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Romańczyk M, Osmola M, Link A, Druet A, Hémont C, Martin J, Chapelle N, Matysiak-Budnik T. Non-Invasive Markers for the Detection of Gastric Precancerous Conditions. Cancers (Basel) 2024; 16:2254. [PMID: 38927959 PMCID: PMC11202181 DOI: 10.3390/cancers16122254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Gastric cancer (GC) is still one of the most prevalent cancers worldwide, with a high mortality rate, despite improvements in diagnostic and therapeutic strategies. To diminish the GC burden, a modification of the current diagnostic paradigm, and especially endoscopic diagnosis of symptomatic individuals, is necessary. In this review article, we present a broad review and the current knowledge status on serum biomarkers, including pepsinogens, gastrin, Gastropanel®, autoantibodies, and novel biomarkers, allowing us to estimate the risk of gastric precancerous conditions (GPC)-atrophic gastritis and gastric intestinal metaplasia. The aim of the article is to emphasize the role of non-invasive testing in GC prevention. This comprehensive review describes the pathophysiological background of investigated biomarkers, their status and performance based on available data, as well as their clinical applicability. We point out future perspectives of non-invasive testing and possible new biomarkers opportunities.
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Affiliation(s)
- Marcin Romańczyk
- Department of Gastroenterology, Academy of Silesia, 40-555 Katowice, Poland
- H-T. Medical Center, 43-100 Tychy, Poland
| | | | - Alexander Link
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Amaury Druet
- IMAD, Hepato-Gastroenterology & Digestive Oncology, University Hospital of Nantes, F-44093 Nantes, France
| | - Caroline Hémont
- CHU de Nantes, Laboratoire d’Immunologie, Center for ImmunoMonitoring Nantes-Atlantique (CIMNA), F-44000 Nantes, France
| | - Jerome Martin
- CHU de Nantes, Laboratoire d’Immunologie, Center for ImmunoMonitoring Nantes-Atlantique (CIMNA), F-44000 Nantes, France
- University of Nantes, INSERM, Centre de Recherche Translationnel en Transplantation et Immunologie, UMR 1064, ITUN, F-44000 Nantes, France
| | - Nicolas Chapelle
- IMAD, Hepato-Gastroenterology & Digestive Oncology, University Hospital of Nantes, F-44093 Nantes, France
- University of Nantes, INSERM, Centre de Recherche Translationnel en Transplantation et Immunologie, UMR 1064, ITUN, F-44000 Nantes, France
| | - Tamara Matysiak-Budnik
- IMAD, Hepato-Gastroenterology & Digestive Oncology, University Hospital of Nantes, F-44093 Nantes, France
- University of Nantes, INSERM, Centre de Recherche Translationnel en Transplantation et Immunologie, UMR 1064, ITUN, F-44000 Nantes, France
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Lee SY, Ahn YS, Moon HW. Comparison between the GastroPanel test and the serum pepsinogen assay interpreted with the ABC method-A prospective study. Helicobacter 2024; 29:e13056. [PMID: 38402559 DOI: 10.1111/hel.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND AND AIMS This study aimed to validate Helicobacter pylori serological and pepsinogen (PG) assays for detecting infection and gastric neoplasm. METHODS Individuals who underwent serum Chorus H. pylori and HBI PG assays were included from May to September 2023. The GastroPanel test was performed using the same blood sample. HBI assay findings were interpreted with the ABC method using the criteria of corpus atrophy (PG I ≤ 70 ng/mL & I/II ≤3) and advanced corpus atrophy (PG I ≤ 30 ng/mL & I/II ≤2). RESULTS A total of 144 H. pylori-infected and 184 non-infected Koreans were analyzed. The Chorus test (sensitivity 97.2%, specificity 89.1%) showed higher area under the curve (0.993 vs. 0.972, p = 0.003) than the GastroPanel test (sensitivity 95.8%, specificity 86.4%). Using the GastroSoft application, the incidence of gastric neoplasms was highest in the corpus atrophy group (50%), followed by the low acid-output (25.8%), H. pylori infection (11.6%), and antral atrophy (9.1%) groups. There were no gastric neoplasms in the normal and high acid output groups. Using the ABC method, the incidence of gastric neoplasms was highest in the corpus atrophy groups (23.8% in Groups C and D), followed by Group B (12.3%) and Group A (2.4%). Corpus atrophy interpreted with the GastroSoft showed poor agreement (k = 0.225) with corpus atrophy interpreted with the ABC method, whereas it showed excellent agreement (k = 0.854) with advanced corpus atrophy. CONCLUSIONS Although the Chorus test was more accurate than the GastroPanel test, both assays discriminated high-risk individuals by detecting atrophy or infection. There were no gastric neoplasms in the normal or high acid-output groups (GastroSoft application), and gastric neoplasm incidence was lowest in Group A (ABC method). Corpus atrophy determined by GastroSoft application is more consistent with advanced corpus atrophy determined by the ABC method than is corpus atrophy.
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Affiliation(s)
- Sun-Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yeon-Sun Ahn
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hee-Won Moon
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
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Dottori L, Pivetta G, Annibale B, Lahner E. Update on Serum Biomarkers in Autoimmune Atrophic Gastritis. Clin Chem 2023; 69:1114-1131. [PMID: 37680186 DOI: 10.1093/clinchem/hvad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/05/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Autoimmune atrophic gastritis (AAG) is a persistent, corpus-restricted immune-mediated destruction of the gastric corpus oxyntic mucosa with reduced gastric acid and intrinsic factor secretion, leading to iron deficiency and pernicious anemia as a consequence of iron and cobalamin malabsorption. Positivity toward parietal cell (PCA) and intrinsic factor (IFA) autoantibodies is very common. AAG may remain asymptomatic for many years, thus making its diagnosis complex and often delayed. Due to the increased risk of gastric neoplasms, a timely diagnosis of AAG is clinically important. CONTENT The gold standard for AAG diagnosis is histopathological assessment of gastric biopsies obtained during gastroscopy, but noninvasive, preendoscopic serological screening may be useful in some clinical scenarios. Serum biomarkers for AAG may be divided into 2 groups: gastric autoimmunity-related biomarkers, such as PCA and IFA, and gastric corpus atrophy/reduced gastric acid secretion-related biomarkers, such as serum gastrin and pepsinogens. The present review focuses on the clinical significance and pitfalls of serum biomarkers related to gastric autoimmunity and gastric corpus atrophy, including some discussion of analytical methods. SUMMARY Serum assays for PCA, IFA, gastrin, and pepsinogen I show good diagnostic accuracy for noninvasive diagnostic work-up of AAG. Diagnostic performance may increase by combining >1 of these tests, overcoming the problem of seronegative AAG. However, appropriately designed, comparative studies with well-characterized patient cohorts are needed to better define the reliability of these biomarkers in the diagnosis of patients with AAG. Currently, positive serum tests should always be followed by the state-of-art diagnostic test, that is, histopathological assessment of gastric biopsies obtained during gastroscopy to definitively confirm or rule out AAG and eventually neoplastic complications.
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Affiliation(s)
- Ludovica Dottori
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Giulia Pivetta
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Bruno Annibale
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Edith Lahner
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
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Sassano M, Mariani M, Pelucchi C, Lunet N, Morais S, Martín V, Moreno V, Curado MP, Dias-Neto E, Leja M, Gašenko E, La Vecchia C, Boccia S, Pastorino R. Intake of Proton-Pump Inhibitors and Gastric Cancer within the Stomach Cancer Pooling (StoP) Project. Cancer Epidemiol Biomarkers Prev 2023; 32:1174-1181. [PMID: 37364052 PMCID: PMC10472102 DOI: 10.1158/1055-9965.epi-23-0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/14/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND A potential association between proton-pump inhibitors (PPI) and gastric cancer remains undefined. Thus, we aimed to evaluate such association within the Stomach cancer Pooling (StoP) Project. METHODS Data from five case-control studies of the StoP Project were included (1,889 cases and 6,517 controls). We assessed the impact of different exposure definitions, specifically any reported use of PPIs and exposure definitions based on the duration of PPI intake. Additionally, we modeled the dose-response relationship between the cumulative duration of PPI intake and gastric cancer. RESULTS Significant associations between PPI intake and gastric cancer, both overall and in the stratified analyses, were limited to exposure definitions based on short durations of intake. The overall odds ratio (OR) for any reported PPI intake was 1.78 [95% confidence interval (CI): 0.76-4.14]. In the dose-response analysis, the ORs of gastric cancer were found to be higher for short durations of PPI intake (6 months: OR 3.26; 95% CI: 2.40-4.42; one year: OR 2.14; 95% CI: 1.69-2.70; 2 years: OR 1.50; 95% CI: 1.22-1.85; 3 years: OR 1.27; 95% CI: 1.03-1.56), with the association becoming not significant for durations longer than 3 years. CONCLUSIONS Our findings suggest that the observed association between PPIs and gastric cancer might be mainly due to reverse causality. IMPACT The results of this study suggest that PPIs are a safe therapeutic choice regarding their effect on the occurrence of gastric cancer. See related commentary by Richman and Leiman, p. 1127.
