1.72-fold significantly higher likelihood of eradication failure. There was no association between MDR1 polymorphisms and H. pylori eradication failure. The certainty of evidence was moderate.

CONCLUSION: Based on meta-analysis, we identified host genetic polymorphisms significantly associated with H. pylori eradication failure; host genetics might underlie eradication failure among treatment-adherent individuals with confirmed H. pylori antibiotic susceptibility.

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