Proton Pump Inhibitor Response — CYP2C19 determines how quickly PPIs are cleared, creating the difference between H. pylori treatment failure in ultra-rapid metabolizers and drug accumulation with interaction risk in poor metabolizers.
Whole genome sequencing provides the complete CYP2C19 diplotype — the same gene that governs clopidogrel, escitalopram, and PPI metabolism — giving your physician the information to select the right PPI dose before a treatment course fails.
Proton Pump Inhibitor Response — CYP2C19
Proton pump inhibitors (PPIs) — omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole — are among the most frequently prescribed medications worldwide, used for gastroesophageal reflux disease (GERD), peptic ulcer disease, Helicobacter pylori eradication, and prevention of NSAID-induced gastropathy. PPIs are prodrugs that require acid activation in the gastric lumen and are subsequently metabolized primarily by CYP2C19 in the liver. CYP2C19 metabolizer status determines PPI plasma concentrations and, consequently, efficacy and interaction potential.
CYP2C19 ultra-rapid metabolizers (UM) and rapid metabolizers clear PPIs so quickly that plasma concentrations of the active drug fall below the threshold needed for complete acid suppression. In H. pylori eradication therapy — where sustained acid suppression is required for antibiotic efficacy — CYP2C19 UMs have significantly lower eradication rates at standard triple or quadruple therapy PPI doses. Studies in populations with high CYP2C19 UM frequency (particularly East Asians) have demonstrated that double-dose PPI therapy dramatically improves H. pylori eradication rates in UMs. CYP2C19 poor metabolizers (PM), conversely, achieve sustained high PPI plasma concentrations — beneficial for acid suppression but creating drug interaction risk (PPIs compete for CYP2C19 with clopidogrel, some antifungals, and antiepileptics).
CPIC Level A guidelines for CYP2C19 and PPIs recommend considering increased PPI doses for UMs when used for H. pylori eradication or moderate-to-severe GERD. The guidelines note that for standard GERD at standard doses, CYP2C19 genotype has less clinical impact because even UMs may achieve symptomatic control. The pharmacogenomic distinction is most clinically significant for H. pylori eradication, where treatment failure has direct consequences — antibiotic resistance emergence and ulcer recurrence. CYP2C19 is a high-priority pharmacogenomic gene precisely because it governs the response to a diverse range of commonly prescribed medications spanning multiple drug classes.
CYP2C19 governs clopidogrel, PPIs, escitalopram, and multiple other drugs. A complete CYP2C19 diplotype from whole genome sequencing answers the prescribing question for all of these simultaneously — not just the single drug being prescribed today.
CYP2C19 UM status predicts first-course H. pylori eradication failure before it occurs
Standard H. pylori eradication therapy — clarithromycin-based triple therapy or bismuth-based quadruple therapy — uses standard PPI doses designed for the average metabolizer. In CYP2C19 ultra-rapid metabolizers, these doses produce PPI exposures insufficient for complete intragastric acid suppression, reducing antibiotic efficacy and eradication rates from approximately 85-90% to 50-70%. First-course H. pylori eradication failure leads to antibiotic re-treatment with higher resistance risk and extended morbidity. Knowing CYP2C19 UM status before initiating H. pylori therapy allows the prescriber to double the PPI dose in the initial treatment course, achieving efficacy equivalent to extensive metabolizers and avoiding the re-treatment cycle entirely.
One CYP2C19 diplotype result covers every CYP2C19-substrate drug for life
CYP2C19 is one of the most clinically consequential pharmacogenomic genes — it metabolizes PPIs, clopidogrel (CPIC Level A antiplatelet guidance), escitalopram and citalopram (CPIC Level A antidepressant guidance with FDA dose cap), sertraline, voriconazole, and multiple other medications. A patient who takes a PPI today may be prescribed clopidogrel after a cardiac stent next year and escitalopram for mood the year after that. Each of these prescribing decisions involves the same CYP2C19 diplotype. A complete result from whole genome sequencing answers all of these questions at once — the same result that informs PPI dosing also informs antiplatelet selection after cardiovascular events, with no additional testing required.
Your full DNA (not just a part of it)
Traditional genetic testing looks at narrow sets of genes, missing most parts of your genome. We sequence your full genome — every gene and every region between genes.
Comprehensive insights and specialized reports
Easy to read and with answers you and your doctor can act on. Not a file to interpret — 200+ clinical reports, organized by category.
Your test becomes more valuable every year
Your DNA does not change, but genome science is accelerating. Every month, new variant-disease associations are discovered. We validate these findings and update your reports automatically. Your test becomes more valuable every year.
The results doctors bring to their hardest cases.
Forty years of uncertainty. One test.
A patient had spent decades in the UK healthcare system without a diagnosis. Dante data, accepted by NHS clinical teams at Queen Elizabeth University Hospital Glasgow, identified Noonan Syndrome and a RUNX1 leukemia-associated variant that had gone undetected. After 40 years, they finally had an answer.