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Affiliation(s)
- Michele Sassano
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Mariani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Samantha Morais
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Vicente Martín
- Faculty of Health Sciences, Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Universidad de León, León, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Victor Moreno
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Oncology Data Analytics Program, Catalan Institute of Oncology (ICO), Barcelona, Spain
- Colorectal Cancer Group, ONCOBELL Program, Institut de Recerca Biomedica de Bellvitge (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria Paula Curado
- Centro Internacional de Pesquisa, A. C. Camargo Cancer Center, São Paulo, Brasil
| | - Emmanuel Dias-Neto
- Centro Internacional de Pesquisa, A. C. Camargo Cancer Center, São Paulo, Brasil
| | - Marcis Leja
- Digestive Diseases Centre GASTRO, Riga, Latvia
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
- Faculty of Medicine, University of Latvia, Riga, Latvia
- Riga East University Hospital, Riga, Latvia
| | - Evita Gašenko
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
- Faculty of Medicine, University of Latvia, Riga, Latvia
- Riga East University Hospital, Riga, Latvia
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health–Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health–Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Knaze V, Freisling H, Cook P, Heise K, Acevedo J, Cikutovic M, Wagner KH, Marculescu R, Ferreccio C, Herrero R, Park JY. Association between salt intake and gastric atrophy by Helicobacter pylori infection: first results from the Epidemiological Investigation of Gastric Malignancy (ENIGMA). Eur J Nutr 2023; 62:2129-2138. [PMID: 36964250 DOI: 10.1007/s00394-023-03132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/02/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE Gastric atrophy (GA), usually linked to chronic infection with Helicobacter pylori (H. pylori), may over time evolve into gastric malignancy. Besides H. pylori, high salt intake may play a role in GA development. This study evaluates cross sectionally the association between salt intake and GA in Chilean adults. METHODS Population-based samples were recruited from two sites, Antofagasta and Valdivia, partaking in the Epidemiological Investigation of Gastric Malignancies. At recruitment, participants answered questionnaires and provided biospecimens. Salt intake (g/day) was estimated from casual spot urine samples using the Tanaka equation. GA was determined by serum pepsinogen levels. Only participants ≥ 40 to 70 years of age were considered in this analysis, n = 565. For the association between salt intake (as sex-specific quartiles) and GA, odds ratios (ORs) and the corresponding 95% confidence intervals (CI) were estimated through multivariable logistic regression. RESULTS In women, the multivariable-adjusted OR for GA comparing quartile 4 of the estimated salt intake (12.8 g/day) to quartile 1 (6.6 g/day) was 1.18 (95% CI 0.52-2.68, P-trend = 0.87). The corresponding OR in men was 0.49 (95% CI 0.19-1.27, P-trend = 0.17) with salt intakes of 12.8 g/day and 7.1 g/day for quartiles 4 and 1, respectively. CONCLUSION There was little evidence for an association between salt intake estimated from spot urine and GA risk in our cross-sectional analysis of middle aged and older adults in Chile. Reverse causation bias cannot be ruled out and the sample size was limited to provide more precise estimates.
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Affiliation(s)
- Viktoria Knaze
- Early Detection, Prevention and Infections Branch, International Agency for Research On Cancer (IARC/WHO), Lyon, France
| | - Heinz Freisling
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Paz Cook
- Pontificia Universidad Católica de Chile, Santiago, Chile
- Advanced Center for Chronic Diseases, ACCDiS, Santiago, Chile
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Katy Heise
- Hospital Cancer Registry, Hospital Base Valdivia, Valdivia, Chile
| | | | - Marcos Cikutovic
- Faculty of Health Sciences, Universidad de Antofagasta, Antofagasta, Chile
| | - Karl-Heinz Wagner
- Department of Nutritional Sciences and Research Platform Active Ageing, University of Vienna, Vienna, Austria
| | - Rodrig Marculescu
- Division of Medical-Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Rolando Herrero
- Early Detection, Prevention and Infections Branch, International Agency for Research On Cancer (IARC/WHO), Lyon, France
- Agencia Costarricense de Investigaciones Biomédicas, Fundacion INCIENSA, San José, Costa Rica
| | - Jin Young Park
- Early Detection, Prevention and Infections Branch, International Agency for Research On Cancer (IARC/WHO), Lyon, France.
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The Diagnostic Value of Anti-Parietal Cell and Intrinsic Factor Antibodies, Pepsinogens, and Gastrin-17 in Corpus-Restricted Atrophic Gastritis. Diagnostics (Basel) 2022; 12:diagnostics12112784. [PMID: 36428844 PMCID: PMC9689963 DOI: 10.3390/diagnostics12112784] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to determine the diagnostic value of anti-parietal cell antibodies (anti-PCA), anti-intrinsic factor antibodies (anti-IFA), pepsinogen ratio (PGI/II), and gastrin-17 (G-17) in corpus-restricted atrophic gastritis (CRAG) detected by ELISA (Inova, Biohit). Our study compared 29 CRAG cases against 58 age- and sex-matched controls with mild or no atrophy. Anti-PCA and anti-IFA positive cutoff values were ≥25 units for both. PGI/II value <3 was considered characteristic for atrophy; positive cutoff values for G-17 and anti-H. pylori IgG were >5 pg/L and >30 EIU. Anti-PCA was positive in 65.5% For CRAG cases and 13.8% of the controls (p < 0.0001), anti-IFA was positive in 13.8% and 0% (p = 0.01), respectively. Decreased pepsinogen levels were present in 79.3% of CRAG cases and 10.3% of the controls (p < 0.0001). PGI/II ratio was the best single biomarker, with sensitivity = 79%, specificity = 90%, and AUC 0.90. The combined use of PGI/II and anti-PCA resulted in AUC 0.93 for detecting CRAG. Our study suggests that the best combination of non-invasive biomarkers for detecting CRAG is PGI/II with anti-PCA. The addition of G-17 and anti-IFA is of little utility in clinical application.
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Razuka-Ebela D, Polaka I, Daugule I, Parshutin S, Santare D, Ebela I, Rudzite D, Vangravs R, Herrero R, Young Park J, Leja M. Lifestyle and dietary factors associated with serologically detected gastric atrophy in a Caucasian population in the GISTAR study. Eur J Cancer Prev 2022; 31:442-450. [PMID: 35131967 DOI: 10.1097/cej.0000000000000723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify dietary and lifestyle factors associated with decreased pepsinogen levels indicative of gastric atrophy. METHODS Participants aged 40 to 64 from the "Multicentric randomized study of H. pylori eradication and pepsinogen testing for prevention of gastric cancer mortality (GISTAR study)" in Latvia tested for serum pepsinogen, as well as for Helicobacter pylori infection by 13 C-urea breath test or serology were included. Data on sex, age, education, employment, diet, smoking, alcohol and proton pump inhibitor use were obtained by survey and compared for participants with and without serologically detected gastric atrophy defined as pepsinogen I/pepsinogen II ≤ 2 and pepsinogen I ≤ 30 ng/mL. RESULTS Of 3001 participants (median age 53, interquartile range, 11.0, 36.9% male) 52.8% had H. pylori and 7.7% had serologically detected gastric atrophy. In multivariate analysis, increasing age, consumption of alcohol, coffee, and onions were positively, while H. pylori , former smoking, pickled product and proton pump inhibitor use were inversely associated with gastric atrophy. Pepsinogen values were higher in smokers and those with H. pylori . Pepsinogen ratio was lower in those with H. pylori . When stratifying by H. pylori presence, significantly higher pepsinogen levels remained for smokers without H. pylori . CONCLUSION Several dietary factors and smoking were associated with serologically detected gastric atrophy. Pepsinogen levels differed by smoking and H. pylori status, which may affect the serologic detection of gastric atrophy. There seems to be a complicated interaction between multiple factors. A prospective study including atrophy determined by both serology and histology is necessary.
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Affiliation(s)
- Danute Razuka-Ebela
- Faculty of Medicine
- Institute of Clinical and Preventive Medicine, University of Latvia
| | - Inese Polaka
- Institute of Clinical and Preventive Medicine, University of Latvia
| | - Ilva Daugule
- Faculty of Medicine
- Institute of Clinical and Preventive Medicine, University of Latvia
| | - Sergei Parshutin
- Institute of Clinical and Preventive Medicine, University of Latvia
| | - Daiga Santare
- Faculty of Medicine
- Institute of Clinical and Preventive Medicine, University of Latvia
| | | | - Dace Rudzite
- Institute of Clinical and Preventive Medicine, University of Latvia
- Riga East University Hospital, Riga, Latvia
| | - Reinis Vangravs
- Institute of Clinical and Preventive Medicine, University of Latvia
| | - Rolando Herrero
- International Agency for Research on Cancer, Lyon, France
- Agencia Costarricense de Investigaciones Biomedicas, Fundación INCIENSA, Costa Rica
| | - Jin Young Park
- International Agency for Research on Cancer, Lyon, France
| | - Marcis Leja
- Faculty of Medicine
- Institute of Clinical and Preventive Medicine, University of Latvia
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Robles C, Rudzite D, Polaka I, Sjomina O, Tzivian L, Kikuste I, Tolmanis I, Vanags A, Isajevs S, Liepniece-Karele I, Razuka-Ebela D, Parshutin S, Murillo R, Herrero R, Young Park J, Leja M. Assessment of Serum Pepsinogens with and without Co-Testing with Gastrin-17 in Gastric Cancer Risk Assessment-Results from the GISTAR Pilot Study. Diagnostics (Basel) 2022; 12:1746. [PMID: 35885649 PMCID: PMC9325279 DOI: 10.3390/diagnostics12071746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction−−Serum pepsinogen tests for gastric cancer screening have been debated for decades. We assessed the performance of two pepsinogen assays with or without gastrin-17 for the detection of different precancerous lesions alone or as a composite endpoint in a Latvian cohort. Methods−−Within the intervention arm of the GISTAR population-based study, participants with abnormal pepsinogen values by ELISA or latex-agglutination tests, or abnormal gastrin-17 by ELISA and a subset of subjects with all normal biomarker values were referred for upper endoscopy with biopsies. Performance of biomarkers, corrected by verification bias, to detect five composite outcomes based on atrophy, intestinal metaplasia, dysplasia or cancer was explored. Results−−Data from 1045 subjects were analysed, of those 273 with normal biomarker results. Both pepsinogen assays showed high specificity (>93%) but poor sensitivity (range: 18.4−31.1%) that slightly improved when lesions were restricted to corpus location (40.5%) but decreased when dysplasia and prevalent cancer cases were included (23.8%). Adding gastrin-17 detection, sensitivity reached 33−45% while specificity decreased (range: 61.1−62%) and referral rate for upper endoscopy increased to 38.6%. Conclusions−−Low sensitivity of pepsinogen assays is a limiting factor for their use in population-based primary gastric cancer screening, however their high specificity could be useful for triage.
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Affiliation(s)
- Claudia Robles
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, 69372 Lyon, France; (R.M.); (R.H.); (J.Y.P.)
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, 08908 L’Hospitalet de Llobregat, Spain
| | - Dace Rudzite
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, 1007 Riga, Latvia; (D.R.); (I.P.); (O.S.); (L.T.); (I.K.); (S.I.); (I.L.-K.); (D.R.-E.); (S.P.); (M.L.)
