The prediction model of operative link on gastric intestinal metaplasia stage III-IV: A multicenter study

Purpose

Intestinal metaplasia plays a crucial role in the risk stratification of gastric cancer development. The objective of the study was to develop a prediction model for Operative Link on Gastric Intestinal Metaplasia (OLGIM) Stage III-IV.

Methods

We analyzed 7945 high-risk gastric cancer individuals from 115 hospitals who underwent questionnaires and gastroscope. The participants were assigned to either the development or validation cohort randomly. Demographics and clinical characteristics were obtained. The outcome measurement was OLGIM III-IV. Univariate logistic regression was used for feature selection and multivariate logistic analysis was performed to develop the nomogram. Area under the curves, calibration plots, decision curve and clinical impact analysis were used to assess the performance of the nomogram.

Results

4600 individuals and 3345 individuals were included in the development and validation cohort, of which 124 and 86 individuals were diagnosed with OLGIM III-IV, respectively. Parameters in the training validation cohort matched well and there was no significant difference between two cohorts. A nomogram model for predicting OLGIM Stage III-IV consisted of 4 significantly associated variables, including age, gender, PG I and G-17 (AUC 0.723 and 0.700 for the 2 cohorts). The nomogram demonstrated excellent performance in the calibration curve. Decision curve and clinical impact analysis suggested clinical benefit of the prediction model.

Conclusions

This reliable individualized nomogram might contribute to more accurate management for patients with OLGIM III-IV. Therefore, we suggest that this study be used as an incentive to promote the application.

Prediction of canceration of gastric ulcer with serum pepsinogen Ⅰ/Ⅱ ratio and gastrin-17

BACKGROUND

Screening sensitivity markers for canceration of gastric ulcer is of great significance for the prevention and treatment of gastric cancer. Previous studies have suggested that pepsinogen and gastrin-17 (G-17) may have appreciated value in the prediction of early gastric cancer, but there is still no definitive consensus on this.

AIM

To assess the clinical value of serum pepsinogen I (PGⅠ)/pepsinogen Ⅱ (PGⅡ) ratio combined with G-17 in predicting canceration of gastric ulcer to provide sensitive biochemical markers for early diagnosis of gastric cancer.

METHODS

A retrospective analysis was conducted on 215 patients with gastric ulcer at our hospital from July 2020 to April 2023. According to the histopathological diagnosis by gastroscopy, the patients were divided into either a simple ulcer group (184 cases) or a gastric cancer group (31 cases). Serum PGⅠ, PGⅡ, G-17, and tumor markers [including carbohydrate antigen (CA)724, CA199, carcinoembryonic antigen (CEA), and ferritin] were detected on admission. The delta over baseline (DOB) value of Helicobacter pylori (H. pylori) infection was measured by the ¹³C breath test.

RESULTS

There were no differences in gender, age, DOB value, or disease course between the two groups (P > 0.05). Compared with the simple ulcer group, serum levels of PGⅡ, G-17, CA724, CA199, and CEA in the gastric cancer group were increased, while PGⅠ, ferritin, and PGⅠ/PGⅡ ratio were decreased (P < 0.05). Spearman test showed that PGⅠ/PGⅡ ratio was negatively correlated with G-17, CA724, CA199, and CEA, and positively correlated with ferritin (P < 0.05). G-17 was positively correlated with CA724, CA199, and CEA, and negatively correlated with ferritin (P < 0.05). Receiver operating curve (ROC) analysis showed that the area under the ROC curve (AUC) of PGⅠ/PGⅡ ratio and G-17 for diagnosing canceration of gastric ulcer was 0.804 and 0.742, respectively. The AUC of PGⅠ/PGⅡ ratio combined with G-17 was 0.899, significantly higher than that of either indicator alone (P < 0.05).

CONCLUSION

The decrease of serum PGⅠ/PGⅡ ratio and increase of G-17 are closely related to the canceration of gastric ulcer. The combination of PGⅠ/PGⅡ ratio and G-17 has good predictive performance for canceration of gastric ulcer. PGⅠ/PGⅡ ratio and G-17 can serve as sensitive biomarkers for the early diagnosis of gastric cancer.

Development and validation of LightGBM algorithm for optimizing of Helicobacter pylori antibody during the minimum living guarantee crowd based gastric cancer screening program in Taizhou, China

Gastric cancer continues to be a significant health concern in China, with a high incidence rate. To mitigate its impact, early detection and treatment is key. However, conducting large-scale endoscopic gastric cancer screening is not feasible in China. Instead, a more appropriate approach would be to initially screen high-risk groups and follow up with endoscopic testing as needed. We conducted a study on 25,622 asymptomatic participants aged 45-70 years from a free gastric cancer screening program in the Taizhou city government's Minimum Living Guarantee Crowd (MLGC) initiative. Participants completed questionnaires, blood tests, and underwent gastrin-17 (G-17), pepsinogen I and II (PGI and PGII), and H. pylori IgG antibody (IgG) assessments. Using the light gradient boosting machine (lightGBM) algorithm, we developed a predictive model for gastric cancer risk. In the full model, F1 score was 2.66%, precision was 1.36%, and recall was 58.14%. In the high-risk model, F1 score was 2.51%, precision was 1.27%, and recall was 94.55%. Excluding IgG, the F1 score was 2.73%, precision was 1.40%, and recall was 68.62%. We conclude that H. pylori IgG appears to be able to be excluded from the prediction model without significantly affecting its performance, which is important from a health economic point of view. It suggests that screening indicators can be optimized, and expenditures reduced. These findings can have important implications for policymakers, as we can focus resources on other important aspects of gastric cancer prevention and control.

