Helicobacter pylori gastritis and serum pepsinogen levels in a healthy population: development of a biomarker strategy for gastric atrophy in high risk groups.
This study aimed to estimate the prevalence and type of chronic gastritis in an asymptomatic working population and to determine whether a combination of serum pepsinogen levels and Helicobacter pylori serology could be used to identify a subgroup with atrophic gastritis at elevated risk of gastric carcinoma. A 10% subsample of 544 male volunteer factory workers aged 18-63 years and participating in a larger study underwent endoscopy and biopsy. Of these men, 29 were seropositive for Helicobacter pylori; all but three (89.7%) had chronic gastritis. Serum pepsinogen A levels increased with progression from a corpus predominant pattern of gastritis through pangastritis to an antral predominant pattern. Nine subjects had corpus atrophy, which was in most cases accompanied by fasting hypochlorhydria and hypergastrinaemia. A combination of pepsinogen A below 80 ng ml-1 and Helicobaceter pylori seropositivity detected corpus atrophy with sensitivity 88.9% and specificity 92.3%. A second screening stage, using a pepsinogen A/C ratio of below 2.5 as a cut-off, resulted in a reduction in numbers requiring further investigation but with some loss of sensitivity (77.8%). Application of this two-stage screening programme to the original sample of 544 workers would have resulted in 11 (2.2%) men being selected for follow-up, excluding 25 (5.1%) false negatives. Our results suggest that a combination of serum pepsinogen levels and Helicobacter pylori serology could be useful as a biomarker strategy for detection of individuals at increased risk of gastric carcinoma and for non-invasive investigation of the natural history of Helicobacter pylori gastritis.
Knight
T
T
Depaprtment of Surgery, School of Postgraduate Medicine (Keele University), Stoke-on-Trent, UK.
Wyatt
J
J
Wilson
A
A
Greaves
S
S
Newell
D
D
Hengels
K
K
Corlett
M
M
Webb
P
P
Forman
D
D
Elder
J
J
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D005755:Gastrins / Q000097:blood; D005757:Gastritis, Atrophic / Q000097:blood* / Q000453:epidemiology / Q000382:microbiology; D016481:Helicobacter Infections / Q000097:blood*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000097:blood / Q000453:epidemiology / Q000382:microbiology; D010435:Pepsinogens / Q000097:blood*; D015995:Prevalence; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000209:etiology
D015415:Biomarkers; D005755:Gastrins; D010435:Pepsinogens