- Department of Research, Riga East University Hospital, 1038 Riga, Latvia
| | - Inese Polaka
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, 1007 Riga, Latvia; (D.R.); (I.P.); (O.S.); (L.T.); (I.K.); (S.I.); (I.L.-K.); (D.R.-E.); (S.P.); (M.L.)
| | - Olga Sjomina
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, 1007 Riga, Latvia; (D.R.); (I.P.); (O.S.); (L.T.); (I.K.); (S.I.); (I.L.-K.); (D.R.-E.); (S.P.); (M.L.)
| | - Lilian Tzivian
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, 1007 Riga, Latvia; (D.R.); (I.P.); (O.S.); (L.T.); (I.K.); (S.I.); (I.L.-K.); (D.R.-E.); (S.P.); (M.L.)
| | - Ilze Kikuste
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, 1007 Riga, Latvia; (D.R.); (I.P.); (O.S.); (L.T.); (I.K.); (S.I.); (I.L.-K.); (D.R.-E.); (S.P.); (M.L.)
- Digestive Diseases Centre GASTRO, 1586 Riga, Latvia; (I.T.); (A.V.)
| | - Ivars Tolmanis
- Digestive Diseases Centre GASTRO, 1586 Riga, Latvia; (I.T.); (A.V.)
| | - Aigars Vanags
- Digestive Diseases Centre GASTRO, 1586 Riga, Latvia; (I.T.); (A.V.)
| | - Sergejs Isajevs
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, 1007 Riga, Latvia; (D.R.); (I.P.); (O.S.); (L.T.); (I.K.); (S.I.); (I.L.-K.); (D.R.-E.); (S.P.); (M.L.)
- Department of Research, Riga East University Hospital, 1038 Riga, Latvia
- Academic Histology Laboratory, 1073 Riga, Latvia
| | - Inta Liepniece-Karele
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, 1007 Riga, Latvia; (D.R.); (I.P.); (O.S.); (L.T.); (I.K.); (S.I.); (I.L.-K.); (D.R.-E.); (S.P.); (M.L.)
- Department of Research, Riga East University Hospital, 1038 Riga, Latvia
- Academic Histology Laboratory, 1073 Riga, Latvia
| | - Danute Razuka-Ebela
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, 1007 Riga, Latvia; (D.R.); (I.P.); (O.S.); (L.T.); (I.K.); (S.I.); (I.L.-K.); (D.R.-E.); (S.P.); (M.L.)
| | - Sergej Parshutin
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, 1007 Riga, Latvia; (D.R.); (I.P.); (O.S.); (L.T.); (I.K.); (S.I.); (I.L.-K.); (D.R.-E.); (S.P.); (M.L.)
| | - Raul Murillo
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, 69372 Lyon, France; (R.M.); (R.H.); (J.Y.P.)
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá 11001, Colombia
| | - Rolando Herrero
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, 69372 Lyon, France; (R.M.); (R.H.); (J.Y.P.)
- Agencia Costarricense de Investigaciones Biomedicas, Fundacion INCIENSA, San Jose 2250, Costa Rica
| | - Jin Young Park
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, 69372 Lyon, France; (R.M.); (R.H.); (J.Y.P.)
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, 1007 Riga, Latvia; (D.R.); (I.P.); (O.S.); (L.T.); (I.K.); (S.I.); (I.L.-K.); (D.R.-E.); (S.P.); (M.L.)
- Department of Research, Riga East University Hospital, 1038 Riga, Latvia
- Digestive Diseases Centre GASTRO, 1586 Riga, Latvia; (I.T.); (A.V.)
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9
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Morais S, Costa A, Albuquerque G, Araújo N, Tsugane S, Hidaka A, Hamada GS, Ye W, Plymoth A, Leja M, Gasenko E, Zaridze D, Maximovich D, Malekzadeh R, Derakhshan MH, Pelucchi C, Negri E, Camargo MC, Curado MP, Vioque J, Zhang ZF, La Vecchia C, Boffetta P, Lunet N. "True" Helicobacter pylori infection and non-cardia gastric cancer: A pooled analysis within the Stomach Cancer Pooling (StoP) Project. Helicobacter 2022; 27:e12883. [PMID: 35235224 DOI: 10.1111/hel.12883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Helicobacter pylori is the most important risk factor for non-cardia gastric cancer (NCGC); however, the magnitude of the association varies across epidemiological studies. This study aimed to quantify the association between H. pylori infection and NCGC, using different criteria to define infection status. METHODS A pooled analysis of individual-level H. pylori serology data from eight international studies (1325 NCGC and 3121 controls) from the Stomach Cancer Pooling (StoP) Consortium was performed. Cases and controls with a negative H. pylori infection status were reclassified as positive considering the presence of anti-Cag A antibodies, gastric atrophy, or advanced stage at diagnosis, as available and applicable. A two-stage approach was used to pool study-specific adjusted odds ratios (OR), and 95% confidence intervals (95% CI). A meta-analysis of published prospective studies assessing H. pylori seropositivity in NCGCs was conducted. RESULTS The OR for the association between serology-defined H. pylori and NCGC was 1.45 (95% CI: 0.87-2.42), which increased to 4.79 (95% CI: 2.39-9.60) following the reclassification of negative H. pylori infection. The results were consistent across strata of sociodemographic characteristics, clinical features and lifestyle factors, though significant differences were observed according to geographic region-a stronger association in Asian studies. The pooled risk estimates from the literature were 3.01 (95% CI: 2.22-4.07) for ELISA or EIA and 9.22 (95% CI: 3.12-27.21) for immunoblot or multiplex serology. CONCLUSION The NCGC risk estimate from StoP based on the reclassification of H. pylori seronegative individuals is consistent with the risk estimates obtained from the literature. Our classification algorithm may be useful for future studies.
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Affiliation(s)
- Samantha Morais
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Adriana Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Gabriela Albuquerque
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Natália Araújo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Akihisa Hidaka
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | | | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Amelie Plymoth
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marcis Leja
- Digestive Diseases Centre GASTRO, Riga, Latvia.,Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia.,Faculty of Medicine, University of Latvia, Riga, Latvia.,Riga East University Hospital, Riga, Latvia
| | - Evita Gasenko
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia.,Faculty of Medicine, University of Latvia, Riga, Latvia.,Riga East University Hospital, Riga, Latvia
| | - David Zaridze
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Dmitry Maximovich
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad H Derakhshan
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Eva Negri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Humanities, Pegaso Telematic University, Naples, Italy
| | - M Constanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Maria Paula Curado
- Centro Internacional de Pesquisa, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Jesus Vioque
- Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL-UMH, Alicante, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Zuo-Feng Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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10
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Serum pepsinogen: A potential non-invasive screening method for moderate and severe atrophic gastritis among an asian population. Ann Med Surg (Lond) 2022; 78:103844. [PMID: 35734694 PMCID: PMC9207076 DOI: 10.1016/j.amsu.2022.103844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background Serum pepsinogen has been approved and used widely as an effective biomarker in diagnosis of atrophic gastritis and gastric cancer; however, its validity and appropriate cut-off values vary among different populations. This study aimed to initially assess the diagnostic value of the serum pepsinogen in diagnosis of moderate and severe atrophic gastritis for Vietnamese population. Materials and methods A cross-sectional study enrolled 273 participants from June 2008 to November 2019. All participants underwent a gastroscopy procedure and three tests including serum PG test, pathology test, and Hp-Igg Elisa test. The Kimura-Takemoto classification and OLGA system were used to classify the mild versus moderate-severe atrophic gastritis. Receiver Operating Characteristic curve was used to assess the value of PGI, PGII and PGR. Results Based on Kimura-Takemoto classification, the AUC of PGI and PGR was 0.635 (p = 0.008, 95% CI 0.554–0.716) and 0.766 (p < 0.001, 95% CI 0.676–0.857) respectively. The best cut-off values were PGI ≤69.0 and PGR ≤4.6 (sensitivity: 73%, specificity: 83.9%, positive predictive value: 41.5%, negative predictive value: 95.2%, accuracy: 82.4%). According to the OLGA system, the AUC of PGI and PGR was 0.612 (p = 0.004, 95% CI 0.540–0.684) and 0.689 (p < 0.001, 95% CI 0.621–0.758) respectively. The best cut-off values were PGI ≤63.5 and PGR ≤5.2 (sensitivity: 49.4%, specificity: 82.1%, positive predictive value: 52.1%, negative predictive value: 80.5%, accuracy: 72.9%). Conclusions The serum pepsinogen II and pepsinogen I/II ratio had reliable diagnostic value for screening of moderate and severe atrophic gastritis among Vietnamese population. Further research was recommended to focus on larger scale to improve the diagnostic yield and to continue finding the cut-off values for diagnosis of gastric cancer among Vietnamese population. The validity and appropriate cut-off values of serum pepsinogen vary among different populations. In Vietnamese population, based on Kimura-Takemoto classification, the best cut-off values were PGI ≤69.0 and PGR ≤4.6. According to the OLGA system, the best cut-off values were PGI ≤63.5 and PGR ≤5.2. The serum pepsinogen II and pepsinogen I/II ratio had reliable diagnostic value for screening of moderate and severe atrophic gastritis among Vietnamese population.
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11
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Razuka-Ebela D, Polaka I, Daugule I, Parshutin S, Santare D, Ebela I, Rudzite D, Vangravs R, Herrero R, Young Park J, Leja M. Factors Associated with False Negative Results in Serum Pepsinogen Testing for Precancerous Gastric Lesions in a European Population in the GISTAR Study. Diagnostics (Basel) 2022; 12:1166. [PMID: 35626319 PMCID: PMC9139962 DOI: 10.3390/diagnostics12051166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 01/27/2023] Open
Abstract
The accuracy of plasma pepsinogen (Pg) as a marker for precancerous gastric lesions (PGL) has shown variable results. We aimed to identify factors associated with false negative (FN) cases in Pg testing and to adjust cut-off values for these factors in order to improve Pg yield. Plasma Pg was measured and upper endoscopy with biopsy was performed within the "Multicentric randomized study of Helicobacter pylori eradication and pepsinogen testing for prevention of gastric cancer mortality: the GISTAR study". A multivariable logistic model was built for FN and multiple factors. Values of Pg were compared and sensitivity and specificity were calculated using pre-existing Pg cut-offs for factors showing strong associations with FN. New cut-offs were calculated for factors that showed substantially lower sensitivity. Of 1210 participants, 364 (30.1%) had histologically confirmed PGL, of which 160 (44.0%) were FN. Current smokers, men, and H. pylori positives were more likely FN. Smoking in H. pylori negatives was associated with a higher Pg I/II ratio and substantially lower sensitivity of Pg testing than in other groups. Adjusting Pg cut-offs for current smokers by H. pylori presence improved sensitivity for detecting PGL in this group. Our study suggests that adjusting Pg cut-offs for current smokers by H. pylori status could improve Pg test performance.
