Advantages of serum pepsinogen A combined with gastrin or pepsinogen C as first‐line analytes in the evaluation of suspected cobalamin deficiency: a study in patients previously not subjected to gastrointestinal surgery

Abstract

Lindgren A, Lindstedt G, Kilander AF (Borås Central Hospital and Sahlgrenska University Hospital, Göteborg, Sweden). Advantages of serum pepsinogen A combined with gastrin or pepsinogen C as first‐line analytes in the evaluation of suspected cobalamin deficiency: a study in patients previously not subjected to gastrointestinal surgery. J Intern Med 1998; 244: 341–349. Objectives Since there is a significant overlap in serum cobalamin concentrations between healthy and cobalamin‐deficient individuals, we wanted to compare two different principles for use as supplementary tests to serum cobalamin concentration in patients with suspected cobalamin malabsorption and deficiency. Design Clinical study of consecutive patients. Setting The catchment area of Sahlgrenska University Hospital, Göteborg. Subjects A total of 112 patients with suspected cobalamin deficiency who had not previously undergone gastrointestinal surgery. Interventions Gastroduodenoscopy with biopsies taken from the gastric body and the duodenum, Schilling test, and measurement of serum methylmalonic acid (MMA), total homocysteine (Hcy), pepsinogens A and C, and gastrin. Main outcome measures Number of patients with gastric body atrophy identified with the combination of MMA and Hcy, and pepsinogen A combined with pepsinogen C or gastrin. Results About 95% of the patients with severe gastric body atrophy had abnormal concentrations of serum pepsinogen A and/or gastrin or pepsinogen A/C ratio, whereas 65% had abnormal metabolite concentrations. Serum pepsinogen A combined with pepsinogen C identified 100%, and combined with gastrin 88%, of the patients with gastric body atrophy and elevated metabolite tests, and 67 and 75%, respectively, of those who had not yet developed elevated metabolite tests. Conclusions Pepsinogen A, combined with pepsinogen C or gastrin, should be the first option in evaluating patients with suspected cobalamin deficiency who have not previously undergone gastrointestinal surgery.

Holotranscobalamin — a sensitive marker of cobalamin malabsorption

“…Such a difference could not be found with the Schilling or protein-bound absorption tests ( Table 2). We have also reported normal findings of serum pepsinogen A and gastrin, sensitive indicators of gastric body mucosa atrophy, in all the patients of these two groups [37].…”

Reported symptoms and clinical findings in relation to serum cobalamin, folate, methylmalonic acid and total homocysteine among elderly Swedes: a population‐based study

“…In addition, a number of studies have analysed deficiency markers versus gastrointestinal chemical atrophy markers, such as pepsinogen and gastrin and in some cases biopsy findings, but not versus reported symptoms [17–20].…”

Physicians’ use of plasma methylmalonic acid as a diagnostic tool

“…A recent study by Lindgren et al . [22] suggested that determination of serum pepsinogen A in combination with gastrin or pepsinogen C is a rational first option in evaluation of suspected cobalamin deficiency in patients with no previous gastrointestinal surgery. The finding of a concentration of P‐MMA above the current reference interval was ignored in 62% of the cases, and the recommendation to treat patients when P‐MMA was above 0.45 µmol L –1 [8, 9] was infrequently followed.…”