Association of serum pepsinogen with atrophic body gastritis in Costa Rica

Abstract

Individuals with atrophic gastritis (AG), especially atrophic body gastritis (ABG), are at increased risk of developing gastric cancer. Serum concentrations of pepsinogens (PG) have been proposed as markers for ABG. The aim of this study was to determine the risk factors for AG and ABG and the potential of using serum PG concentrations to detect ABG in a dyspeptic population in Costa Rica, which is one of the countries with the highest incidence and mortality rates of gastric cancer in the world. Seven biopsy specimens, a fasting blood sample and a questionnaire concerning sociodemographic factors were obtained from 501 consecutive dyspeptic patients. The serum PGI level and the PGI/PGII ratios were significantly lower in patients with ABG than in other groups (P<0.000). A cut-off point of 3.4 led to a sensitivity of 91.2% in identifying ABG, a negative predictive value of 98.1%, but a positive predictive value of only 11.2%. Helicobacter pylori were present in 93% of the patients and all those with peptic ulcers were positive. AG was associated with increased age, lower body mass index, high alcohol intake and low fruit consumption. ABG was associated with age, alcohol consumption and PGI/PGII<3.4. In dyspeptic patients with a high prevalence of H. pylori infection, serum PG levels provide an assessment of ABG but it is necessary to introduce other serological and genetic markers in order to achieve a better specificity. Those markers could be serum antibodies to H. pylori-CagA, cytokine gene polymorphisms or others.

Why is the coexistence of gastric cancer and duodenal ulcer rare? Examination of factors related to both gastric cancer and duodenal ulcer

“…1) Chen et al [60] and Sierra et al [61] indicated that male gender and smoking were associated with an increased risk of duodenal ulcer in H. pylori-infected patients. Graham [4] speculated that poor nutrition in childhood and low parietal cell function may leave H. pylori-infected patients open to gastric cancer, whereas good nutrition in childhood and high parietal cell function may precede the development of duodenal ulcer.…”

Serum pepsinogen and gastrin-17 as potential biomarkers for pre-malignant lesions in the gastric corpus

“…Various studies in different populations demonstrated different levels of serum PGI, PGII and the PGI:II ratio (Table I) (19)(20)(21)(22)(23)(24). Serum PG concentrations measured in certain areas of Asia appear to be higher than those in Western countries.…”

Relation of atrophic gastritis with Helicobacter pylori -CagA+ and interleukin-1 gene polymorphisms

“…The prevalence of H pylori associated gastritis is high from an early age [14] . Recently, we found an association between the PGI/PGII ratio and atrophic body gastritis in dyspeptic patients [15] . In the present study, the same population was analyzed for associations of atrophic body and antral gastritis and presence of peptic ulcers with H pylori CagA + infection and pro-inflammatory interleukin-1 (IL-1) gene polymorphisms.…”

“…As previously described [15] , between January and July, 2000, 800 consecutive patients referred to the endoscopy service at the Calderón Guardia Hospital in San José for dyspeptic symptoms were interviewed. This hospital is a tertiary hospital that, however, also provides gastroenterology service at primary and secondary levels.…”

“…The project had been previously approved by the ethic committees of the University of Costa Rica and the Hospital. A questionnaire with information concerning sociodemographic factors, family history, general health status, consumption of salt, coffee, alcohol, fruit, vegetables, and smoking habits was filled out [15] . Blood pressure and height and weight were recorded to calculate the body mass index.…”