Development of amplified luminescent proximity homogeneous assay for quantitation of gastrin-17

A highly sensitive and convenient amplified luminescent proximity homogeneous assay (AlphaLISA) method with high throughput and automation potential was developed for quantitation of serum Gastrin-17 (G-17) levels, which can facilitate the early diagnosis of atrophic gastritis in people at high risk of gastric cancer using a non-invasive approach. In this study, donor and acceptor beads with modified carboxyl groups on the surface were directly coupled to anti-G-17 antibodies through activation was proposed for application in the development of the new AlphaLISA, which can effectively simplify the steps and shorten the reaction time to achieve faster detection. Therefore, the G-17-AlphaLISA only needs to react for 15 min to obtain good analysis results. The proposed method has a wider detection range than commercial enzyme-linked immunosorbent assay (ELISA) kits (0.12-112.8 pmol/L > 0.5-40 pmol/L). In addition, results of G-17-AlphaLISA and ELISA had good correlation and agreement (ρ = 0.936). Importantly, the developed method may be more suitable for the large-scale screening of people at high risk for gastric cancer than traditional ELISA and provides a novel solution for other biomarkers that require accurate, highly sensitive, and high throughput detection.

Value of Serological Biomarker Panel in Diagnosis of Atrophic Gastritis and Helicobacter pylori Infection

Background: Gastric cancer is one of the most common types of cancer worldwide. Helicobacter pylori infection is clearly correlated with gastric carcinogenesis. Therefore, the use of a new non-invasive test, known as the GastroPanel test, can be very helpful to identify patients at a high risk, including those with atrophic gastritis, intestinal metaplasia, and dysplasia. This study aimed to compare the results of GastroPanel test with the pathological findings of patients with gastric atrophy to find a safe and simple alternative for endoscopy and biopsy as invasive methods. Methods: This cross-sectional study was performed on patients with indigestion, who were referred to Motahari Clinic and Shahid Faghihi Hospital of Shiraz, Iran, since April 2017 until August 2017 for endoscopy of the upper gastrointestinal tract. The serum levels of gastrin-17 (G17), pepsinogen I (PGI), and pepsinogen II (PGII), as well as H. pylori antibody IgG, were determined by ELISA assays. Two biopsy specimens from the antrum and gastric body were taken for standard histological analyses and rapid urease test. A pathologist examined the biopsy specimens of patients blindly. Results: A total of 153 patients with indigestion (62.7% female; mean age, 63.7 years; 37.3% male; mean age, 64.9 years) were included in this study. The G17 levels significantly increased in patients with chronic atrophic gastritis (CAG) of the body (9.7 vs. 32.8 pmol/L; P = 0.04) and reduced in patients with antral CAG (1.8 vs. 29.1 pmol/L; P = 0.01). The results were acceptable for all three types of CAG, including the antral, body, and multifocal CAG (AUCs of 97%, 91%, and 88% for body, antral, and multifocal CAG, respectively). The difference in PGII level was not significant. Also, the PGI and PGI/PGII ratio did not show a significant difference (unacceptably low AUCs for all). The H. pylori antibody levels were higher in patients infected with H. pylori (251 EIU vs. 109 EIU, AUC = 70, P = 0.01). There was a significant relationship between antibody tests and histopathology. Conclusion: Contrary to Biohit's claims, the GastroPanel kit is not accurate enough to detect CAG; therefore, it cannot be used for establishing a clinical diagnosis.

Value of gastrin-17, RHBDD1, and Helicobacter pylori IgG antibody in diagnosis of gastric cancer and their relationship with tumor infiltration

BACKGROUND

The occurrence of gastric cancer is a multi-step process involving many factors. Gastrin-17 (G-17), rhomboid domain-containing protein 1 (RHBDD1), and Helicobacter pylori (H. pylori) infection play an important role in the development of gastric cancer and may be used as markers for gastric cancer screening and disease assessment.

AIM

To assess the value of serum G-17, RHBDD1, and H. pylori IgG antibody (H. pylori-IgG) in the screening of gastric cancer and precancerous lesions and to analyze their relationship with the depth of tumor infiltration.

METHODS

Eighty-five gastric cancer patients treated at our hospital from January 2021 to January 2022 were selected as a study group, and 85 patients with gastric precancerous lesions in the same period were selected as a control group according to the 1:1 matched case-control principle. The general data, serum G-17 and RHBDD1 levels, and H. pylori-IgG positive rate were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the value of serum G-17 and RHBDD1 levels and H. pylori-IgG positive rate in diagnosing gastric cancer. Serum G-17 and RHBDD1 levels and H. pylori-IgG positive rate were compared in gastric cancer patients with different tumor infiltration depth, and their correlation with and impact on tumor infiltration depth were analyzed using Spearman's correlation coefficient.

