title: Serum pepsinogen levels, Helicobacter pylori CagA Status, and cytokine gene polymorphisms associated with gastric premalignant lesions in Costa Rica.
abstract: The detection of gastric premalignant lesions, atrophic gastritis, corpus atrophic gastritis, and intestinal metaplasia, using several potential markers was examined in Costa Rica. Depending on the lesion investigated, from a total of 223 dyspeptic patients, 58 (26.0%), 31 (13.9%), or 23 (10.3%) were histologically diagnosed with atrophic gastritis, corpus atrophic gastritis, or intestinal metaplasia, respectively. Sera were used for the measurement of pepsinogen (PG) and Helicobacter pylori CagA antibody (CagA-ab) levels by ELISA, and human genomic DNAs were used for the genotyping of interleukin (IL)-1beta (-511 and +3954), IL-10 (-1082 and -592), and IL-1RN intron 2 by PCR and RFLP. Multivariate analysis was done adjusting for sex, age, and H. pylori seropositivity. Low PG levels (L-PG; PG I < or = 70 microg/L + PG I/II < or = 3), very low PG levels (VL-PG; PG I < or = 30 microg/L + PG I/II < or = 2), and CagA-ab were individually associated with all premalignant lesions whereas IL-1beta +3954T-carrier and IL-1RN homozygous 2 allele were associated with intestinal metaplasia. VL-PG, for corpus atrophic gastritis detection, was the single marker with the highest combination of test characteristics, sensitivity (77.4%), specificity (80.7%), positive predictive value (39.3%), negative predictive value (95.7%), and seropositivity rate (27.4%), expected to improve after periodic measurements. Combined examinations of VL-PG and CagA-ab improved the specificity (92.7%) and positive predictive value (62.2%), with similar sensitivity (74.2%) and negative predictive value (95.7%). In conclusion, corpus atrophic gastritis detection with periodic measurements of serum PG, alone or in combination with CagA-ab status, to identify high gastric cancer risk, seems to be the method best suited for mass screening in Costa Rica.
authors: Centro Digestivo Doctores Con-Mediplaza, Pavas, San José, Costa Rica. scon@gastrocolon.com
authors: Sergio A
authors: SA
authors: Con
authors: Reinaldo
authors: R
authors: Con-Wong
authors: Gil R
authors: GR
authors: Con-Chin
authors: Vicky G
authors: VG
authors: Con-Chin
authors: Hiroaki
authors: H
authors: Takeuchi
authors: Ana L
authors: AL
authors: Valerín
authors: Guillermo
authors: G
authors: Echandi
authors: Fernando
authors: F
authors: Mena
authors: Fernando
authors: F
authors: Brenes
authors: Nobufumi
authors: N
authors: Yasuda
authors: Keijiro
authors: K
authors: Araki
authors: Tetsuro
authors: T
authors: Sugiura
mesh_terms: D000907:Antibodies, Bacterial / Q000097:blood; D000942:Antigens, Bacterial / Q000276:immunology; D001426:Bacterial Proteins / Q000276:immunology; D016207:Cytokines / Q000235:genetics*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D020116:Pepsinogen A / Q000097:blood*; D011110:Polymorphism, Genetic; D011230:Precancerous Conditions / Q000097:blood / Q000235:genetics / Q000382:microbiology; D011237:Predictive Value of Tests; D013274:Stomach Neoplasms / Q000517:prevention & control*
chemical_list: D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D001426:Bacterial Proteins; D016207:Cytokines; C080866:cagA protein, Helicobacter pylori; D020116:Pepsinogen A