제주 지역에서 23S rRNA Point Mutations과 관련된 Clarithromycin 내성 Helicobacter pylori

Abstract

Backgrounds/Aim: Most of the clarithromycin-resistant Helicobacter pylori (H. pylori) occur through the point mutations in 23S rRNA gene. There has been no study about clarithromycin-resistance of H. pylori in Jeju Island, because it is isolated place in Korea. This study was conducted 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, a total of 127 patients underwent upper gastrointestinal endoscopy and were diagnosed with H. pylori infection through rapid urease tests and Giemsa staining. Among them, 110 patients were treated with proton pump inhibitor (PPI)-based triple therapy, One month after the first H. pylori eradication therapy, we analyzed the PCR results in terms of the success or failure. Results: The mean age of the 127 patients was 52 ± 14 years (range, 15-82 years), and the ratio of males to females was 79:48 (62.2%:37.8%). The total mutations were 33 patients (26.0%) and A2142G and A2143G mutations were observed in 10 patients (7.9%) and 23 patients (18.1%), respectively. The age of patients with A2143G mutation was significantly higher than those with wild-type (59 ± 11 vs. 50 ± 14 years, p = 0.028). A2143G mutation was more frequently observed in females than in males (35.4% vs. 7.6%, p < 0.005). Among 110 patient treated with PPI-based triple therapy, the success rate of the first 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 first eradication therapy showed point mutations; 9 patients (37.5%) showed wild type, 1 patient (4.2%) showed A2142G mutation and 14 patients (58.3%) showed A2143G mutation. In particular, A2143G mutation was significantly higher in failure group of the first H. pylori eradication therapy compared with success group (58.3% vs. 3.4%; p < 0.001). Conclusions: In Jeju Island, the frequency of 23S rRNA point mutations is similar (26.0%) with any other regions of Korea (15.8~31.3%). A2143G mutation could be associated with the clarithromycin-resistance of H. pylori and with the failure of first H. pylori eradication therapy.

Key words: 23S rRNA point mutation, Clarithromycin resistance, Helicobacter pylori, Jeju