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Affiliation(s)
- Danute Razuka-Ebela
- Faculty of Medicine, University of Latvia, Jelgavas iela 3, LV-1004 Riga, Latvia; (I.D.); (D.S.); (I.E.); (M.L.)
- Institute of Clinical and Preventive Medicine, University of Latvia, Jelgavas iela 3, LV-1004 Riga, Latvia; (I.P.); (S.P.); (D.R.); (R.V.)
| | - Inese Polaka
- Institute of Clinical and Preventive Medicine, University of Latvia, Jelgavas iela 3, LV-1004 Riga, Latvia; (I.P.); (S.P.); (D.R.); (R.V.)
| | - Ilva Daugule
- Faculty of Medicine, University of Latvia, Jelgavas iela 3, LV-1004 Riga, Latvia; (I.D.); (D.S.); (I.E.); (M.L.)
- Institute of Clinical and Preventive Medicine, University of Latvia, Jelgavas iela 3, LV-1004 Riga, Latvia; (I.P.); (S.P.); (D.R.); (R.V.)
| | - Sergei Parshutin
- Institute of Clinical and Preventive Medicine, University of Latvia, Jelgavas iela 3, LV-1004 Riga, Latvia; (I.P.); (S.P.); (D.R.); (R.V.)
| | - Daiga Santare
- Faculty of Medicine, University of Latvia, Jelgavas iela 3, LV-1004 Riga, Latvia; (I.D.); (D.S.); (I.E.); (M.L.)
- Institute of Clinical and Preventive Medicine, University of Latvia, Jelgavas iela 3, LV-1004 Riga, Latvia; (I.P.); (S.P.); (D.R.); (R.V.)
| | - Inguna Ebela
- Faculty of Medicine, University of Latvia, Jelgavas iela 3, LV-1004 Riga, Latvia; (I.D.); (D.S.); (I.E.); (M.L.)
| | - Dace Rudzite
- Institute of Clinical and Preventive Medicine, University of Latvia, Jelgavas iela 3, LV-1004 Riga, Latvia; (I.P.); (S.P.); (D.R.); (R.V.)
- Riga East University Hospital, Hipokrāta iela 2, LV-1038 Riga, Latvia
| | - Reinis Vangravs
- Institute of Clinical and Preventive Medicine, University of Latvia, Jelgavas iela 3, LV-1004 Riga, Latvia; (I.P.); (S.P.); (D.R.); (R.V.)
| | - Rolando Herrero
- International Agency for Research on Cancer, 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France; (R.H.); (J.Y.P.)
- Agencia Costarricense de Investigaciones Biomedicas, Fundación INCIENSA, Avenida 9a Calles 64-68, San Jose 2250, Costa Rica
| | - Jin Young Park
- International Agency for Research on Cancer, 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France; (R.H.); (J.Y.P.)
| | - Marcis Leja
- Faculty of Medicine, University of Latvia, Jelgavas iela 3, LV-1004 Riga, Latvia; (I.D.); (D.S.); (I.E.); (M.L.)
- Institute of Clinical and Preventive Medicine, University of Latvia, Jelgavas iela 3, LV-1004 Riga, Latvia; (I.P.); (S.P.); (D.R.); (R.V.)
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12
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Salt intake and gastric cancer: a pooled analysis within the Stomach cancer Pooling (StoP) Project. Cancer Causes Control 2022; 33:779-791. [PMID: 35304655 DOI: 10.1007/s10552-022-01565-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/22/2022] [Indexed: 12/20/2022]
Abstract
PURPOSE Previous studies show that consuming foods preserved by salting increases the risk of gastric cancer, while results on the association between total salt or added salt and gastric cancer are less consistent and vary with the exposure considered. This study aimed to quantify the association between dietary salt exposure and gastric cancer, using an individual participant data meta-analysis of studies participating in the Stomach cancer Pooling (StoP) Project. METHODS Data from 25 studies (10,283 cases and 24,643 controls) from the StoP Project with information on salt taste preference (tasteless, normal, salty), use of table salt (never, sometimes, always), total sodium intake (tertiles of grams/day), and high-salt and salt-preserved foods intake (tertiles of grams/day) were used. A two-stage approach based on random-effects models was used to pool study-specific adjusted (sex, age, and gastric cancer risk factors) odds ratios (aORs), and the corresponding 95% confidence intervals (95% CI). RESULTS Gastric cancer risk was higher for salty taste preference (aOR 1.59, 95% CI 1.25-2.03), always using table salt (aOR 1.33, 95% CI 1.16-1.54), and for the highest tertile of high-salt and salt-preserved foods intake (aOR 1.24, 95% CI 1.01-1.51) vs. the lowest tertile. No significant association was observed for the highest vs. the lowest tertile of total sodium intake (aOR 1.08, 95% CI 0.82-1.43). The results obtained were consistent across anatomic sites, strata of Helicobacter pylori infection, and sociodemographic, lifestyle and study characteristics. CONCLUSION Salty taste preference, always using table salt, and a greater high-salt and salt-preserved foods intake increased the risk of gastric cancer, though the association was less robust with total sodium intake.
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13
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Serum Pepsinogens Combined with New Biomarkers Testing Using Chemiluminescent Enzyme Immunoassay for Non-Invasive Diagnosis of Atrophic Gastritis: A Prospective, Multicenter Study. Diagnostics (Basel) 2022; 12:diagnostics12030695. [PMID: 35328248 PMCID: PMC8947400 DOI: 10.3390/diagnostics12030695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/05/2022] [Accepted: 03/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Analysis of serum biomarkers for the assessment of atrophic gastritis (AG), a gastric precancerous lesion, is of growing interest for identification of patients at increased risk of gastric cancer. The aim was to analyze the diagnostic performance of serum pepsinogen testing using another method, chemiluminescent enzyme immunoassay (CLEIA), as well as of other new potential biomarkers. Material and Methods: The sera of patients considered at increased risk of gastric cancer and undergoing upper endoscopy collected in our previous prospective, multicenter study were tested for pepsinogen I (PGI) and II (PGII), interleukin-6 (IL-6), human epididymal protein 4 (HE-4), adiponectin, ferritin and Krebs von den Lungen (KL-6) using the CLEIA. The diagnostic performance for the detection of AG was calculated by taking histology as the reference. Results: In total, 356 patients (162 men (46%); mean age 58.6 (±14.2) years), including 152 with AG, were included. For the detection of moderate to severe corpus AG, sensitivity and specificity of the pepsinogen I/II ratio were of 75.0% (95%CI 57.8–87.9) and 92.6% (88.2–95.8), respectively. For the detection of moderate to severe antrum AG, sensitivity of IL-6 was of 72.2% (95%CI 46.5–90.3). Combination of pepsinogen I/II ratio or HE-4 showed a sensitivity of 85.2% (95%CI 72.9–93.4) for the detection of moderate to severe AG at any location. Conclusion: This study shows that PG testing by CLEIA represents an accurate assay for the detection of corpus AG. Additionally, IL-6 and HE-4 may be of interest for the detection of antrum AG. Mini-abstract: Pepsinogens testing by chemiluminescent enzyme immunoassay is accurate for the detection of corpus atrophic gastritis. IL-6 and HE-4 maybe of interest for the detection of antrum atrophic gastritis.
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14
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Chiang TH, Chen YN, Chen YR, Tseng YH, Shieh CF, Liu CY, Chiu HM, Chiang H, Shun CT, Wu MS, Lin JT, Lee YC. Brand interchangeability of pepsinogen tests in the real-world setting after eradication of Helicobacter pylori: a community-based study. BMC Gastroenterol 2022; 22:69. [PMID: 35180851 PMCID: PMC8857789 DOI: 10.1186/s12876-022-02155-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/14/2022] [Indexed: 11/11/2022] Open
Abstract
Background Serum pepsinogen (PG) is recommended as a screening test for premalignant gastric lesions. However, real-world evidence demonstrating its applicability and equivalence between different test brands is limited. Methods Mass screening began in 2018 in a high-risk Taiwanese population after eradication of Helicobacter pylori, with the first stage of two PG tests (GastroPanel®, Helsinki, Finland and LZ-Test®, Tokyo, Japan) and the second stage of endoscopy. A positive test was defined as PG-I < 30 ng/mL or PG-I/II ratio < 3 for GastroPanel® and PG-I ≤ 70 ng/mL and PG-I/II ratio ≤ 3 for LZ-Test®. Index lesions included atrophic gastritis and intestinal metaplasia. Test performance was evaluated based on the participation rate, positivity rate, referral rate, positive predictive value (PPV), and the detection rate. Results Among 7616 eligible participants, 5117 (67.2%) received PG tests and 284 (5.6%) tested positive. Of those who tested positive, 105 (37.0%) underwent endoscopy. Overall PPVs for atrophic gastritis and intestinal metaplasia were 12.4% and 18.9%, respectively, with detection rates of 2.5 and 3.9 per 1000, respectively. Correlations of numerical measures between tests were high and the agreements of test results were substantial. The PPVs (16.3% vs. 16.3% and 23.8% vs. 21.3%, P = 1.00 and 0.71, respectively), detection rates (2.5 vs. 2.5 and 3.7 vs. 3.3 per 1000, P = 1.00 and 0.27, respectively), and the stage distributions of gastritis were all comparable, which were confirmed by multiple regression analyses. Conclusions PG testing is effective for mass screening after eradication of H. pylori. Tests from different manufacturers, even using different analytical methods and cutoff criteria, can perform equivalently. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02155-7.
