Diagnosis of atrophic gastritis in the general population based upon a combination of three non invasive tests.

Background and Aims: Upper gastrointestinal endoscopy (UGIE) and biopsies are needed for diagnosis of atrophic gastritis. Serum levels of Pepsinogen I (PGI) are used as a non-endoscopic test for atrophic corpus gastritis but non-endoscopic diagnosis of atrophic antrum gastritis has not been possible. The aim was to study whether the test panel composed of Elisa assays of Gastrin17 (sG17), PGI after a prandial protein stimulus and Hp antibodies (IgG) can be used as a tool for diagnosis of atrophic gastritis. Material and Methods: 104 subjects(M/F 56/48, mean age 55 yrs) was enrolled. A blood sample was collected for measurement of basal-G17, PGI and Hp IgG serum level; a second blood sample was collected 20 minutes after a prandial peptic stimulus evaluating sG17 serum level. Subjects were grouped according to five histological features, 1) Normal mucosa Hp- (N), 2) Non atrophic antrum gastritis Hp+ (S), 3) Atrophic gastritis of antrum Hp+ (A), 4) Atrophic gastritis of corpus Hp+/- (C), 5) Atrophic gastritis of antrum and corpus Hp+/- (AC). Results: sG17 serum level was higher in subjects with S (12,0 pmol/l) respect to subjects with A (1 pmol/l) (p<0,001) and with N (2,5 pmol/l)(p<0,001).PGI serum level was higher in subjects S and A (117,2µg/l and 119,7 µg/l) compared to subjects with atrophic corpus gastritis C (43,9µg/l)(p<0,001)and normal mucosa N (89,9 µg/l) (p<0,009).Combination of these three serological tests showed a sensitivity of 91% (32/35) and a specificity of 88%(61/69) in evaluating atrophic gastritis, overall accuracy of 87,5% (91/104) in identifying specific histological pattern using the test panel. Conclusions: Serum levels of sG17 and PGI combined with evaluation of Hp status by Hp IgG antibody represent a good non-invasive method to evaluate gastric atrophy and may use in a population screening program for gastric cancer to identify subjects at risk to be referred for upper-GI-endoscopy. [ABSTRACT FROM AUTHOR]