RESULTS

Serum G-17 and RHBDD1 levels and H. pylori-IgG positive rate in the study group were significantly higher than those in the control group (P < 0.05). The area under the curve (AUC) of the three indexes combined in the diagnosis of gastric cancer was 0.915. Serum G-17 and RHBDD1 levels and H. pylori-IgG positive rate increased with the increase in the depth of tumor infiltration in gastric cancer patients (P < 0.05), and they were positively correlated with the depth of tumor infiltration (P < 0.05). These three indexes and infiltration depth showed a positive interaction in a sub-phase multiplicative model (P < 0.05).

CONCLUSION

Combined detection of serum G-17 and RHBDD1 and H. pylori-IgG antibody can help to improve the screening of gastric cancer and precancerous lesions, and these indexes are involved in and positively correlated with gastric cancer tumor infiltration.

The relationship of serum gastrin-17 and oral mucositis in head and neck carcinoma patients receiving radiotherapy

OBJECTIVE

The aim of this study was to analyze the relationship of serum gastrin-17 (G-17) and oral mucositis in head and neck carcinoma (HNC) patients receiving radiotherapy.

METHODS

Serum G-17 were detected in patients before and after radiotherapy. Patients were divided into high G-17 group (baseline serum G-17 ≥ 5pmol/L) and low G-17 group (baseline serum G-17 < 5pmol/L). The severity of oral mucositis was analyzed between the two groups. Other complications such as dysphagia, salivary gland, mandible, thyroid function, larynx, pain, and weight loss were also investigated.

RESULTS

Forty-two patients were analyzed in this study. The level of serum G-17 had a significant decrease after radiotherapy (7.29 ± 5.70pmol/L versus 4.93 ± 4.46pmol/L, P = 0.038). In low serum G-17 group, the incidences of grade 0, 1-2 and 3-4 of oral mucositis were 0%, 30.4%, and 69.6%, respectively. In high serum G-17 group, the incidences of grade 0, 1-2 and 3-4 of oral mucositis were 0%, 63.2%, and 36.8%, respectively. Pearson correlation analysis showed that serum G-17 was negatively correlated with oral mucositis (r=-0.595, P < 0.01). Weight loss of low G-17 group was more serious than that of high G-17 group.

CONCLUSION

Serum G-17 has a close relationship with oral mucositis. Baseline serum G-17 may be a potential predictor for the severity of oral mucositis in HNC patients receiving radiotherapy.

Value of serum G-17, PGⅠ, PGⅡ, Hp-IgG in the screening of gastric cancer and precancerous lesions and its relationship with the depth of tumor invasion

BACKGROUND

Screening for gastric cancer is an effective method for early diagnosis of gastric cancer. Studies at home and abroad have found significant differences in serum gastrin-17, pepsinogen Ⅰ, Ⅱ and Helicobacter pylori (H. pylori) IgG (Hp-IgG) antibody levels between patients with gastric cancer and precancerous lesions. It is speculated that screening can be used in the diagnosis and evaluation of gastric cancer.

AIM

To explore the screening of gastric cancer and precancerous lesions by serum gastrin-17 (G-17), pepsinogen (PG) I, PG II, Hp-IgG antibody levels value and its relationship with the depth of tumor invasion.

METHODS

From August 2019 to March 2021, 90 patients with gastric cancer in our hospital were selected as the research group, 90 patients with gastric precancerous lesions during the same period were selected as the control group A, and 90 healthy subjects were selected as the control group B. Compare 3 groups of general information, serum G-17, PG Ⅰ, PG Ⅱ levels, Hp-IgG positive rate, compare serum G-17, PG Ⅰ, PG Ⅱ levels of Hp-IgG positive and negative patients, and analyze serum G-17, PG Ⅰ, PG Ⅱ The relationship between the level and Hp-IgG positive, analyze the value of each index in the diagnosis of gastric cancer and the relationship with the depth of gastric cancer tumor invasion.

RESULTS

Serum G-17, PGII levels and Hp-IgG positive rate in the study group were all > control group A > control group B, serum PG Ⅰ level < control group A < control group B (P < 0.05); the serum G-17 and PGⅡ levels of Hp-IgG positive patients in the study group Both were higher than in negative patients, and serum PG Ⅰ levels were lower than in negative patients (P < 0.05); serum G-17 and PG Ⅱ levels were positively correlated with Hp-IgG positive, and serum PG Ⅰ was negatively correlated with Hp-IgG positive (P < 0.05); The area under curve (AUC) of serum G-17, PG Ⅰ, PG Ⅱ, and Hp-IgG positive diagnosis of gastric cancer were 0.828, 0.845, 0.821, 0.650, respectively. The combined diagnosis of each index had the largest AUC, which was 0.887. The best diagnostic sensitivity and specificity The levels were 80.03% and 84.46%, respectively; serum G-17, PG Ⅱ levels, and Hp-IgG positive rates gradually increased with the increase of gastric cancer tumor invasion depth, and serum PG Ⅰ levels gradually decreased with the increase of gastric cancer tumor invasion depth (P < 0.05); The depth of gastric cancer tumor invasion was positively correlated with serum G-17, PG Ⅱ, Hp-IgG positive, and negatively correlated with serum PG Ⅰ (P < 0.05).

