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Non-invasive diagnosis of gastric mucosal atrophy in an asymptomatic population with high prevalence of gastric cancer

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World Journal of Gastroenterology 2006年第44期12卷 7172-7178页

作者： Antonio Rollan Catterina Ferreccio alessandra gederlini Carolina Serrano Javiera Torres Paul Harris Department of Gastroenterology Faculty ofMedicine Pontificia Universidad Católica de Chile Marcoleta367 Santiago 6510260 Chile Department of Public Health Faculty of Medicine Pontificia Universidad Católica de Chile Marcoleta 367 Santiago 6510260 Chile Department of Pediatrics Faculty of Medicine Pontificia Universidad Católica de Chile Marcoleta 367 Santiago 6510260 Chile Department of Pathology Faculty of Medicine Pontificia Universidad Católica de Chile Marcoleta 367 Santiago 6510260 Chile

AIM: To validate a non-invasive method to detect gastric mucosal atrophy in a Chilean population with high prevalence of gastric cancer and a poor survival rate. METHODS: We first determined the optimal cut-off level of serum pepsinogen (PG)-1, PG-1/PG-2 ratio and 17-gastrin in 31 voluntary symptomatic patients (mean age: 66.1 years), of them 61% had histologically confirmed gastric atrophy. Then, in a population-based sample of 536 healthy individuals (209 residents in counties with higher relative risk and 327 residents in counties with lower relative risk for gastric cancer), we measured serum anti-H pylori antibodies, PG and 17-gastrin and estimated their risk of gastric cancer. RESULTS: We found that serum PG-1 13.3 pmol/L had a high specificity (91%-100%) and a fair sensitivity (56%-78%) to detect corpus-predominant atrophy. Based on low serum PG-1 and PG-1/PG-2 ratio together as diagnostic criteria, 12.5% of the asymptomatic subjects had corpus-predominant atrophy (0% of those under 25 years and 20.2% over 65 years old). The frequency of gastric atrophy was similar (12% vs 13%) but H pylori infection rate was slightly higher (77% vs 71%) in the high-risk compared to the low-risk counties. Based on their estimated gastric cancer risk, individuals were classified as: low-risk group (no H pylori infection and no atrophy; n = 115; 21.4%); moderate-risk group(H pylori infection but no atrophy; n = 354, 66.0%); and high-risk group (gastric atrophy, with or without H pylori infection; n = 67, 12.5%). The high-risk group was significantly older (mean age: 61.9 ± 13.3 years), more frequently men and less educated as compared with the low-risk group. CONCLUSION: We propose to concentrate on an upper gastrointestinal endoscopy for detection of early gastric cancer in the high-risk group. This intervention model could improve the poor prognosis of gastric cancer in Chile.

关键词： Gastric cancer H pylori Gastric atrophy Non-invasive diagnosis Pepsinogen Gastrin

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