Serological markers as predictors of the severity of gastric mucosal atrophy in autoimmune and <i>Helicobacter рylori</i>-associated gastritis

• Published in: Терапевтический архив
• Main Authors: Margarita V. Chebotareva, Karine A. Nikolskaya, Dmitry N. Andreev, Alexey S. Dorofeev, Sergey G. Khomeriki, Larisa A. Tsapkova, Elena V. Parfenchikova, Artur M. Veliev, Alexey Yu. Spasenov, Irina N. Voynovan, Dmitry S. Bordin
• Format: Article
• Language: Russian
• Published: "Consilium Medicum" Publishing house 2025-01-01
• Subjects: atrophic gastritis; autoimmune gastritis; gastric cancer; serum pepsinogens; helicobacter pylori
• Online Access: https://ter-arkhiv.ru/0040-3660/article/viewFile/681970/205482
• ISSN: 0040-3660; 2309-5342

Aim. To evaluate the possibility of using serum markers of atrophy (pepsinogens – PG I and II) to form high-risk groups for gastric cancer (Operative Link for Gastritis Assessment – OLGA stage III–IV) depending on the etiology of gastritis. Materials and methods. A total of 237 (56 men and 181 women) patients were examined. All patients underwent a 13C-urea breath test, a blood test for GastroPanel (PG I, PG II, gastrin-17, antibodies to Helicobacter pylori immunoglobulin G), a blood test for antibodies to gastric parietal cells. All patients underwent esophagogastroduodenoscopy with a biopsy of the gastric mucosa from 5 standard points according to the Sydney system and a histomorphological study according to the OLGA system, as well as a biopsy to detect H. pylori infection using the polymerase chain reaction. The patients were divided into 3 groups depending on the etiology of gastritis: Group 1 included 55 patients with chronic gastritis, autoimmune gastritis and associated with H. pylori gastritis (AIG+HP+); Group 2 – 47 patients with AIG and negative tests for H. pylori infection (AIG+HP-); Group 3 – 135 patients with chronic gastritis associated with H. pylori and negative markers of AIG (AIG-HP+). Results. The analysis showed that in patients with AIG (group 2), the most reliable serological markers of atrophy predicted severe atrophy (OLGA stage III–IV): when the ratio PG I/PG II was ≤ 3, it was detected in 70.21% of cases, and when PG I decreased to ≤ 30 μg/L, it was found in 68.08%. In group 1, stages III–IV according to OLGA were diagnosed in 20% of cases with PG I/PG II indicators ≤ 3; and in 18.18% with a decrease in PG I ≤ 30 μg/L. When analyzing the diagnostic accuracy of GastroPanel biomarkers in identifying severe atrophy (OLGA stages III–IV) in the total sample of patients (all 3 groups), it was possible to achieve cut-off indicators as close as possible to the reference values while maintaining a relatively high sensitivity and specificity – 75.81% and 81.50% for PG I ≤ 30 μg/L and 85.48% and 64.50% for PG I/PG II ≤ 3, respectively. The optimal cut-off in the study population for the PG I indicator was 22.5 μg/L (sensitivity – 72.58%, specificity – 88.00%), and for the PG I/PG II ratio ≤ 2 (sensitivity – 80.65%, specificity – 78.50%). Conclusion. Serum pepsinogens can be used in the Moscow population as a non-invasive marker of gastric mucosa atrophy for the formation of high-risk patient groups for gastric cancer requiring endoscopic examination.