CONCLUSION

Serum levels of G-17, PG Ⅰ, PG Ⅱ, and Hp-IgG have certain diagnostic value in the screening of gastric cancer and precancerous lesions, and are closely related to the depth of gastric cancer tumor invasion.

Performance evaluation of four prediction models for risk stratification in gastric cancer screening among a high-risk population in China

OBJECTIVE

Early detection of gastric cancer (GC) is a critical step for decreasing mortality. The aim of this study was to evaluate the performance of four prediction models for risk stratification in the screening of GC and precancerous lesions among a large, high-risk population in China.

DESIGN

This study was a retrospective analysis of data from the Provincial Gastric Cancer Screening Program (Zhejiang, China) spanning the period between October 2016 and April 2019, in which 97,541 individuals from the urban areas of 10 cities in Zhejiang province, China participated in this program. Demographic and clinical characteristics data were collected, and serum pepsinogens I and II, gastrin-17, and anti-H. pylori IgG antibody were detected. Participants were asked to voluntarily undergo gastroscopy. The performance of the ABC method, new ABC method, Tu's prediction model, and Li's prediction model, which stratified participants into low-, medium- and high-risk subgroups, were evaluated using the area under the receiver-operating characteristic (ROC) curve (AUC) and Youden index.

RESULTS

Among the participants, 6005 (3447 males and 2558 females, mean age of 58.35 years), voluntarily underwent gastroscopy. Overall, 72 (1.20%) GC cases (30 early and 42 advanced) and 2006 cases with precancerous lesions (270 atrophic gastritis, 1634 intestinal metaplasia, and 102 dysplasia/intraepithelial neoplasia) were identified. Notably, Li's prediction model achieved the greatest AUC and Youden index values (0.708 and 0.319, respectively) for predicting GC, and exhibited the greatest ability to detect precancerous lesions, especially intestinal metaplasia.

CONCLUSION

Li's prediction model performs the best for risk stratification in the screening, detection, and diagnosis of GC and precancerous lesions, whereas the overall performance of the other three models is similar ( www.chictr.org.cn , ChiCTR2100043363).

Relationship of delta over baseline with serum levels of gastrin 17, interleukin-32, and soluble interleukin 2 receptor and gastroscopic pathological changes in patients with chronic atrophic gastritis and Helicobacter pylori infection

BACKGROUND

Helicobacter pylori (H. pylori) is a recognized causative factor of gastric cancer. The diagnosis and treatment of chronic atrophic gastritis (CAG) and H. pylori infection have always been the focus of clinical research.

AIM

To investigate the relationship of the delta over baseline (DOB) and serum gastrin 17 (G-17), interleukin-32 (IL-32), soluble interleukin 2 receptor (sIL-2R) levels and gastroscopic pathological changes in patients with CAG and H. pylori infection.

METHODS

A total of 224 CAG patients at the Physical Examination Center of Wenzhou Central Hospital from January 2017 to December 2019 were selected as the research subjects, including 124 patients with H. pylori infection as an observation group, and 100 patients without H. pylori infection as a control group. The clinical data, DOB, and serum levels of G-17, IL-32, and sIL-2R in the two groups were compared. Logistic regression analysis was used to identify the influencing factors of CAG and H. pylori infection, and the correlation of DOB with serum G-17, IL-32, and sIL-2R was analyzed. The levels of DOB and serum G-17, IL-32, and sIL-2R in patients with different gastroscopic pathological changes were compared, and ROC curves were drawn to evaluate the value of DOB, G-17, IL-32, and sIL-2R in assessing CAG and H. pylori infection.

RESULTS

There were statistically significant differences in the course of disease and gastroscopic pathological changes (chronic inflammation, atrophy, intestinal metaplasia, and intraepithelial neoplasia) between the two groups (P < 0.05). The DOB and serum levels of IL-32 and sIL-2R were significantly higher and serum G-17 level was significantly lower in the observation group than in the control group (P < 0.05). Logistic regression analysis showed that the course of disease, chronic inflammation, atrophy, intestinal metaplasia, intraepithelial neoplasia, DOB, and serum G-17, IL-32, and sIL-2R levels were all influencing factors of CAG and H. pylori infection (P < 0.05). Pearson correlation analysis showed that the DOB of patients with CAG and H. pylori infection was negatively correlated with G-17, and positively correlated with IL-32 and sIL-2R (P < 0.05). Spearman correlation analysis showed that the DOB and serum levels of G-17, IL-32, and sIL-2R in patients with CAG and H. pylori infection were significantly related to chronic inflammation, atrophy, intestinal metaplasia, and intraepithelial neoplasia (P < 0.05). ROC curve analysis showed that the area under the curve of combined DOB, G-17, IL-32, and sIL-2R was the largest (0.975), and the best sensitivity and specificity were 85.48% and 98.00%, respectively.

CONCLUSION

Serum levels of G-17, IL-32, and sIL-2R in patients with CAG and H. pylori infection are related to DOB. H. pylori infection may be involved in the occurrence and progression of gastric mucosal pathological changes in CAG patients by affecting the expression of G-17, IL-32, and sIL-2R. Combined detection of all the above indicators can effectively predict H. pylori infection, which is of great significance for clinical diagnosis and treatment.

