Serum pepsinogen I: an early marker of pernicious anemia in patients with type 1 diabetes.
BACKGROUND
Pernicious anemia (PA) is an autoimmune organ disease much more common in type 1 diabetic patients (DM1) than in nondiabetic subjects, but it is clinically silent until its end stage.


OBJECTIVE
This study aimed to determine biochemical markers of latent PA in a population of DM1 patients attending the endocrinology outpatient clinic of a university hospital.


METHODS
The population studied consisted of 186 unselected patients (32.4 +/- 8.7 yr) and 118 healthy controls (30.9 +/- 9.4 yr).


METHODS
Plasma gastrin and pepsinogen I were determined in patients and controls, whereas hemoglobin A1c, serum cobalamin, hemoglobin, and organ-specific antibodies were determined only in patients. Latent PA was defined as serum pepsinogen I less than 30 microg/liter. In patients with low pepsinogen I concentrations and hypergastrinemia, esophagogastroduodenoscopy (EGD) was performed.


RESULTS
DM1 patients showed significantly lower pepsinogen I concentrations (P < 0.001) and higher gastrinemia than controls. Latent PA was present in 12.4% of patients vs. 0.9% of controls. Among patients, more women than men showed low plasma pepsinogen I concentrations (P = 0.002) and thyroperoxidase antibody positivity (P < 0.001). Only the highest parietal cell antibody titers (> or =1:640) identified patients with significantly higher levels of plasma gastrin (P < 0.001) and lower levels of pepsinogen I (P < 0.001). The histopathological EGD findings confirmed different degrees of gastric body mucosa atrophy in all cases.


CONCLUSIONS
The high prevalence of latent PA found in our DM1 patients leads us to recommend its screening using serum pepsinogen I concentrations. In patients with hypergastrinemia and high parietal cell antibody titers, EGD should be considered to confirm gastric mucosa atrophy.
Alonso
Núria
N
Department of Endocrinology and Nutrition, Hospital Universitari Germans Trias i Pujol, Ctra Canyet s/n, Badalona, 08916 Catalonia, Spain.
Granada
M Luisa
ML
Salinas
Isabel
I
Lucas
Ana M
AM
Reverter
Jordi L
JL
Juncà
Jordi
J
Oriol
Albert
A
Sanmartí
Ana
A
D000328:Adult; D000752:Anemia, Pernicious / Q000097:blood* / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D041981:Gastrointestinal Tract / Q000473:pathology; D006801:Humans; D008297:Male; D010295:Parietal Cells, Gastric / Q000276:immunology; D020116:Pepsinogen A / Q000097:blood*; D015995:Prevalence; D012737:Sex Factors
D001323:Autoantibodies; D015415:Biomarkers; D020116:Pepsinogen A