Predictive value of gastrin levels for the diagnosis of gastric enterochromaffin-like cell hyperplasia in patients with Hashimoto's thyroiditis.
OBJECTIVE
Gastrin and chromogranin A (CgA) levels have been tested for the diagnosis of enterochromaffin-like cell hyperplasia (ECLH) in patients with type 1 diabetes and autoimmune atrophic gastritis but not for patients with Hashimoto's thyroiditis (HT). The aim of the study was to develop receiver operating characteristic (ROC) curves for gastrin and CgA levels and other clinical and biochemical parameters, as means for pretest probability of gastric ECLH in patients with HT.


METHODS
A total of 115 patients with HT were prospectively studied for a median period of 4 (2-7) years. Gastrin, CgA, vitamin B12, anti-parietal cell antibodies, free thyroxine, thyrotropin, and neuron-specific enolase levels were measured. Their predictive values were calculated according to the histological findings for ECLH diagnosis from esophagogastroduodenoscopy-obtained biopsies.


RESULTS
Thirteen patients (11.3%) had ECLH. The areas under the curve for gastrin and CgA level were 0.898 (p < 0.001) and 0.853 (p < 0.001), respectively. The product sensitivity × specificity was 0.803 and 0.653 for gastrin and CgA levels >89.5 and >89.1 ng/ml, respectively. Two and 4 patients with ECLH had normal gastrin and CgA levels, respectively. The most specific combined parameters predicting ECLH were gastrin >89.5 ng/ml with concomitant low B12 levels (96.1% specificity).


CONCLUSIONS
Gastrin levels have high diagnostic accuracy for ECLH identification in patients with HT, and are highly specific when combined with low B12 levels. However, they should be interpreted with caution, as some patients may harbor gastric ECLH even if gastrin levels are not increased, necessitating further follow-up.
Endocrine Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece.
Argyro
A
Nicolaou
Dimitrios
D
Thomas
Krystallenia I
KI
Alexandraki
Stavros
S
Sougioultzis
Apostolos V
AV
Tsolakis
Gregory
G
Kaltsas
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D053379:Chromogranin A / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D019861:Enterochromaffin-like Cells / Q000473:pathology*; D005260:Female; D005755:Gastrins / Q000097:blood*; D050031:Hashimoto Disease / Q000150:complications*; D006801:Humans; D006965:Hyperplasia / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013270:Stomach / Q000473:pathology*; D013272:Stomach Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*
D015415:Biomarkers; D053379:Chromogranin A; D005755:Gastrins