Gastrin-17 induces gastric cancer cell epithelial-mesenchymal transition via the Wnt/β-catenin signaling pathway

Gastric cancer (GC) is one of the most common cancers, with most patients often succumbing to death as a result of tumor metastasis. Recent work has demonstrated that gastrin is closely associated with GC metastasis. However, the specific molecular mechanisms underlying this relationship remain to be unveiled. In this study, we assessed the impact of gastrin and the Wnt/β-catenin inhibitor XAV939 on the epithelial-mesenchymal transition (EMT) of the SGC-7901 and MKN45 GC cell lines, and we determined that gastrin-17 significantly decreased E-cadherin expression and upregulated the expression of Snail1 and N-cadherin in GC cells. In addition, gastrin 17 also significantly increased the expression of Wnt3α in a dose-dependent manner. Consistent with these results, gastrin-17 promoted GC cell invasion, proliferation, and migration in a dose-dependent fashion, and these effects were inhibited by XAV939. Together, these results indicated that gastrin-17 induced GC cell EMT, migration, and invasion via the Wnt/β-catenin signaling pathway, which suggests that this gastrin/Wnt/β-catenin signaling axis may represent a therapeutic target for the prevention of GC metastasis.

Type I and type II Helicobacter pylori infection status and their impact on gastrin and pepsinogen level in a gastric cancer prevalent area

BACKGROUND

Type I Helicobacter pylori (H. pylori) infection causes severe gastric inflammation and is a predisposing factor for gastric carcinogenesis. However, its infection status in stepwise gastric disease progression in this gastric cancer prevalent area has not been evaluated; it is also not known its impact on commonly used epidemiological gastric cancer risk markers such as gastrin-17 (G-17) and pepsinogens (PGs) during clinical practice.

AIM

To explore the prevalence of type I and type II H. pylori infection status and their impact on G-17 and PG levels in clinical practice.

METHODS

Thirty-five hundred and seventy-two hospital admitted patients with upper gastrointestinal symptoms were examined, and 523 patients were enrolled in this study. H. pylori infection was confirmed by both ¹³C-urea breath test and serological assay. Patients were divided into non-atrophic gastritis (NAG), non-atrophic gastritis with erosion (NAGE), chronic atrophic gastritis (CAG), peptic ulcers (PU) and gastric cancer (GC) groups. Their serological G-17, PG I and PG II values and PG I/PG II ratio were also measured.

RESULTS

A total H. pylori infection rate of 3572 examined patients was 75.9%, the infection rate of 523 enrolled patients was 76.9%, among which type I H. pylori infection accounted for 72.4% (291/402) and type II was 27.6%; 88.4% of GC patients were H. pylori positive, and 84.2% of them were type I infection, only 11.6% of GC patients were H. pylori negative. Infection rates of type I H. pylori in NAG, NAGE, CAG, PU and GC groups were 67.9%, 62.7%, 79.7%, 77.6% and 84.2%, respectively. H. pylori infection resulted in significantly higher G-17 and PG II values and decreased PG I/PG II ratio. Both types of H. pylori induced higher G-17 level, but type I strain infection resulted in an increased PG II level and decreased PG I/PG II ratio in NAG, NAGE and CAG groups over uninfected controls. Overall PG I levels showed no difference among all disease groups and in the presence or absence of H. pylori; in stratified analysis, its level was increased in GC and PU patients in H. pylori and type I H. pylori-positive groups.

CONCLUSION

Type I H. pylori infection is the major form of infection in this geographic region, and a very low percentage (11.6%) of GC patients are not infected by H. pylori. Both types of H. pylori induce an increase in G-17 level, while type I H. pylori is the major strain that affects PG I and PG IIs level and PG I/PG II ratio in stepwise chronic gastric disease. The data provide insights into H. pylori infection status and indicate the necessity and urgency for bacteria eradication and disease prevention in clinical practice.

Clinical significance of expression of serum gastrin-17, pepsinogen I, pepsinogen II, and homocysteine in evolution of gastric cancer

BACKGROUND

Abnormalities of multiple serum factors occur in the early stage of gastric cancer. Among them, serum gastrin-17 (G-17), pepsinogen I (PG I), pepsinogen II (PG II), and homocysteine (Hcy) have attracted wide attention. The combined detection of these four factors may be of important clinical significance for the diagnosis of early gastric cancer.

AIM

To detect the levels of serum G-17, PG I, PG II, and Hcy in early gastric cancer and analyze their clinical value in the diagnosis of early gastric cancer.

METHODS

The clinical data of 230 patients with suspected gastric cancer were retrospectively analyzed. According to the results of endoscopy and pathological diagnosis, the patients were divided into three groups: patients with benign gastric lesions (136 cases), those with early gastric cancer (53 cases), and those with advanced gastric cancer (41 cases). The clinical data of 118 healthy subjects were included as a healthy control group. The levels of serum G-17, PG I, PG II, and Hcy were compared between the four groups. The differences in possible factors between the gastric cancer and non-gastric cancer group were compared. Logistic regression analysis was used to analyze the risk factors for gastric cancer. The diagnostic value of serum G-17, PG I, PG II, and Hcy, alone or in combination, for early gastric cancer and advanced gastric cancer were assessed by receiver operating curve (ROC) analysis.