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Affiliation(s)
- Tsung-Hsien Chiang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Nien Chen
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yi-Ru Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yu-Hua Tseng
- Lienchiang County Public Health Bureau, Nangan Township, Lienchiang County, Matsu, Taiwan
| | - Chun-Fu Shieh
- Lienchiang County Hospital, Nangan Township, Lienchiang County, Matsu, Taiwan
| | - Cheng-Ying Liu
- Lienchiang County Government, Nangan Township, Lienchiang County, Matsu, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hung Chiang
- Taipei Institute of Pathology, Taipei, Taiwan
| | - Chia-Tung Shun
- Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jaw-Town Lin
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. .,Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
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15
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Murphy JD, Olshan AF, Lin FC, Troester MA, Nichols HB, Butt J, Qiao YL, Abnet CC, Inoue M, Tsugane S, Epplein M. A predictive model of non-cardia gastric adenocarcinoma risk using antibody response to Helicobacter pylori proteins and pepsinogen. Cancer Epidemiol Biomarkers Prev 2022; 31:811-820. [DOI: 10.1158/1055-9965.epi-21-0869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/02/2021] [Accepted: 01/24/2022] [Indexed: 12/24/2022] Open
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16
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Morais S, Peleteiro B, Araújo N, Malekzadeh R, Ye W, Plymoth A, Tsugane S, Hidaka A, Shigueaki Hamada G, López-Carrillo L, Zaridze D, Maximovich D, Aragonés N, Castaño-Vinyals G, Pakseresht M, Hernández-Ramírez RU, López-Cervantes M, Leja M, Gasenko E, Pourfarzi F, Zhang ZF, Yu GP, Derakhshan MH, Pelucchi C, Negri E, La Vecchia C, Lunet N. Identifying the profile of Helicobacter pylori negative gastric cancers: a case only analysis within the Stomach cancer Pooling (StoP) Project. Cancer Epidemiol Biomarkers Prev 2021; 31:200-209. [PMID: 34728467 DOI: 10.1158/1055-9965.epi-21-0402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/25/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The prevalence of Helicobacter pylori negative gastric cancer (HpNGC) can be as low as 1%, when infection is assessed using more sensitive tests or considering the presence of gastric atrophy. HpNGC may share a high-risk profile contributing to the occurrence of cancer in the absence of infection. We estimated the proportion of HpNGC, using different criteria to define infection status, and compared HpNGC and positive cases regarding gastric cancer risk factors. METHODS Cases from 12 studies from the Stomach cancer Pooling (StoP) Project providing data on H. pylori infection status determined by serological test were included. HpNGC was reclassified as positive (eight studies) when cases presented CagA markers (four studies), gastric atrophy (six studies), or advanced stage at diagnosis (three studies), and were compared with positive cases. A two-stage approach (random-effects models) was used to pool study-specific prevalence and adjusted odds ratios (ORs). RESULTS Among non-cardia cases, the pooled prevalence of HpNGC was 22.4% (n=166/853) and decreased to 7.0% (n=55) when considering CagA status; estimates for all criteria were 21.8% (n=276/1325) and 6.6% (n=97), respectively. HpNGC had a family history of gastric cancer more often (OR=2.18, 95% confidence interval [CI]:1.03-4.61) and were current smokers (OR=2.16, 95%CI:0.52-9.02). CONCLUSION This study found a low prevalence of HpNGC, who are more likely to have a family history of gastric cancer in first-degree relatives. IMPACT Our results support that H. pylori infection is present in most non-cardia gastric cancers, and suggest that HpNGC may have distinct patterns of exposure to other risk factors.
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Affiliation(s)
- Samantha Morais
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, Instituto de Saúde Pública da Universidade do Porto
| | - Bárbara Peleteiro
- Department of Hygiene and Epidemiology, University of Porto Medical School
| | - Natália Araújo
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, Instituto de Saúde Pública da Universidade do Porto
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Tehran University of Medical Sciences
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute
| | - Amelie Plymoth
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Centre
| | | | | | | | - David Zaridze
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center
| | - Dmitry Maximovich
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center
| | | | - Gemma Castaño-Vinyals
- Non-communicable Diseases and Environment, Center for Research in Environmental Epidemiology
| | - Mohammadreza Pakseresht
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences
| | | | | | - Marcis Leja
- Riga Eastern Clinical University hospital, Digestive Diseases Centre GASTRO, University of Latvia
| | - Evita Gasenko
- Riga Eastern Clinical University hospital, Digestive Diseases Centre GASTRO, University of Latvia
| | - Farhad Pourfarzi
- Digestive Disease Research Center, Ardabil University of Medical Sciences
| | - Zuo-Feng Zhang
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Guo-Pei Yu
- Medical Informatics Center, Peking University
| | | | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, University of Milan
| | - Eva Negri
- Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto
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17
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Zhou X, Zhu H, Zhu C, Lin K, Cai Q, Li Z, Du Y. Helicobacter pylori Infection and Serum Pepsinogen Level With the Risk of Gastric Precancerous Conditions: A Cross-sectional Study of High-risk Gastric Cancer Population in China. J Clin Gastroenterol 2021; 55:778-784. [PMID: 33116065 DOI: 10.1097/mcg.0000000000001444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/04/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Gastric precancerous conditions are generally considered to play an essential role in the gastric carcinogenesis cascade. This study identified risk factors of gastric precancerous conditions in a nationwide multicenter cross-sectional study. METHODS Individuals who made their visit to 115 hospitals in China for gastric cancer screening were recruited. Lifestyle habits and personal information were collected through a series of questionnaires. Serum biomarker test (pepsinogen I, pepsinogen II, gastrin-17, and anti-Helicobacter pylori immunoglobulin G antibody) and endoscopy were then performed. Risk factors for gastric precancerous conditions were identified by univariate and multivariate analyses. RESULTS Of 14,929 subjects eligible for analysis, 4477 (30.0%) developed gastric precancerous conditions and 405 (2.71%) developed gastric cancer. In multiple logistic regression, precancerous conditions were associated with advanced age [odds ratio (OR)=1.027; 95% confidence interval (Cl), 1.023-1.032; P<0.001], male gender (OR=1.303; 95% Cl, 1.188-1.429; P<0.001), H. pylori infection (OR=1.377; 95% Cl, 1.272-1.490, P<0.001), and smoking (OR=1.142; 95% Cl, 1.005-1.298, P=0.004), whereas they were inversely correlated with white meat intake (OR=0.731; 95% Cl, 0.673-0.794; P<0.001) and pepsinogen I level (30 to 70 subgroup OR=1.536; 95% Cl, 1.163-2.028; P=0.002; <30 subgroup OR=1.354; 95% Cl, 1.206-1.520; P<0.001). Also, the authors observed a statistically lower prevalence of reflux esophagitis (2.8% vs. 4.7%) and of gastric polyps (11.0% vs. 13.7%) in H. pylori-infected population. CONCLUSIONS Patients with H. pylori have a 1.4-fold higher risk of having gastric precancerous conditions. Besides, precancerous conditions were associated with advanced age, male gender, H. pylori infection, and smoking in a large population. However, regular white meat intake and higher pepsinogen I level were associated with reduced risk of having precancerous lesions.
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Affiliation(s)
- Xianzhu Zhou
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
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18
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Leja M, Linē A. Early detection of gastric cancer beyond endoscopy - new methods. Best Pract Res Clin Gastroenterol 2021; 50-51:101731. [PMID: 33975677 DOI: 10.1016/j.bpg.2021.101731] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/08/2021] [Indexed: 01/31/2023]
Abstract
Early detection of gastric cancer is remaining a challenge. This review summarizes current knowledge on non-invasive methods that could be used for the purpose. The role of traditional cancer markers such as CEA, CA 72-4, CA 19-9, CA 15-3, and CA 12-5 lies mainly in therapy monitoring than early detection. Most extensive studied biomarkers (pepsinogens, ABC method) are aiming at the detection of precancerous lesions with modest sensitivity for cancer. Tests based on the detection of cancer-specific methylation patterns (PanSeer), circulating proteins and mutations in circulating tumour DNA (CancerSEEK), as well as miRNA panels have demonstrated promising results bringing those closer to practice. More extensive research is required before tests based on the detection of circulating tumour cells, extracellular vesicles and cell-free RNA could reach the practice. Detection of volatile organic compounds in the human breath is a promising development; sensor technologies for this purpose could be very attractive in screening settings.
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Affiliation(s)
- Mārcis Leja
- Institute of Clinical and Preventive Medicine, University of Latvia, 1 Gailezera iela iela, LV1079, Riga, Latvia.
| | - Aija Linē
- Latvian Biomedical Research and Study Centre, Latvia.
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19
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Lahner E, Marzinotto I, Lampasona V, Dottori L, Bazzigaluppi E, Brigatti C, Secchi M, Piemonti L, Conti L, Pilozzi E, Davidson HW, Wenzlau JM, Annibale B. Autoantibodies Toward ATP4A and ATP4B Subunits of Gastric Proton Pump H+,K+-ATPase Are Reliable Serological Pre-endoscopic Markers of Corpus Atrophic Gastritis. Clin Transl Gastroenterol 2020; 11:e00240. [PMID: 33031196 PMCID: PMC7544173 DOI: 10.14309/ctg.0000000000000240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Noninvasive assessment of corpus atrophic gastritis (CAG), a condition at increased risk of gastric cancer, is based on the measurement of pepsinogens, gastrin, and Helicobacter pylori antibodies. Parietal cell autoantibodies (PCAs) against the gastric proton pump (ATP4) are potential serological biomarkers of CAG. The purpose of this study was to compare the diagnostic performance of PCA and pepsinogen I tests in patients with clinical suspicion of CAG with the histopathological evaluation of gastric biopsies as reference standard. METHODS A prospective case-finding study was performed on 218 naive adult patients (131 women, median age 65 years) who underwent gastric biopsies to confirm/exclude CAG. Patients with histopathological CAG were defined as cases, conversely as controls. Autoantibodies against the individual alpha (ATP4A) and beta (ATP4B) subunits of ATP4 were measured by luciferase immunoprecipitation, and global PCA and pepsinogen I by enzyme-linked immunosorbent assay. RESULTS Histopathology classified 107 subjects (49%) as cases (CAG+, autoimmune 81.2%, and multifocal extensive 18.8%) and 111 subjects (51%) as controls (CAG-). In cases, ATP4A, ATP4B, and PCA titers were increased compared with controls, whereas pepsinogen I was reduced (P < 0.0001 for all). ATP4B, ATP4A, and pepsinogen I tests showed sensitivities of 77%, 75%, and 73% and specificities of 88%, 88%, and 80%, respectively. The receiver operating characteristic (ROC) area under the ROC curve (AUC) of these serological biomarkers confirmed their ability to discriminate cases from controls (ATP4B = 0.838, ATP4A = 0.826, pepsinogen I = 0.775, and PCA = 0.805), whereas the partial ROC-pAUC90 analysis showed that the ATP4B test had the best diagnostic performance (P = 0.008 vs ATP4; P = 0.0002 vs pepsinogen I). The presence of autoimmune or extensive gastritis was not significantly different between ATP4B positive or negative cases (P = 0.217). DISCUSSION PCAs are promising serological biomarkers for the identification of CAG in high-risk individuals, particularly in an autoimmune pattern but also in an extensive-multifocal atrophy pattern.
