title: The validity of a biomarker method for indirect detection of gastric mucosal atrophy versus standard histopathology.
abstract: BACKGROUND
  Atrophy of the stomach mucosa is considered to be premalignant lesion for gastric cancer development; easy identification of this condition from a blood-sample would allow identifying the group of individuals at increased risk for cancer development.
  
  
  OBJECTIVE
  The objective of the current study was to validate a biomarker method (pepsinogen I/II ratio and gastrin-17) for indirect detection of atrophy of the stomach mucosa versus standard histopathology in Caucasian and Asian populations.
  
  
  METHODS
  Altogether, 241 patients aged 55 and above referred for upper endoscopy due to dyspeptic symptoms (125 from Latvia, 76 from Lithuania, and 40 from Taiwan) were enrolled. Pepsinogen I, pepsinogen II, gastrin-17 (the latter after stimulation with protein-rich meal) and IgG/IgA antibodies to Helicobacter pylori infection were determined by ELISA method; standard histopathology according to the updated Sydney classification read by two independent expert pathologists was used for the comparison.
  
  
  RESULTS
  Pepsinogen I/II ratio below 3 was well related to atrophy (moderate to severe) in the corpus part of the stomach (P < 0.0001) with 83.3% sensitivity and 87.1% specificity. Gastrin-17 below 5 pmol/L was related to atrophy in the antral part (P = 0.007) with 36.8% sensitivity and 86.5% specificity.
  
  
  CONCLUSIONS
  Decreased pepsinogen I/II ratio is a reliable marker for atrophy in the corpus, and may be recommended for identification of individuals with this type of atrophy. The utility of gastrin-17 for the detection of atrophy in the antral part of the stomach still requires further evaluation due to the low sensitivity.
authors.affiliation: Digestive Diseases Centre GASTRO, Riga Eastern Clinical University Hospital, University of Latvia, 6 Linezera iela, Riga 1006, Latvia. cei@latnet.lv
authors.forename: Marcis
authors.initials: M
authors.lastname: Leja
authors.forename: Limas
authors.initials: L
authors.lastname: Kupcinskas
authors.forename: Konrads
authors.initials: K
authors.lastname: Funka
authors.forename: Agnese
authors.initials: A
authors.lastname: Sudraba
authors.forename: Laimas
authors.initials: L
authors.lastname: Jonaitis
authors.forename: Audrius
authors.initials: A
authors.lastname: Ivanauskas
authors.forename: Dainius
authors.initials: D
authors.lastname: Janciauskas
authors.forename: Gediminas
authors.initials: G
authors.lastname: Kiudelis
authors.forename: Han-Mo
authors.initials: HM
authors.lastname: Chiu
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005755:Gastrins / Q000097:blood*; D005757:Gastritis, Atrophic / Q000097:blood* / Q000175:diagnosis*; D005773:Gastroscopy; D006801:Humans; D007844:Latvia; D008097:Lithuania; D008297:Male; D008875:Middle Aged; D020116:Pepsinogen A / Q000097:blood*; D020115:Pepsinogen C / Q000097:blood*; D012680:Sensitivity and Specificity; D013624:Taiwan
chemical_list: D015415:Biomarkers; D005755:Gastrins; C013550:gastrin 17; D020115:Pepsinogen C; D020116:Pepsinogen A