RESULTS

Serum G-17, PG II, and Hcy showed a decreasing trend from the advanced gastric cancer group to early gastric cancer group, benign gastric lesion group, and healthy control group (P < 0.05), while serum PG I showed an increasing trend (P < 0.05). The proportions of patients with intake of hot food and high-salt diet as well as serum levels of G-17, PG II, and Hcy in the gastric cancer group were significantly higher than those in the non-gastric cancer group (P < 0.05), while serum PG I was significantly lower than that in the non-gastric cancer group (P < 0.05). Logistic regression analysis confirmed that all of these were risk factors for gastric cancer. ROC analysis showed that the best cut-off points for serum G-17, PG I, PG II, and Hcy for the diagnosis of early gastric cancer were 13.46 pmol/L, 60.98 ng/mL, 27.56 ng/mL, and 23.01 μmol/L, respectively, and the corresponding areas under the curves (AUCs) were 0.71, 0.70, 0.71, and 0.78, respectively. The best cutoff points for serum G-17, PG I, PG II, and Hcy for the diagnosis of advanced gastric cancer were 18.53 pmol/L, 47.56 ng/mL, 28.41 ng/mL, and 27.63 μmol/L, respectively, and the corresponding AUCs were 0.71, 0.68, 0.73, and 0.75, respectively. The AUCs of combined detection of the four factors for the diagnosis of early gastric cancer and advanced gastric cancer were 0.83 and 0.80, respectively.

CONCLUSION

Serum G-17, PG II, and Hcy show abnormally high expression in early gastric cancer, and serum PG I shows abnormally low expression. The combined detection of the four factors has appreciated clinical value for the diagnosis of early gastric cancer.

The Difference of Serum Gastrin-17 Level Based on Gastritis Severity and Helicobacter Pylori Infection

BACKGROUND

Gastritis was defined as the histological presence of gastric mucosal inflammation. One of the most common aetiology was H. pylori. Gastrin-17 was a hormone that was secreted by G cells. H. pylori infection induced increased in gastrin-17 in gastritis. Therefore, this study was to investigate the relationship of gastrin-17 with gastritis severity and H. pylori infection.

AIM

To determine the difference in serum Gastrin-17 level based on gastritis severity and H. pylori infection.

METHODS

A cross-sectional study enrolling 45 patients with gastritis was conducted in Haji Adam Malik General Hospital between April and July 2018. Endoscopy and biopsy examinations were performed to confirm the diagnosis of gastritis. Gastritis severity was assessed using the Updated Sydney System. The presence of H. pylori infection was detected by a Campylobacter-like organism (CLO) examination. Gastrin-17 level and demographic data were also gathered. The analysis was done using Mann Whitney and Kruskal-Wallis test. P-value of < 0.05 was considered statistically significant.

RESULTS

Serum Gastrin-17 level was significantly different based on gastritis severity (P = 0.001 according to neutrophils infiltration and P = 0.023 according to degree of atrophy), H. pylori infection (P = 0.038), and combined gastritis severity and H. pylori infection (P < 0.001). Serum Gastrin-17 level was higher in subjects with severe neutrophils infiltration, without atrophy, and with H. pylori infection.

CONCLUSION

There was a significant difference in serum Gastrin-17 level based on gastritis severity and H. pylori infection.

[Comparison of different serological methods in screening early gastric cancer]

Objective: To compare the consistency and detection rate of early gastric cancer (EGC) of three different methods including anti-Helicobacter pylori (Hp) antibody combined with pepsinogen (PG) (ABC method), serum PG combined with gastrin-17 (G-17) (new ABC method) and the new scoring system. Methods: Serological tests were performed in Zhejiang population, which divided the subjects into low risk, intermediate risk and high risk groups. High risk subjects were examined by endoscopic and pathological examination. SPSS19.0 were used to evaluate the consistency of three methods. According to the receiver operating characteristic (ROC) curve, the ratio of G-17 to PG (PGR) was calculated for the optimal diagnostic cut-off value of EGC. Results: A total of 30 126 subjects were recruited. Based on the data of ABC method, the proportions of low risk, intermediate risk and high risk group were 15 368 (51.01%), 13 246 (43.97%), and 1 512 (5.02%), respectively. These proportions by the new ABC method were 20 584 (68.32%), 8 990 (29.84%), 552 cases (1.83%), respectively. By new scoring system, these were 20 810 (69.08%), 8 059 (26.75%), and 1 257 (4.17%), respectively. Among them, 1 263 subjects underwent endoscopy and 22 cases (1.74%) were finally diagnosed as gastric cancer including 19 EGC (86.4%). There were 1 case (0.35%), 14 cases (1.84%), and 7 cases (3.21%) with gastric cancer in low risk, intermediate risk, and high risk groups by ABC methods, respectively. Gastric cancer patients were 7 (1.68%), 10 (1.38%), and 5 (4.10%) in three groups respectively by new ABC methods. Via new scoring system, gastric cancer were detected in 5 (0.66%), 9 (2.22%), and 8 (7.84%) patients of three risk groups respectively. The consistency of three screening methods was poor. The detection rate of gastric cancer in high risk group was higher than that in the other two (P<0.05). The area under the curve (AUC) for diagnosis of gastric cancer by G-17 and PGR was 0.588 and 0.729, respectively. According to the PGR cut-off value determined by the fitted model, the incidence of gastric cancer in the low, intermediate and high risk groups was 0.94%, 1.97%, and 6.31%, respectively. When the cut-off value is PGR<4.135, the sensitivity is 0.855 and the specificity is 0.545. Conclusion: The new scoring system has a better predictive value in EGC screening. The detection rate of EGC in high risk group is higher than that in low and intermediate risk groups.

