[Serological markers as predictors of the severity of gastric mucosal atrophy in autoimmune and Helicobacter рylori-associated gastritis].

Abstract

Aim: To evaluate the possibility of using serum markers of atrophy (pepsinogens - PG I and II) to form high-risk groups for gastric cancer (Operative Link for Gastritis Assessment - OLGA stage III-IV) depending on the etiology of gastritis.

Materials and methods: A total of 237 (56 men and 181 women) patients were examined. All patients underwent a ¹³C-urea breath test, a blood test for GastroPanel (PG I, PG II, gastrin-17, antibodies to Helicobacter pylori immunoglobulin G), a blood test for antibodies to gastric parietal cells. All patients underwent esophagogastroduodenoscopy with a biopsy of the gastric mucosa from 5 standard points according to the Sydney system and a histomorphological study according to the OLGA system, as well as a biopsy to detect H. pylori infection using the polymerase chain reaction. The patients were divided into 3 groups depending on the etiology of gastritis: Group 1 included 55 patients with chronic gastritis, autoimmune gastritis and associated with H. pylori gastritis (AIG+HP+); Group 2 - 47 patients with AIG and negative tests for H. pylori infection (AIG+HP-); Group 3 - 135 patients with chronic gastritis associated with H. pylori and negative markers of AIG (AIG-HP+).

Results: The analysis showed that in patients with AIG (group 2), the most reliable serological markers of atrophy predicted severe atrophy (OLGA stage III-IV): when the ratio PG I/PG II was ≤ 3, it was detected in 70.21% of cases, and when PG I decreased to ≤ 30 μg/L, it was found in 68.08%. In group 1, stages III-IV according to OLGA were diagnosed in 20% of cases with PG I/PG II indicators ≤ 3; and in 18.18% with a decrease in PG I ≤ 30 μg/L. When analyzing the diagnostic accuracy of GastroPanel biomarkers in identifying severe atrophy (OLGA stages III-IV) in the total sample of patients (all 3 groups), it was possible to achieve cut-off indicators as close as possible to the reference values while maintaining a relatively high sensitivity and specificity - 75.81% and 81.50% for PG I ≤ 30 μg/L and 85.48% and 64.50% for PG I/PG II ≤ 3, respectively. The optimal cut-off in the study population for the PG I indicator was < 22.5 μg/L (sensitivity - 72.58%, specificity - 88.00%), and for the PG I/PG II ratio ≤ 2 (sensitivity - 80.65%, specificity - 78.50%).

Conclusion: Serum pepsinogens can be used in the Moscow population as a non-invasive marker of gastric mucosa atrophy for the formation of high-risk patient groups for gastric cancer requiring endoscopic examination.