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Affiliation(s)
- Edith Lahner
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sant'Andrea Hospital, University Sapienza, Rome, Italy
| | - Ilaria Marzinotto
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vito Lampasona
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ludovica Dottori
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sant'Andrea Hospital, University Sapienza, Rome, Italy
| | - Elena Bazzigaluppi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristina Brigatti
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimiliano Secchi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lorenzo Piemonti
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Laura Conti
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sant'Andrea Hospital, University Sapienza, Rome, Italy
| | | | - Howard W. Davidson
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Janet M. Wenzlau
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bruno Annibale
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sant'Andrea Hospital, University Sapienza, Rome, Italy
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20
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21
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Herrero R, Heise K, Acevedo J, Cook P, Gonzalez C, Gahona J, Cortés R, Collado L, Beltrán ME, Cikutovic M, Gonzalez P, Murillo R, Leja M, Megraud F, Hernandez MDLL, Barbier S, Park JY, Ferreccio C. Regional variations in Helicobacter pylori infection, gastric atrophy and gastric cancer risk: The ENIGMA study in Chile. PLoS One 2020; 15:e0237515. [PMID: 32898138 PMCID: PMC7478833 DOI: 10.1371/journal.pone.0237515] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/28/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Regional variations in gastric cancer incidence are not explained by prevalence of Helicobacter pylori, the main cause of the disease, with several areas presenting high H. pylori prevalence but low gastric cancer incidence. The IARC worldwide H. pylori prevalence surveys (ENIGMA) aim at systematically describing age and sex-specific prevalence of H. pylori infection around the world and generating hypotheses to explain regional variations in gastric cancer risk. METHODS We selected age- and sex-stratified population samples in two areas with different gastric cancer incidence and mortality in Chile: Antofagasta (lower rate) and Valdivia (higher rate). Participants were 1-69 years old and provided interviews and blood for anti-H. pylori antibodies (IgG, VacA, CagA, others) and atrophy biomarkers (pepsinogens). RESULTS H. pylori seroprevalence (Age-standardized to world population) and antibodies against CagA and VacA were similar in both sites. H. pylori seroprevalence was 20% among children <10 years old, 40% among 10-19 year olds, 60% in the 20-29 year olds and close to or above 80% in those 30+ years. The comparison of the prevalence of known and potential H. pylori cofactors in gastric carcinogenesis between the high and the low risk area showed that consumption of chili products was significantly higher in Valdivia and daily non-green vegetable consumption was more common in Antofagasta. Pepsinogen levels suggestive of gastric atrophy were significantly more common and occurred at earlier ages in Valdivia, the higher risk area. In a multivariate model combining both study sites, age, chili consumption and CagA were the main risk factors for gastric atrophy. CONCLUSIONS The prevalence of H. pylori infection and its virulence factors was similar in the high and the low risk area, but atrophy was more common and occurred at younger ages in the higher risk area. Dietary factors could partly explain higher rates of atrophy and gastric cancer in Valdivia. IMPACT The ENIGMA study in Chile contributes to better understanding regional variations in gastric cancer incidence and provides essential information for public health interventions.
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Affiliation(s)
- Rolando Herrero
- International Agency for Research on Cancer, Lyon, France
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, Costa Rica
| | - Katy Heise
- Hospital Cancer Registry, Hospital Base Valdivia, Valdivia, Chile
| | | | - Paz Cook
- Public Health Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Advanced Center for Chronic Diseases, ACCDis, Santiago, Chile
| | - Claudia Gonzalez
- Secretaría Regional Ministerial de Salud, Antofagasta Region, Chile
| | - Jocelyne Gahona
- Faculty of Health Sciences, Universidad de Antofagasta, Antofagasta, Chile
| | - Raimundo Cortés
- Faculty of Health Sciences, Universidad de Antofagasta, Antofagasta, Chile
| | - Luis Collado
- Institute of Biochemistry and Microbiology, Faculty of Sciences, Universidad Austral de Chile, Valdivia, Chile
| | | | - Marcos Cikutovic
- Faculty of Health Sciences, Universidad de Antofagasta, Antofagasta, Chile
| | - Paula Gonzalez
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, Costa Rica
| | - Raul Murillo
- International Agency for Research on Cancer, Lyon, France
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Francis Megraud
- Bordeaux University, INSERM, UMR1053, BaRITOn, Team 2 "Helicobacter Infection, Inflammation and Cancer", Bordeaux, France
- Pellegrin University Hospital, Bacteriology Laboratory, French National Reference Center for Campylobacters and Helicobacters, Bordeaux, France
| | | | | | - Jin Young Park
- International Agency for Research on Cancer, Lyon, France
| | - Catterina Ferreccio
- Public Health Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Advanced Center for Chronic Diseases, ACCDis, Santiago, Chile
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22
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Ferro A, Morais S, Pelucchi C, Aragonés N, Kogevinas M, López-Carrillo L, Malekzadeh R, Tsugane S, Hamada GS, Hidaka A, Hernández-Ramírez RU, López-Cervantes M, Zaridze D, Maximovitch D, Pourfarzi F, Zhang ZF, Yu GP, Pakseresht M, Ye W, Plymoth A, Leja M, Gasenko E, Derakhshan MH, Negri E, La Vecchia C, Peleteiro B, Lunet N. Smoking and Helicobacter pylori infection: an individual participant pooled analysis (Stomach Cancer Pooling- StoP Project). Eur J Cancer Prev 2020; 28:390-396. [PMID: 30272597 DOI: 10.1097/cej.0000000000000471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Smoking has been associated with acquisition and increased persistence of Helicobacter pylori infection, as well as with lower effectiveness of its eradication. A greater prevalence of infection among smokers could contribute to the increased risk for gastric cancer. We aimed to estimate the association between smoking and seropositivity to H. pylori through an individual participant data pooled analysis using controls from 14 case-control studies participating in the Stomach Cancer Pooling Project. Summary odds ratios and prevalence ratios (PRs), adjusted for age, sex and social class, and the corresponding 95% confidence intervals (CIs) were estimated through random-effects meta-analysis. Heterogeneity was quantified using the I statistic and publication bias with Egger's test. There was no significant association between smoking (ever vs. never) and H. pylori seropositivity (adjusted odds ratio = 1.08; 95% CI: 0.89-1.32; adjusted PR = 1.01; 95% CI: 0.98-1.05). The strength of the association did not increase with the intensity or duration of smoking; stratified analyses according to sex, age, region or type of sample did not yield a consistent pattern of variation or statistically significant results, except for participants younger than 55 years and who had been smoking for more than 30 years (adjusted PR = 1.08; 95% CI: 1.02-1.15). This is the first collaborative analysis providing pooled estimates for the association between smoking and H. pylori seropositivity, based on detailed and uniform information and adjusting for major covariates. The results do not support an association between smoking and H. pylori infection.
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Affiliation(s)
- Ana Ferro
- EPIUnit - Instituto de Saúde Pública
| | | | | | - Nuria Aragonés
- Department of Health of Madrid, Epidemiology Section, Public Health Division.,CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Manolis Kogevinas
- CIBER Epidemiología y Salud Pública, Madrid, Spain.,ISGlobal, Centre for Research in Environmental Epidemiology.,IMIM (Hospital del Mar Medical Research Institute).,Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | | | - Akihisa Hidaka
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Raúl U Hernández-Ramírez
- Mexico National Institute of Public Health, Morelos.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, New Haven, USA
| | | | - David Zaridze
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Dmitry Maximovitch
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Farhad Pourfarzi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran.,Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Zuo-Feng Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | - Guo-Pei Yu
- Medical Informatics Center, Peking University, Peking, China
| | - Mohammadreza Pakseresht
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran.,Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.,Nutritional Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Amelie Plymoth
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, Riga
| | - Evita Gasenko
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, Riga
| | - Mohammad H Derakhshan
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran.,Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Eva Negri
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | - Bárbara Peleteiro
- EPIUnit - Instituto de Saúde Pública.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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23
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Abstract
PURPOSE OF THE REVIEW Atrophic gastritis is a complex syndrome with gastric atrophy as a common trait. Helicobacter pylori infection and autoimmunity are the two main contexts in which it develops. It is slightly symptomatic, affects various aspects of general health, and remains a predisposing factor for gastric cancer. This review will update current knowledge and progress on atrophic gastritis. RECENT FINDINGS Atrophic gastritis affects mostly adults with persistent dyspepsia, deficient anemia, autoimmunity disease, long-term proton pump inhibitor use, and a family history of gastric cancer. Gastric biopsies, expressed as Sydney system grade and OLGA/OLGIM classifications, represent the gold standard for diagnosis and cancer risk stage, respectively. Recently, electronic chromoendoscopy has allowed "targeted biopsies" of intestinal metaplasia. The associated hypochlorhydria affects the gastric microbiota composition suggesting that non-Helicobacter pylori microbiota may participate in the development of gastric cancer. Physicians should be aware of multifaceted clinical presentation of atrophic gastritis. It should be endoscopically monitored by targeted gastric biopsies. Autoimmune and Helicobacter pylori-induced atrophic gastritis are associated with different gastric microbial profiles playing different roles in gastric tumorigenesis.
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Affiliation(s)
- Edith Lahner
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035 -, 00189, Rome, Italy
| | - Laura Conti
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035 -, 00189, Rome, Italy
| | - Bruno Annibale
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035 -, 00189, Rome, Italy
| | - Vito Domenico Corleto
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035 -, 00189, Rome, Italy.