The correlation between histological gastritis staging- 'OLGA/OLGIM' and serum pepsinogen test in assessment of gastric atrophy/intestinal metaplasia in China

BACKGROUND

Serum pepsinogen (PG) test, as an indicator of gastric mucosal atrophy, reflects the functional and morphologic status of gastric mucosal and it is suggested to serve as a useful predictive marker for patients with gastric cancer (GC). The available classifications of gastritis, known as the Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastritis Intestinal Metaplasia (OLGIM), integrating the severity and topography of atrophy/intestinal metaplasia (IM), have been gradually accepted and used in screening for GC in recent years.

GOALS

To assess whether serum pepsinogen test, including PGI, PGII, PGI/PGII and gastrin-17 (G-17) could reflect the extent and topography of gastric mucosal atrophy/IM. Furthermore, to discuss the relationship between OLGA/OLGIM staging system and serum pepsinogen test in assessment of gastric atrophy/IM.

METHODS

The OLGA/OLGIM ranks the gastric staging according to both the topography and the severity of gastric atrophy/IM. A retrospective study was conducted with 331 patients who underwent endoscopy with consecutive biopsy sampling and reassessed according to OLGA/OLGIM staging system. Serum pepsinogen test, including PGI, PGII, PGI/PGII and G-17, as well as serological Helicobacter pylori (Hp) antibody were also measured. Results were presented as gastritis stage, serum pepsinogen level and Hp status. Baseline characteristics were compared using analysis of variance (ANOVA) test for continuous data and Pearson's χ² test for categorical data. A logistic regression model was used for the correlation analysis between OLGA/OLGIM and serological pepsinogen test.

RESULTS

A total of 177 non-atrophic gastritis and 154 atrophic gastritis were analyzed, among which 40 were antrum atrophy, 32 were corpus atrophy and 82 were pan-atrophy. All patients were assessed applying the OLGA/OLGIM criteria with a mean age of 54.7 ± 10.8 years. Patients among OLGA/OLGIM Stage III-IV were presented with a lower level of serum PGI and PGI/PGII (p < .05), especially for Stage IV (p = .01). For both Hp-positive patients and Hp-negative patients according to OLGA system, PGI/PGII level correlated inversely with the rising stage (p = .022; p = .028). As for OLGIM system, similar difference can be seen in PGI/PGII level in either Hp-positive patients, or Hp-negative patients (p = .036; p = .013). In addition, the percentage of G-17 <1 pmol/L combined with PG-negative in antrum atrophy group was much higher than that of non-atrophy group and corpus atrophy group (25 versus 15.8 versus 6.3%) (p = .029). The proportion of G-17 > 15 pmol/L combined with PG-positive was apparently higher in corpus atrophy group, compared with other two groups (25 versus 11.3 versus 8.1%) (p = .023). Logistic regression modeling showed there exist significant connections between OLGA/OLGIM stages and serum pepsinogen test in patient stratification for gastric mucosal atrophy assessment (p < .001, p < .001).

CONCLUSIONS

Serum pepsinogen test has a strong correlation with OLGA/OLGIM gastritis stage and could provide important information in assessment of atrophy/intestinal metaplasia.

Compound salvia pellet in combination with rebeprazole for treatment of elderly patients with chronic atrophic gastritis: Curative efficacy and effect on serum gastrin and endothelin

AIM: To assess the clinical effects of compound salvia pellet in combination with rebeprazole in the treatment of elderly patients with chronic atrophic gastritis (CAG) and the effect on serum gastrin and endothelin.

METHODS: One hundred and sixty CAG patients were randomly and equally divided into two groups: a control group and an observation group. Besides amoxicillin and clarithromycin, the control group was treated with rebeprazole, while the observation group was treated with compound salvia pellet and rebeprazole. The curative efficacy, improvement of clinical symptoms, pathological changes of the gastric mucosa and levels of serum gastrin-17 and endothelin-1 (ET-1) were observed and compared for the two groups.

RESULTS: The observation group had a response rate of 93.8%, which was significantly higher than that in the control group (81.2%; P < 0.05). After treatment, the observation group had significantly fewer cases with upper abdominal distention and pain, eructation, acid regurgitation and nausea than those in the control group (P < 0.05 for all). As to pathological results of the gastric mucosa, the observation group had significantly fewer cases with gastric mucosal atrophy, intestinal metaplasia and atypical hyperplasia than those in the control group (P < 0.05). In comparison with the control group, serum level of gastrin-17 was statistically higher and that of ET-1 was statistically lower in the treatment group (P < 0.05 for both). During the treatment, there were no severe adverse reactions.

CONCLUSION: Combined compound salvia pellet with rebeprazole in elderly patients with CAG is effective, and can increase the response rate, significantly improve clinical symptoms and gastric mucosal lesions, promote secretion of gastrin and decrease endothelin level with fewer adverse reactions.

