Predictive Value of Gastrin Levels for the Diagnosis of Gastric Enterochromaffin-Like Cell Hyperplasia in Patients with Hashimoto's Thyroiditis

Abstract

Aim: 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). Conclusion: 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 somepatients may harbor gastric ECLH even if gastrin levels are not increased, necessitating further follow-up.

Risk factors of type 1 gastric neuroendocrine neoplasia in patients with chronic atrophic gastritis. A retrospective, multicentre study

“…Nicolaou A described a high diagnostic accuracy of gastrin level for ECL cell hyperplasia identification in patients with Hashimoto's thyroiditis [24]. Vannella described a significantly higher value in patients with type 1 gNENs if compared to patients with CAG alone.…”

Functional anatomy and physiology of gastric secretion

“…ECL cells are predominant and constitute approximately 40% of neuroendocrine cells of the oxyntic mucosa [12]. Interestingly, although 95% of parietal cells were located in the oxyntic mucosa, 5% were observed to be present in the antrum.…”

Alpha-enolase involvement in intestinal and extraintestinal manifestations of celiac disease

“…Interestingly, similar situation is observed in chronic autoimmune thyroiditis, were huge excess of Hürthle-Askanazy cells expressing plenty of NSE [ 99 ] may co-exist with increase in AAE Ab [ 35 ]. Moreover, hyperplasia of gut enterochromaffin cells is common not only in CD, but also in autoimmune thyroiditis [ 100 ].…”