A complete read delivers a complete picture.
A patient came to Dante to investigate periodic paralysis. Reading the complete genome identified a concurrent hereditary cardiac finding — Brugada syndrome — that their doctor confirmed with an ECG. The result also explained a family member's unresolved cardiac history. One test. Every answer in it.
Sequenced in 2019. The data worked in 2021.
Jennifer sequenced her genome with Dante two years before her breast cancer diagnosis. When treatment began, Dante's pharmacogenomics data showed her prescribed chemotherapy would cause serious adverse effects. Her doctor selected an alternative — and she started effective treatment from day one.
Every genetic question deserves a complete answer.
Whether you are searching for answers today or protecting your health for tomorrow, a complete read of your entire genome is the only place to start.
It runs in your family. Now you can know if it runs in your genes.
Your genome contains inherited variants associated with medical conditions like cardiac, cancer, and neurological. We read all of them — with the clinical depth to give the result meaning.
Learn more →When traditional lab tests say you're fine. And you know you're not.
Standard diagnostic tests check for a pre-selected set of answers. We sequence your full DNA — including parts that no test was designed to check. If the answer is in your genome, we will help you find it.
Learn more →Your diagnosis may be right. Your treatment plan may be incomplete.
Your genes determine which treatments are most likely to work — and which are not. We give your doctor the tools and insights to inform your treatment plan.
Learn more →You want to know before something forces the question.
Some people don't wait for a diagnosis or a family history to act. Whole genome sequencing gives you the complete genetic picture now — so you and your doctor can make informed decisions before anything becomes urgent.
Learn more →You already took a DNA test. Here's what it couldn't tell you.
Most consumer DNA tests read less than 0.1% of your genome. We read all of it.
Learn more →Clinical-grade results. Chosen by individuals, trusted by doctors for their most complex cases.
Dante Genome Test helped specialists at a UK national acute hospital in the identification of Noonan Syndrome and a rare leukemia-associated genetic variant that had gone undetected. That result changed the medical care of the patient.
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Common questions about whole genome sequencing.
What is the difference between whole genome sequencing and a targeted genetic test?
Targeted genetic tests — including standard hereditary cancer panels — read a pre-defined list of known variants in a specific set of genes. They are designed to find what they already know to look for. Whole genome sequencing reads your entire genome: all 6 billion base pairs, every gene, every region between genes. A Mayo Clinic study published in JAMA Oncology found that standard testing guidelines missed more than half of patients with inherited cancer mutations. Genome Test does not have a fixed list.
What will I receive when my results are ready?
Your Dante Genome delivers 200+ physician-ready reports organized by clinical category — hereditary cancer, cardiac conditions, rare diseases, pharmacogenomics, carrier status, and more. Reports are delivered to your secure Genome Manager and are formatted for direct clinical use. Your genome data is permanently retained and re-analyzed automatically as science advances.
What happens if a clinically significant variant is found?
If a pathogenic or likely-pathogenic variant is identified, it will be clearly flagged in your physician-ready report with clinical context, published evidence, and recommended next steps. We recommend sharing any clinically significant finding with your physician or a genetic counselor, who can guide decisions about surveillance, risk reduction, or cascade testing for family members.
How is this different from a consumer DNA test like 23andMe or AncestryDNA?
Consumer DNA tests use genotyping chips that read less than 0.1% of your genome — a tiny pre-selected set of common variants. They are optimized for ancestry and population-level traits, not clinical genetic findings. The Dante Genome Test sequences 100% of your genome at 30X coverage, the same standard used in clinical diagnostic settings. The two tests are not comparable in scope, methodology, or clinical utility.
How long does it take to get results, and how are they delivered?
Your collection kit ships within 48 hours of ordering. Once your sample arrives at our CLIA-certified laboratory, sequencing and analysis takes 6–8 weeks. Results are delivered securely to your Genome Manager, where you can access your reports, share them with your physician, and receive automatic updates as new findings are validated against your genome.
We work with patient advocacy groups worldwide.
Dante Labs works with patient advocacy groups of any size — for Proton Pump Inhibitor Response — CYP2C19 and other conditions, rare and common. We support groups in any country, including virtual patient advocacy groups.
We can provide customized reports, group discounts, and packages tailored for your members. Please reach out using the form and we'll be in touch within two business days.
- Custom genomic reports for your members
- Group discounts and tailored packages
- Any country — including virtual groups
- Rare and common conditions covered
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We'll be in touch within 2 business days. To follow up directly: hello@dantelabs.com
One test.
A lifetime of answers.
One kit, sent to your home. Your entire genome sequenced at the clinical standard used for diagnostic decisions. 200+ physician-ready reports delivered to your Genome Manager in 6–8 weeks — permanent and updated as science advances.
Ships within 48 hours · Results in 6–8 weeks