Pepsinogen testing for evaluation of the success of Helicobacter pylori eradication at 4 weeks after completion of therapy

BACKGROUND AND OBJECTIVE

Pepsinogen levels in plasma are increased by inflammation in the gastric mucosa, including inflammation resulting from Helicobacter pylori infection. A decrease in pepsinogen II level has been suggested as a reliable marker to confirm the successful eradication of infection. The aim of our study was to evaluate the potential role of pepsinogens I and II, gastrin-17 and H. pylori antibodies in confirming successful eradication.

MATERIAL AND METHODS

Altogether 42 patients (25 women, 17 men), mean age 45 years (range 23-74), were enrolled. Pepsinogens I and II, gastrin-17 and H. pylori IgG antibodies were measured in plasma samples using an ELISA test (Biohit, Oyj., Finland) before the eradication and 4 weeks after completing the treatment. The success of eradication was determined by a urea breath test.

RESULTS

Eradication was successful in 31 patients (74%) and unsuccessful in 11 patients (26%). Pepsinogen II decreased significantly in both the successful (P=0.029) and unsuccessful (P=0.042) eradication groups. Pepsinogen I decreased significantly in the successful (P=0.025) but not the unsuccessful (P=0.29) eradication group. The pepsinogen I/II ratio increased in the successful eradication group (P=0.0018) but not in the group in which treatment failed (P=0.12). There were no differences in gastrin-17 or H. pylori antibody values.

CONCLUSIONS

A decrease in pepsinogen II levels cannot be used as a reliable marker for the successful eradication of H. pylori 4 weeks after the completion of treatment. The increase in pepsinogen I/II ratio reflects differences in pepsinogen production following the eradication irrespective of improvement in atrophy.

Clinical significance of serum pepsinogen I and II and gastrin-17 in patients with functional dyspepsia

AIM: To investigate the clinical significance of serum pepsinogen (PG) I and II and gastrin-17 (G-17) in patients with functional dyspepsia (FD).

METHODS: A case-control study was performed. Two hundreds and twenty-nine FD patients recruited were diagnosed according to Rome III criteria. Serum PG I and II and G-17 levels were measured by enzyme-linked immunosorbent assay (ELISA). The PG I/II ratio (PGR) was calculated. Serum IgG antibody against Helicobacter pylori (H. pylori) was determined by ELISA to evaluate H. pylori infection.

RESULTS: In FD patients, the PGR was lower in the ≥ 61 age group than in the ≤ 40 age group (P = 0.049). The levels of serum PG II and G-17 were significantly higher in FD patients than in normal controls (both P = 0.000), while the PGR was significantly lower in FD patients than in normal controls (P = 0.000). No significant difference was noted in serum PG I level between FD patients and normal controls (P = 0.067). The receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off points of PG II and G-17 values for the diagnosis of FD were 13.2 μg/L (sensitivity 52.8%, specificity 100%, and accuracy 67.5%) and 6.84 μg/L (sensitivity 52.8%, specificity 100%, and accuracy 67.5%), respectively. The levels of serum PG I and PG II were significantly higher in male FD patients than in female ones (P = 0.003 and 0.004, respectively). The positive rate of serum IgG antibody against H. pylori was higher in FD patients than in normal controls (P = 0.028).

CONCLUSION: The levels of serum PGII and G-17 are elevated in FD patients, which may suggest functional changes in gastric sinus and proximal duodenal mucosa. There is an association between FD and H. pylori infection.

Low circulating levels of gastrin-17 in patients with Barrett's esophagus

AIM: To examine whether the fasting levels of serum gastrin-17 (G-17) are lower in Barrett's esophagus (BE) patients than in non-Barrett controls.

METHODS: Nineteen patients with BE (presenting with a tubular segment ≥2 cm long in lower esophagus and intestinal metaplasia of incomplete type ("pecialized columnar epithelium") in endoscopic biopsies from the tubular segment below the squamocolumnar junction were collected prospectively from outpatients referred to diagnostic gastroscopy. The controls comprised 199 prospectively collected dyspeptic outpatients without BE or any endoscopically visible lesions in the upper GI tract. Fasting levels of serum G-17 (G-17fast) were assayed with an EIA test using a Mab highly specific to amidated G-17. None of the patients and controls received therapy with PPIs or other antisecretory agents.

RESULTS: The mean and median levels of G-17fast in serum were significantly lower (P = 0.001) in BE patients than in controls. The positive likelihood ratios (LR+) of low G-17fast to predict BE in the whole study population at G-17fast levels <0.5, <1, or <1.5 pmol/L were 3.5, 3.0, and 2.8, respectively. Among patients and controls with healthy stomach mucosa, the LR+ were 5.6, 3.8, and 2.6, respectively. In the whole study population, serum G-17 was below 2 pmol/L in 15 of 19 BE patients (79%). The corresponding prevalence was 66 of 199 (33%) in controls (P<0.001). The G-17fast was 5 pmol/L or more in only one of the 19 BE patients (5%). In controls, 76 of the 199 patients (38%) had such high serum G-17fast levels (P<0.01).

CONCLUSION: Serum levels of G-17fast tend to be lower in native patients with BE than in healthy controls.