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24
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Kim YJ, Chung WC. Is serum pepsinogen testing necessary in populationbased screening for gastric cancer? Korean J Intern Med 2020; 35:544-546. [PMID: 32392661 PMCID: PMC7214357 DOI: 10.3904/kjim.2020.139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/23/2020] [Indexed: 01/06/2023] Open
Affiliation(s)
- Yeon-Ji Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo Chul Chung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Woo Chul Chung, M.D. Division of Gastroenterology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea Tel: +82-31-249-5850 Fax: +82-31-253-8898 E-mail:
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25
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Abstract
Introduction: Atrophic gastritis (AG) is a complex syndrome which arises as a consequence of H. pylori infection or in the context of gastric autoimmunity. It often deserves a benign course but may lead to potentially life-threatening complications: cancer and anemia. This review aims to address traditional and innovative knowledge on this often under-diagnosed disorder.Areas covered: This review covers clinical presentation, risk factors, diagnosis, and management of AG and provides an updated resource for clinicians to get insight into this challenging disorder. Updated literature was searched in PubMed. Manual search from reference lists of publications was performed.Expert opinion: A case-finding strategy may be beneficial in individuals with anemia, dyspepsia, autoimmune thyropaties and type 1 diabetes, and family history of gastric cancer. AG is linked to gastric cancer risk and endoscopic surveillance is indicated according to topography of gastric atrophy and risk factors. The direction for future research in AG is summarized.
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Affiliation(s)
- Bruno Annibale
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy
| | - Gianluca Esposito
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy
| | - Edith Lahner
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy
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26
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Mezmale L, Isajevs S, Bogdanova I, Polaka I, Krigere A, Rudzite D, Rudule A, Kikuste I, Parshutin S, Tazhedinov A, Mushinskiy D, Sametayev D, Belikhina T, Igissinov N, Park JY, Herrero R, Leja M. Prevalence of Atrophic Gastritis in Kazakhstan and the Accuracy of Pepsinogen Tests to Detect Gastric Mucosal Atrophy. Asian Pac J Cancer Prev 2019; 20:3825-3829. [PMID: 31870128 PMCID: PMC7173362 DOI: 10.31557/apjcp.2019.20.12.3825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/08/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Atrophic gastritis is considered precursor condition for gastric cancer. There is so far limited evidence on the performance of pepsinogens for atrophy detection in Central Asia. The aim of our study was to detect the prevalence of atrophic gastritis in the asymptomatic adult population in Kazakhstan as well as address the accuracy of pepsinogen testing in atrophy detection. METHODS Healthy individuals aged 40-64 were included. Upper endoscopy and pepsinogens (PG) evaluation were performed. PG were analysed in plasma by latex agglutination. Cut off values were used to define decreased PG values (PGR ≤ 3 and PG I ≤ 70 ng/mL); severely decreased PG values (PGR ≤ 2 and PG I ≤ 30 ng/mL). Biopsies were analyzed and obtained according to the updated Sydney System. PG test sensitivity, specificity and overall accuracy were assessed using the histological diagnosis as the "gold standard". RESULTS Altogether 157 individuals - female 40,1% and male 59,9% were included. Histologically, moderate to severe corpus atrophy, was present only in 1,3% cases. From all study subjects, 26,8% had decreased plasma PG values with cut-off values PGR ≤ 3 and PG I ≤ 70 ng/mL. The sensitivity of the PG test with this cut-off values was 50,0%, specificity 73,5%, overall accuracy 73,2% for detection of moderate to severe atrophy in the corpus. The sensitivity of PG test with cut-off values PGR ≤ 2 and PG I ≤30 ng/mL was 50,0%, specificity 90,9% and overall accuracy 90,4%. CONCLUSIONS The prevalence of gastric mucosal atrophy was low in the Kazakh population. Serological PG test screening nevertheless can play an important role in the diagnosis of gastric precancerous lesions. However, the diagnostic accuracy of the PG test is mainly dependent on the cut-off values for positive results.
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Affiliation(s)
- Linda Mezmale
- Institute of Clinical and Preventive Medicine,
- Faculty of Medicine, University of Latvia,
| | - Sergejs Isajevs
- Institute of Clinical and Preventive Medicine,
- Academic Histology Laboratory,
| | - Inga Bogdanova
- Institute of Clinical and Preventive Medicine,
- Academic Histology Laboratory,
| | | | | | | | - Aiga Rudule
- Institute of Clinical and Preventive Medicine,
| | - Ilze Kikuste
- Institute of Clinical and Preventive Medicine,
- Faculty of Medicine, University of Latvia,
- Digestive Disease Centre GASTRO, Riga, Latvia,
| | | | | | | | | | | | - Nurbek Igissinov
- Astana Medical University,
- Central Asian Cancer Institute, Nur-Sultan, Kazakhstan,
- International High School of Medicine,
- Eurasian Institute For Cancer Research, Bishkek, Kyrgyzstan,
| | - Jin Young Park
- Prevention and Implementation Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France.
| | - Rolando Herrero
- Prevention and Implementation Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France.
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine,
- Faculty of Medicine, University of Latvia,
- Digestive Disease Centre GASTRO, Riga, Latvia,
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27
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Lahner E, Zagari RM, Zullo A, Di Sabatino A, Meggio A, Cesaro P, Lenti MV, Annibale B, Corazza GR. Chronic atrophic gastritis: Natural history, diagnosis and therapeutic management. A position paper by the Italian Society of Hospital Gastroenterologists and Digestive Endoscopists [AIGO], the Italian Society of Digestive Endoscopy [SIED], the Italian Society of Gastroenterology [SIGE], and the Italian Society of Internal Medicine [SIMI]. Dig Liver Dis 2019; 51:1621-1632. [PMID: 31635944 DOI: 10.1016/j.dld.2019.09.016] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/03/2019] [Accepted: 09/23/2019] [Indexed: 02/08/2023]
Abstract
Chronic atrophic gastritis (CAG) is an underdiagnosed condition characterised by translational features going beyond the strict field of gastroenterology as it may manifest itself by a variable spectrum of gastric and extra-gastric symptoms and signs. It is relatively common among older adults in different parts of the world, but large variations exist. Helicobacter pylori-related CAG [multifocal] and autoimmune CAG (corpus-restricted) are apparently two different diseases, but they display overlapping features. Patients with cobalamin and/or iron deficiency anaemia or autoimmune disorders, including autoimmune thyroiditis and type 1 diabetes mellitus, should be offered screening for CAG. Pepsinogens, gastrin-17, and anti-H. pylori antibodies serum assays seem to be reliable non-invasive screening tools for the presence of CAG, helpful to identify individuals to refer to gastroscopy with five standard gastric biopsies in order to obtain histological confirmation of diagnosis. Patients with CAG are at increased risk of developing gastric cancer, and they should be estimated with histological staging systems (OLGA or OLGIM). H. pylori eradication may be beneficial by modifying the natural history of atrophy, but not that of intestinal metaplasia. Patients with advanced stages of CAG (Stage III/IV OLGA or OLGIM) should undergo endoscopic surveillance every three years, those with autoimmune CAG every three-five years. In patients with CAG, a screening for autoimmune thyroid disease and micronutrient deficiencies, including iron and vitamin B12, should be performed. The optimal treatment for dyspeptic symptoms in patients with CAG remains to be defined. Proton pump inhibitors are not indicated in hypochlorhydric CAG patients.
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Affiliation(s)
- Edith Lahner
- Department of Surgical-Medical Sciences and Translational Medicine, Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | | | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Alberto Meggio
- Department of Gastroenterology, Trento and Rovereto Hospital, Trento, Italy
| | - Paola Cesaro
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Bruno Annibale
- Department of Surgical-Medical Sciences and Translational Medicine, Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gino Roberto Corazza
- First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
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Bang CS, Lee JJ, Baik GH. Prediction of Chronic Atrophic Gastritis and Gastric Neoplasms by Serum Pepsinogen Assay: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy. J Clin Med 2019; 8:jcm8050657. [PMID: 31083485 PMCID: PMC6572271 DOI: 10.3390/jcm8050657] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 12/16/2022] Open
Abstract
Serum pepsinogen assay (sPGA), which reveals serum pepsinogen (PG) I concentration and the PG I/PG II ratio, is a non-invasive test for predicting chronic atrophic gastritis (CAG) and gastric neoplasms. Although various cut-off values have been suggested, PG I ≤70 ng/mL and a PG I/PG II ratio of ≤3 have been proposed. However, previous meta-analyses reported insufficient systematic reviews and only pooled outcomes, which cannot determine the diagnostic validity of sPGA with a cut-off value of PG I ≤70 ng/mL and/or PG I/PG II ratio ≤3. We searched the core databases (MEDLINE, Cochrane Library, and Embase) from their inception to April 2018. Fourteen and 43 studies were identified and analyzed for the diagnostic performance in CAG and gastric neoplasms, respectively. Values for sensitivity, specificity, diagnostic odds ratio, and area under the curve with a cut-off value of PG I ≤70 ng/mL and PG I/PG II ratio ≤3 to diagnose CAG were 0.59, 0.89, 12, and 0.81, respectively and for diagnosis of gastric cancer (GC) these values were 0.59, 0.73, 4, and 0.7, respectively. Methodological quality and ethnicity of enrolled studies were found to be the reason for the heterogeneity in CAG diagnosis. Considering the high specificity, non-invasiveness, and easily interpretable characteristics, sPGA has potential for screening of CAG or GC.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Sakju-ro 77, Chuncheon, Gangwon-do 24253, Korea.
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea.
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24253, Korea.
| | - Jae Jun Lee
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea.
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon 24253, Korea.
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Sakju-ro 77, Chuncheon, Gangwon-do 24253, Korea.
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24253, Korea.
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Sex differences in the prevalence of Helicobacter pylori infection: an individual participant data pooled analysis (StoP Project). Eur J Gastroenterol Hepatol 2019; 31:593-598. [PMID: 30839435 DOI: 10.1097/meg.0000000000001389] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Helicobacter pylori (H. pylori) infection is more frequent among men, though the magnitude of the association might be inaccurate due to potential misclassification of lifetime infection and publication bias. Moreover, infection is common, and most studies are cross-sectional. Thus, prevalence ratios (PRs) may be easier to interpret than odds ratios (ORs). AIM The aim of this study was to quantify the association between sex and H. pylori infection using controls from 14 studies from the Stomach Cancer Pooling (StoP) Project. PARTICIPANTS AND METHODS H. pylori infection was defined based on IgG serum antibody titers or multiplex serology. Participants were also classified as infected if gastric atrophy was present, based on histological examination or serum pepsinogen (PG) levels (PG I≤70 and PG I/II ratio≤3). Summary ORs and PRs, adjusted for age, social class and smoking, and corresponding 95% confidence intervals (CIs), were estimated through random-effects meta-analysis. RESULTS Men had significantly higher OR (OR: 1.33, 95% CI: 1.04-1.70) and PR (PR: 1.05, 95% CI: 1.00-1.10) of infection, with stronger associations among hospital-based or older controls. Results were similar when considering the presence of gastric atrophy to define infection status, particularly among participants older than 65 years. CONCLUSION This collaborative pooled-analysis supports an independent effect of sex on the prevalence of H. pylori infection, while minimizing misclassification of lifetime infection status and publication bias.
