Usefulness of Serum Pepsinogen I as a Biomarker in Early Diagnosis of Aetiology of Dyspepsia

BACKGROUND

Dyspepsia, according to Rome III criteria, is defined as pain or discomfort centred in the upper abdomen in addition to symptoms like early satiety, postprandial fullness, bloating and nausea. Pepsinogens which are secreted by chief cells of the stomach play an important role in its physiology. They could determine the functional state of the mucosa in health and in diseased conditions. Serum levels of pepsinogen have aided the diagnosis of gastric pathologies such as atrophic gastritis, peptic ulcer disease and gastric cancer. Pepsinogen assay, being a simple, non-invasive procedure, can aid in determining the aetiology of dyspepsia especially in a resource poor setting.

OBJECTIVE

This was to evaluate the diagnostic significance of serum pepsinogen I in patients with dyspepsia.

METHODS

The study involved 112 adult patients with dyspepsia and an equal number of controls. A questionnaire was used to obtain biodata, clinical features and other relevant information. The patients had abdominal ultrasound scan, urea breath test and upper gastrointestinal endoscopy (UGIE), while the controls had only abdominal ultrasound scan. Sera prepared from 10ml of venous blood from each participant were stored at -20ºC and later analysed for pepsinogen I (PG I).

RESULTS

Females predominated in both groups (F:M = 1.4:1). The mean age of cases was 51±15.9 years and was similar to that of controls 51.4±16.5. The most frequent symptom was epigastric pain in 101 (90.2%) patients. Median pepsinogen I level in patients (28.5ng/ml) was significantly lower than in controls (68.8ng/ml) (p<0.001). The most frequent endoscopic finding was gastritis. Serum PG I level at a cut-off point of 79.5ng/ml had a specificity of 88.8% and sensitivity of 40% in identifying dysplasia.

CONCLUSION

Serum PG I level was lower in patients with dyspepsia than controls. It showed high specificity in identifying dysplasia and could be a biomarker for early gastric cancer.

Protein C Deficiency in a Patient with Anomalous Hemiazygous Vein and Portal Vein Thrombosis

Protein C deficiency increases the risk of an individual to develop thromboembolism and its complications. Clinical presentation of the complication of thrombosis in an unusual site may becloud clinical judgment resulting in missed diagnosis. We present an unusual case of protein C deficiency presenting with symptoms referable to the gastrointestinal system. A 34-year-old male with recurrent abdominal discomfort and bloating, managed as a case of gastro-oesophageal reflux disease with poor clinical outcome. Physical examination was unremarkable. Upper gastrointestinal endoscopy showed varices. Abdominal ultrasound scan and CT scan of the abdomen revealed thrombus in the portal vein. Functional assays of protein C and S revealed reduce protein C activity at 65 % (70 - 140%). This case emphasizes the need for extensive investigations in patients with common, sometimes neglected abdominal symptom such as bloating. It has also contributed in expanding the differential diagnosis of bloating and manifestations of protein C deficiency.

Adventitious roots, leaf abscission and nutrient status of flooded Gmelina and Tectona seedlings

When flooded, seedlings of Gmelina arborea Roxb. produced more adventitious roots, had lower foliar Mn concentrations and lost fewer leaves than seedlings of Tectona grandis L.f. Severing the adventitious roots produced by flooded Gmelina seedlings increased leaf Mn concentration and leaf abscission and reduced whole-plant dry matter production. Flooded Gmelina cuttings, which do not produce adventitious roots, abscised few leaves until foliar concentrations of Mn and Fe had risen substantially above those of unflooded cuttings, at which time most leaves were shed. The results indicate that the development of adventitious roots in flooded seedlings of Gmelina suppressed uptake of Mn thereby minimizing leaf abscission.

Comparison of the responses to flooding of seedlings and cuttings of Gmelina

The effects of flooding on Gmelina arborea Roxb. seedlings and cuttings of the same parent stock were compared to determine their suitability as transplanting stock. Flooding caused reductions in stomatal conductance, xylem pressure potential and dry matter accumulation in both groups of plants. In seedlings, flooding induced formation of hypertrophied lenticels, stem hypertrophy and production of short, thick, adventitious roots in seedlings, whereas in cuttings, only thin roots and numerous smaller lenticels were induced. For 8 days after the flooding treatment ended, the flooded seedlings grew faster than control seedlings, whereas in cuttings, post-flooding growth was similar to that of control plants. It is suggested that seedlings may perform better than cuttings in very wet or saturated soil.