title: Rationale in diagnosis and screening of atrophic gastritis with stomach-specific plasma biomarkers.
abstract: OBJECTIVE
  Atrophic gastritis (AG) results most often from Helicobacter pylori (H. pylori) infection. AG is the most important single risk condition for gastric cancer that often leads to an acid-free or hypochlorhydric stomach. In the present paper, we suggest a rationale for noninvasive screening of AG with stomach-specific biomarkers.
  
  
  METHODS
  The paper summarizes a set of data on application of the biomarkers and describes how the test results could be interpreted in practice.
  
  
  RESULTS
  In AG of the gastric corpus and fundus, the plasma levels of pepsinogen I and/or the pepsinogen I/pepsinogen II ratio are always low. The fasting level of gastrin-17 is high in AG limited to the corpus and fundus, but low or non-elevated if the AG occurs in both antrum and corpus. A low fasting level of G-17 is a sign of antral AG or indicates high intragastric acidity. Differentiation between antral AG and high intragastric acidity can be done by assaying the plasma G-17 before and after protein stimulation, or before and after administration of the proton pump inhibitors (PPI). Amidated G-17 will rise if the antral mucosa is normal in structure. H. pylori antibodies are a reliable indicator of helicobacter infection, even in patients with AG and hypochlorhydria.
  
  
  CONCLUSIONS
  Stomach-specific biomarkers provide information about the stomach health and about the function of stomach mucosa and are a noninvasive tool for diagnosis and screening of AG and acid-free stomach.
authors.affiliation: Karolinska Institute, Center for Family and Community Medicine, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Agréus
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Limas
authors.initials: L
authors.lastname: Kupcinskas
authors.forename: Peter
authors.initials: P
authors.lastname: Malfertheiner
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Mario
authors.forename: Marcis
authors.initials: M
authors.lastname: Leja
authors.forename: Varocha
authors.initials: V
authors.lastname: Mahachai
authors.forename: Niv
authors.initials: N
authors.lastname: Yaron
authors.forename: Martijn
authors.initials: M
authors.lastname: van Oijen
authors.forename: Guillermo
authors.initials: G
authors.lastname: Perez Perez
authors.forename: Massimo
authors.initials: M
authors.lastname: Rugge
authors.forename: Jukka
authors.initials: J
authors.lastname: Ronkainen
authors.forename: Mikko
authors.initials: M
authors.lastname: Salaspuro
authors.forename: Pentti
authors.initials: P
authors.lastname: Sipponen
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugano
authors.forename: Joseph
authors.initials: J
authors.lastname: Sung
mesh_terms: D000126:Achlorhydria / Q000097:blood / Q000150:complications; D000907:Antibodies, Bacterial / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D005755:Gastrins / Q000097:blood; D005757:Gastritis, Atrophic / Q000097:blood* / Q000175:diagnosis* / Q000382:microbiology; D016481:Helicobacter Infections / Q000097:blood* / Q000175:diagnosis* / Q000382:microbiology; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D008403:Mass Screening; D020116:Pepsinogen A / Q000097:blood; D020115:Pepsinogen C / Q000097:blood; D013274:Stomach Neoplasms / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control; D014805:Vitamin B 12 / Q000493:pharmacokinetics
chemical_list: D000907:Antibodies, Bacterial; D015415:Biomarkers; D005755:Gastrins; C013550:gastrin 17; D020115:Pepsinogen C; D020116:Pepsinogen A; D014805:Vitamin B 12