{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:58:02Z","timestamp":1785445082929,"version":"3.56.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Gastroesophageal reflux disease is primarily treated with proton pump inhibitors (PPIs), which are metabolized by cytochrome P450 2C19 (\n                      <jats:italic toggle=\"yes\">CYP2C19<\/jats:italic>\n                      ) in the liver.\n                      <jats:italic toggle=\"yes\">CYP2C19<\/jats:italic>\n                      polymorphisms affect PPI plasma levels, with rapid (2\u201327%) and ultra-rapid (&lt;1\u20135%) metabolizers needing higher doses, while poor (3\u201315%) and intermediate (27\u201347%) metabolizers require lower doses for therapeutic effectiveness. Antireflux surgery is recommended for patients refractory to medical therapy or with symptomatic hiatal hernias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This is a multisite retrospective review of adult patients from 2012 to 2023 diagnosed with gastroesophageal reflux disease who underwent hiatal hernia operations and completed\n                      <jats:italic toggle=\"yes\">CYP2C19<\/jats:italic>\n                      testing.\n                      <jats:italic toggle=\"yes\">CYP2C19<\/jats:italic>\n                      phenotypes were grouped as poor metabolizer\/intermediate metabolizer, normal metabolizers, or rapid metabolizer\/ultra-rapid metabolizer. Hiatal hernia size was classified as small, medium, or large based on preoperative and intra-operative findings. Descriptive statistics were used.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty patients [female: 66%, median age: 60.5 (interquartile range 53.3\u201367.0) years, 90% White, 6% Hispanic] had\n                      <jats:italic toggle=\"yes\">CYP2C19<\/jats:italic>\n                      testing and underwent a hiatal hernia repair.\n                      <jats:italic toggle=\"yes\">CYP2C19<\/jats:italic>\n                      phenotypes were poor metabolizer (4%), intermediate metabolizer (24%), normal metabolizers (30%), rapid metabolizer (31%), and ultra-rapid metabolizer (11%). About 28% were grouped as poor metabolizer\/intermediate metabolizer and 43% as rapid metabolizer\/ultra-rapid metabolizer. Among patients with small (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2005=\u200541) and medium (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2005=\u200523) hernias, 39% and 57%, respectively, were classified as rapid metabolizer\/ultra-rapid metabolizer, suggesting they were resistant to PPIs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The prevalence of rapid metabolizer\/ultra-rapid metabolizer\n                      <jats:italic toggle=\"yes\">CYP2C19<\/jats:italic>\n                      phenotypes in patients undergoing antireflux surgery is higher than generally reported in the general population. These patients could potentially benefit from higher PPI doses or surgical intervention if ineffective. Prospective multisite studies with diverse, representative samples are needed to confirm these findings.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/fpc.0000000000000599","type":"journal-article","created":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T21:00:07Z","timestamp":1780261207000},"page":"209-214","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of CYP2C19 phenotypes in patients undergoing a hiatal hernia repair"],"prefix":"10.1097","volume":"36","author":[{"given":"Abdel-Rahman","family":"Naser","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Florida COM Jacksonville, Jacksonville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keouna","family":"Pather","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Florida COM Jacksonville, Jacksonville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin M.","family":"Mobley","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Florida COM Jacksonville, Jacksonville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Climenhage","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Florida COM Jacksonville, Jacksonville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily J.","family":"Cicali","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larisa H.","family":"Cavallari","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana M.","family":"Sacco","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Florida COM Jacksonville, Jacksonville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruchir","family":"Puri","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Florida COM Jacksonville, Jacksonville"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"R1-20260730","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1016\/j.cgh.2022.01.025","article-title":"AGA clinical practice update on the personalized approach to the evaluation and management of GERD: expert review.","volume":"20","author":"Yadlapati","year":"2022","journal-title":"Clin Gastroenterol Hepatol"},{"key":"R2-20260730","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.bpg.2013.06.005","article-title":"Management of the patient with incomplete response to PPI therapy.","volume":"27","author":"Kahrilas","year":"2013","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"R3-20260730","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1007\/s00228-009-0628-5","article-title":"CYP2C19 genotype is associated with symptomatic recurrence of GERD during maintenance therapy with low-dose lansoprazole.","volume":"65","author":"Furuta","year":"2009","journal-title":"Eur J Clin Pharmacol"},{"key":"R4-20260730","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1002\/cpt.2015","article-title":"Clinical pharmacogenetics implementation consortium (CPIC) guideline for CYP2C19 and proton pump inhibitor dosing.","volume":"109","author":"Lima","year":"2020","journal-title":"Clin Pharmacol Ther"},{"key":"R5-20260730","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1080\/17425255.2018.1461835","article-title":"Proton pump inhibitors: from CYP2C19 pharmacogenetics to precision medicine.","volume":"14","author":"El Rouby","year":"2018","journal-title":"Expert Opin Drug Metab Toxicol"},{"key":"R6-20260730","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/BF03262211","article-title":"Individualized therapy for gastroesophageal reflux disease: potential impact of pharmacogenetic testing based on CYP2C19.","volume":"16","author":"Furuta","year":"2012","journal-title":"Mol Diagn Ther"},{"key":"R7-20260730","doi-asserted-by":"crossref","first-page":"267","DOI":"10.5009\/gnl.2011.5.3.267","article-title":"Clinical significance of hiatal hernia.","volume":"5","author":"Hyun","year":"2011","journal-title":"Gut Liver"},{"key":"R8-20260730","doi-asserted-by":"crossref","first-page":"29","DOI":"10.21037\/ales.2020.04.02","article-title":"Which hiatal hernia\u2019s need to be fixed? 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