Diagnosis of atrophic gastritis from a blood sample

Abstract number: 1134_02_58

Douramani P., Mavrea S., Arkas A., Adamopoulos A., Anastasakou E.

Introduction:

The majority of gastritis is related to infectious agents, where H. pylori is the most important and common. H. pylori gastritis could proceed, over time, to atrophic form of gastritis a serious disease that increases the risk of peptic ulcers and gastric cancer. A new test panel was developed for non-endoscopic diagnosis of atrophic antrum and corpus gastritis from a blood sample.

Aim:

To investigate whether atrophic gastritis can be diagnosed and typed non-endoscopically if the serum levels of pepsinogen I (S-PGI) and gastrin-17 are assayed in connection with H. pylori testing.

Materials and methods:

The study population consists of 50 selected dyspeptic outpatients with (cases) or without (controls) advanced (moderate or severe atrophic gastritis) who underwent a diagnostic gastroscopy for dyspeptic symptoms. Of the 50 selected patients,28 (cases) had an advanced atrophic gastritis or a resected stomach. Of these 28 cases, 4 had an advanced antrum-limited atrophic gastritis, 6 had resected antrum,15 had a corpus limited advanced atrophic gastritis. Two patients had an advanced atrophic gastritis in both the antrum and corpus (multofocal atrophic gastritis) and the whole stomach was removed in one patient. The controls comprise 22 patients of whom 10 had a non atrophic H. pylori gastritis; the antrum and corpus were normal and healthy in 12 patients. The sample for ‘postprandial’ gastrin -17 (S-G-17 prand) was taken 20 min after a protein drink. The S-G-17,S-PGI and IgG class antibodies to H. pylori were determined using ELISA methods.

Results:

A low S-PGI (<25 mg/l) was found in 15 of 18 patients (83%) with and in 2 of 32 patients (6%) without corpus atrophy. A low S-G-17 prand (<5 pmol/l) was found in all 4 patients with H. pylori associated antral-atrophy and in 5 of 7 patients (71%) with resected antrum but in one of 10 patients (10%) with H. pylori-related non-atrophic gastritis. The mean values of both S-G-17 prand and S-PGI decreased with increasing grade of antral and corpus atrophy respectively. Among all patients with atrophic gastritis,24 of 28 patients (86%) had a low S-PGI and/or a low S-G-17 prand with positive IgG H. pylori antibodies. Such low values were found only in one of the 22 (4.6%) control patients.

Conclusions:

Low serum levels of G-17 and S-PGI are diagnostic markers of atrophic antral and corpus gastritis, respectively. A low S-G-17prand is a sigh of the multifocal or antrum-limited atrophic gastritis in patients infected with H. pylori.