The validity of a biomarker method for indirect detection of gastric mucosal atrophy versus standard histopathology.

Background: Atrophy of the stomach mucosa is considered to be premalignant lesion for gastric cancer development; easy identification of this condition from a blood-sample would allow identifying the group of individuals at increased risk for cancer development.

Aims: The objective of the current study was to validate a biomarker method (pepsinogen I/II ratio and gastrin-17) for indirect detection of atrophy of the stomach mucosa versus standard histopathology in Caucasian and Asian populations.

Methods: Altogether, 241 patients aged 55 and above referred for upper endoscopy due to dyspeptic symptoms (125 from Latvia, 76 from Lithuania, and 40 from Taiwan) were enrolled. Pepsinogen I, pepsinogen II, gastrin-17 (the latter after stimulation with protein-rich meal) and IgG/IgA antibodies to Helicobacter pylori infection were determined by ELISA method; standard histopathology according to the updated Sydney classification read by two independent expert pathologists was used for the comparison.

Results: Pepsinogen I/II ratio below 3 was well related to atrophy (moderate to severe) in the corpus part of the stomach (P < 0.0001) with 83.3% sensitivity and 87.1% specificity. Gastrin-17 below 5 pmol/L was related to atrophy in the antral part (P = 0.007) with 36.8% sensitivity and 86.5% specificity.

Conclusions: Decreased pepsinogen I/II ratio is a reliable marker for atrophy in the corpus, and may be recommended for identification of individuals with this type of atrophy. The utility of gastrin-17 for the detection of atrophy in the antral part of the stomach still requires further evaluation due to the low sensitivity.