High Prevalence of CYP2C19 Rapid and Ultrarapid Metabolism Among Patients With Gastroesophageal Reflux Disease.

CYP2C19 polymorphisms (rapid/ultrarapid metabolizer) → accelerated PPI degradation → inadequate response, need for dose adjustment

In a retrospective cohort of patients in an outpatient gastroenterology clinic for refractory GERD, CYP2C19 genotyping reveals a high prevalence of rapid and ultrarapid metabolizers. These patients show inadequate response despite dose and timing optimization. Genotyping led to dosing modifications in most cases, with documented clinical improvement. These results support CYP2C19 genotyping as a second-line tool in refractory GERD.

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Refractory GERD is one of the most tangible indications for CYP2C19 genotyping in routine practice — a frequent clinical situation where genotype-guided dosing adjustment can prevent years of therapeutic failure. These data strengthen the argument for integrating CYP2C19 testing in uncontrolled GERD workups, well before referral for anti-reflux surgery.

Clinical impact: 3/3 · Evidence strength: 2/3 · Novelty: 1/2 · Sample size: 1/1 · Publication status: 1/1 → Total: 8/10