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Abstract
Serum pepsinogen can reflect the functional status of the gastric mucosa. The pathological changes of the gastric mucosa include chronic gastritis, gastric ulcer, atrophic gastritis, and gastric cancer, and the relationship between serum pepsinogen and gastric cancer/atrophic gastritis is the most prominent. Since the detection of serum pepsinogen is simple, inexpensive, time-saving, highly sensitive, and highly specific, it has attracted great attention from scholars and is regarded as "serological biopsy". In this paper, we discuss the value of serum pepsinogen in the diagnosis of gastric diseases.
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Affiliation(s)
- Jian Gan
- Department of Gastroenterology, Heji Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
| | - Rong-Gui Cheng
- Department of Gastroenterology, Heji Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
| | - Shao-Feng Wang
- Department of Gastroenterology, Changzhi People's Hospital, Changzhi 046000, Shanxi Province, China
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Epplein M, Butt J, Zhang Y, Hendrix LH, Abnet CC, Murphy G, Zheng W, Shu XO, Tsugane S, Qiao YL, Taylor PR, Shimazu T, Yoo KY, Park SK, Kim J, Jee SH, Waterboer T, Pawlita M, You WC, Pan KF. Validation of a Blood Biomarker for Identification of Individuals at High Risk for Gastric Cancer. Cancer Epidemiol Biomarkers Prev 2018; 27:1472-1479. [PMID: 30158280 DOI: 10.1158/1055-9965.epi-18-0582] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/11/2018] [Accepted: 08/23/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Helicobacter pylori is the leading cause of gastric cancer, yet the majority of infected individuals will not develop neoplasia. Previously, we developed and replicated serologic H. pylori biomarkers for gastric cancer risk among prospective cohorts in East Asia and now seek to validate the performance of these biomarkers in identifying individuals with premalignant lesions. METHODS This cross-sectional study included 1,402 individuals from Linqu County screened by upper endoscopy. H. pylori protein-specific antibody levels were assessed using multiplex serology. Multivariable-adjusted logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for prevalent intestinal metaplasia, indefinite dysplasia, or dysplasia, compared with superficial or mild atrophic gastritis. RESULTS Compared with individuals seronegative to Omp and HP0305, individuals seropositive to both were seven times more likely to have precancerous lesions (OR, 7.43; 95% CI, 5.59-9.88). A classification model for precancerous lesions that includes age, smoking, and seropositivity to H. pylori, Omp, and HP0305 resulted in an area under the curve (AUC) of 0.751 (95% CI, 0.725-0.777), which is significantly better than the same model, including the established gastric cancer risk factor CagA (AUC, 0.718; 95% CI, 0.691-0.746, P difference = 0.0002). CONCLUSIONS The present study of prevalent precancerous gastric lesions provides support for two new serum biomarkers of gastric cancer risk, Omp and HP 0305. IMPACT Our results support further research into the serological biomarkers Omp and HP0305 as possible improvements over the established virulence marker CagA for identifying individuals with precancerous lesions in East Asia.
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Affiliation(s)
| | - Julia Butt
- German Cancer Research Center, Heidelberg, Germany
| | - Yang Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | | | | | - Gwen Murphy
- National Cancer Institute, Rockville, Maryland
| | - Wei Zheng
- Vanderbilt University, Nashville, Tennessee
| | | | | | - You-Lin Qiao
- Chinese Academy of Medical Sciences, Beijing, China
| | | | | | | | - Sue K Park
- Seoul National University, Seoul, Republic of Korea
| | - Jeongseon Kim
- National Cancer Center of Korea, Gyeonggi-do, Republic of Korea
| | - Sun Ha Jee
- Yonsei University, Seoul, Republic of Korea
| | | | | | - Wei-Cheng You
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Kai-Feng Pan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China.
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COELHO LGV, MARINHO JR, GENTA R, RIBEIRO LT, PASSOS MDCF, ZATERKA S, ASSUMPÇÃO PP, BARBOSA AJA, BARBUTI R, BRAGA LL, BREYER H, CARVALHAES A, CHINZON D, CURY M, DOMINGUES G, JORGE JL, MAGUILNIK I, MARINHO FP, MORAES-FILHO JPD, PARENTE JML, PAULA-E-SILVA CMD, PEDRAZZOLI-JÚNIOR J, RAMOS AFP, SEIDLER H, SPINELLI JN, ZIR JV. IVTH BRAZILIAN CONSENSUS CONFERENCE ON HELICOBACTER PYLORI INFECTION. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55:97-121. [DOI: 10.1590/s0004-2803.201800000-20] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 02/06/2023]
Abstract
ABSTRACT Significant progress has been obtained since the III Brazilian Consensus Conference on H. pylori infection held in 2012, in Bento Gonçalves, Brazil, and justify a fourth meeting to establish updated guidelines on the current management of H. pylori infection. Therefore, the Núcleo Brasileiro para Estudo do Helicobacter pylori e Microbiota (NBEHPM), association linked to Brazilian Federation of Gastroenterology (FBG) held its fourth meeting again in Bento Gonçalves, RS, Brazil, on August 25-27, 2017. Twenty-six delegates, including gastroenterologists, endoscopists, and pathologists from the five regions of Brazil as well as one international guest from the United States, participated in the meeting. The participants were invited based on their knowledge and contribution to the study of H. pylori infection. The meeting sought to review different aspects of treatment for infection; establish a correlation between infection, dyspepsia, intestinal microbiota changes, and other disorders with a special emphasis on gastric cancer; and reassess the epidemiological and diagnostic aspects of H. pylori infection. Participants were allocated into four groups as follows: 1) Epidemiology and Diagnosis, 2) Dyspepsia, intestinal microbiota and other afections, 3) Gastric Cancer, and, 4) Treatment. Before the consensus meeting, participants received a topic to be discussed and prepared a document containing a recent literature review and statements that should be discussed and eventually modified during the face-to-face meeting. All statements were evaluated in two rounds of voting. Initially, each participant discussed the document and statements with his group for possible modifications and voting. Subsequently, during a second voting in a plenary session in the presence of all participants, the statements were voted upon and eventually modified. The participants could vote using five alternatives: 1) strongly agree; 2) partially agree; 3) undecided; 4) disagree; and 5) strongly disagree. The adopted consensus index was that 80% of the participants responded that they strongly or partially agreed with each statement. The recommendations reported are intended to provide the most current and relevant evidences to management of H. pylori infection in adult population in Brazil.
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Graham DY. Letter: questions regarding the diagnostic performance of serum assays for atrophic gastritis. Aliment Pharmacol Ther 2017; 46:1117-1118. [PMID: 29105138 PMCID: PMC6905080 DOI: 10.1111/apt.14339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- D Y Graham
- Department of Medicine, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
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Leja M, Park JY, Murillo R, Liepniece-Karele I, Isajevs S, Kikuste I, Rudzite D, Krike P, Parshutin S, Polaka I, Kirsners A, Santare D, Folkmanis V, Daugule I, Plummer M, Herrero R. Multicentric randomised study of Helicobacter pylori eradication and pepsinogen testing for prevention of gastric cancer mortality: the GISTAR study. BMJ Open 2017; 7:e016999. [PMID: 28801429 PMCID: PMC5724070 DOI: 10.1136/bmjopen-2017-016999] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/14/2017] [Accepted: 06/21/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Population-based eradication of Helicobacter pylori has been suggested to be cost-effective and is recommended by international guidelines. However, the potential adverse effects of widespread antibiotic use that this would entail have not been sufficiently studied. An alternative way to decrease gastric cancer mortality is by non-invasive search for precancerous lesions, in particular gastric atrophy; pepsinogen tests are the best currently available alternative. The primary objective of GISTAR is to determine whether H pylori eradication combined with pepsinogen testing reduces mortality from gastric cancer among 40-64-year-old individuals. The secondary objectives include evaluation of H pylori eradication effectiveness in gastric cancer prevention in patients with precancerous lesions and evaluation of the potential adverse events, including effects on microbiome. METHODS AND ANALYSIS Individuals are recruited from general population (50% men) in areas with high gastric cancer risk in Europe and undergo detailed lifestyle and medical history questionnaire before being randomly allocated to intervention or control groups. The intervention group undergoes H pylori testing and is offered eradication therapy if positive; in addition, pepsinogen levels are detected in plasma and those with decreased levels are referred for upper endoscopy. All participants are offered faecal occult blood testing as an incentive for study participation. Effectiveness of eradication and the spectrum of adverse events are evaluated in study subpopulations. A 35% difference in gastric cancer mortality between the groups is expected to be detectable at 90% power after 15 years if 30 000 individuals are recruited. Biological materials are biobanked for the main and ancillary studies. The study procedure and assumptions will be tested during the pilot phase. ETHICS AND DISSEMINATION The study was approved by the respective ethics committees. An independent Data Safety and Monitoring Board has been established. The findings will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER NCT02047994.
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Affiliation(s)
- Marcis Leja
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
- Department of Research, Riga East University Hospital, Riga, Latvia
- Digestive Diseases Centre GASTRO, Riga, Latvia
| | - Jin Young Park
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Raul Murillo
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Inta Liepniece-Karele
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
- Department of Research, Riga East University Hospital, Riga, Latvia
- Academic Histology Laboratory, Riga, Latvia
| | - Sergejs Isajevs
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
- Department of Research, Riga East University Hospital, Riga, Latvia
- Academic Histology Laboratory, Riga, Latvia
| | - Ilze Kikuste
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
- Digestive Diseases Centre GASTRO, Riga, Latvia
| | - Dace Rudzite
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
- Department of Research, Riga East University Hospital, Riga, Latvia
| | - Petra Krike
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Sergei Parshutin
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
- Institute of Information Technology, Riga Technical University, Riga, Latvia
| | - Inese Polaka
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
- Institute of Information Technology, Riga Technical University, Riga, Latvia
| | - Arnis Kirsners
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
- Institute of Information Technology, Riga Technical University, Riga, Latvia
| | - Daiga Santare
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
- Department of Research, Riga East University Hospital, Riga, Latvia
| | - Valdis Folkmanis
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Ilva Daugule
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Martyn Plummer
- Infection and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
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