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Sirs, Helicobacter pylori eradication is in general indicated for the patients with dyspepsia caused by peptic ulcers or even non-ulcer dyspepsia. 1 However, the routine H. pylori eradication is not indicated to the general population, especially when they are asymptomatic. 1 Therefore, only the dyspeptic patients, whose symptoms should have occurred for at least 12 weeks, are enrolled in our recent publication. 2 As shown in Table 1 of our article, 2 the distribution of different CYP2C19 genotypes as homologous (HomoEM), heterologous (HeteroEM) extensive metabolizer or poor metabolizer (PM) were similar between the two H. pylori-infected dyspeptic study groups, as receiving either omeprazole or esomeprazole-based triple therapy.

However, other than the prevalence of HomoEM as approximately 40–45%, the distributions of HeteroEM and PM are different between the H. pylori dyspeptic patients (32 and 22%) and the general population (45 and 11%), reported by Chen et al. 3 In that conference abstract, the general populations are composed of several races in eastern Taiwan, and have not reviewed their H. pylori status and dyspeptic background. Accordingly, it would be better to keep a positive outlook, seeing whether there would be either a status of H. pylori or dyspeptic history predisposing to any change of the distribution between HeteroEM and PM within a similar race background.

The major finding of our study disclosed esomeprazole 40 mg twice daily in the triple therapy could improve the H. pylori eradication rate for HomoEM of CYP2C19, and kept excellent eradication outcome for both HeteroEM and PM.2 Considering the prevalence of HomoEM of our H. pylori dyspeptic patients was compatible with the general population reported in Taiwan, 3 esomeprazole as 40 mg twice daily in the triple therapy will be rational to cover the H. pylori infection either for dyspeptic patients or for the general population. Moreover, it is promising for the western countries, which had even higher rates of HomoEM. Based on nearly half of the orients and more higher of westerners to be HomoEM of CYP2C19, the direct increase of esomeprazole dosage in triple therapy will be more applicable than to check the genostatus of CYP2C19 currently. Nevertheless, once the check-up becomes simple and rapid, it would be a good alternative choice for clinical practice.

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