Proton pump inhibitors, such as omeprazole (OPZ), lansoprazole and rabeprazole (RPZ), have been widely used as acid inhibitory agents for the treatment of upper gastrointestinal diseases. 1 OPZ is a substituted benzimidazole, which effectively inhibits gastric acid secretion by irreversibly binding to the proton pump (H + ,K + -ATPase) in gastric parietal cells, 2, 3 and is mainly metabolized by a genetically determined enzyme, S-mephenytoin-4¢-hydroxylase (CYP2C19), in the liver to hydroxyomeprazole (OH-OPZ). 4±8 OPZ is partially metabolized by CYP3A4 to omeprazole sulphone (OPZ-SFN), which is then metabolized to hydroxyomeprazole sulphone (OH-OPZ-SFN) by CYP2C19. 9 In individuals with a poor metabolizer (PM) phenotype or genotype of CYP2C19, the SUMMARY Background: Omeprazole is mainly metabolized in the liver by CYP2C19, a genetically determined enzyme, whereas rabeprazole is mainly reduced non-enzymatically and partially metabolized by CYP2C19. The therapeutic effects of rabeprazole are therefore assumed to be less affected by an individual's CYP2C19 status. Aim: To investigate the acid inhibitory effects and plasma levels of omeprazole and rabeprazole with reference to different CYP2C19 genotypes. Methods: Fifteen healthy volunteers took a daily dose of 20 mg of omeprazole or rabeprazole for 8 days. On postdose days 1 and 8, 24-h pro®les of intragastric pH were recorded and plasma concentrations of omeprazole, rabeprazole and their metabolites were determined.