Clinical Usefulness Of Endoscopic Features, Serum Pepsinogen And Gastrin-17 For The Histological Diagnosis Of Gastric Precancerous Condition

Background and Objective: The diagnosis of gastric precancerous condition relied on the examination of endoscopy and histological result. Also serological diagnosis as a kind of non-invasive method can detect these diseases, and be used for the risk stratification of gastric cancer. We do a study about correlation between endoscopic features and the histologic diagnosis of precancerous condition. And then compared the serum pepsinogen, gastrin-17 and anti-Helicobacter pylori antibodies with the histologic diagnosis, including atrophic gastritis, intestinal metaplasia and intraepithelial neoplasia. To assess the validity of the serum markers as a screening test for gastric precancerous condition. The influence of some familiar risk factors of gastric cancer to the diagnosis result was discussed. To find some method to improve the validity of the diagnosis for gastric precancerous condition, and to enhance the ability of the risk stratification of gastric cancer.Methods:1 Relationship between endoscopic features and the histologic diagnosis of chronic gastritisThis study collected chronic gastritis outpatients who underwent endoscopic and pathologic examination from October 2012 to October 2014. And compared the endoscpic festures, including erythema, erosions, hematin, and the dominated white phase with histologic diagnosis. Sensitivity and specificity of single and integrated endoscpic festures to histological diagnosis were calculated.2 Screening of gastric precancerous condition by combined assay for serum anti-Helicobacter pylori antibodies, pepsinogen and gastrin-17The patients, who accepted endoscopy and serological test in our hospital from November 2014 to July 2015, were enrolled in this study. Basic information of each patient was obtained. Serum pepsinogen and gastrin-17 levels were measured. H. pyloristatus was determined by anti-Helicobacter pylori antibodies, rapid urease test and 13C-urea breath test. Five biopsies were taken under the endoscopic examination.(1)The levels of serum pepsinogen and gastrin-17 were evaluated in respect to different histological diagnosis,including mucosal atrophy, intestinal metaplasia and intraepithelial neoplasia. The OLGA staging and the OLGIM staging system, resulting from the combination of histological score and its topographical location, was applied to estimate the stage of lesions. And then the levels of serological makers in related to the stage were compared.(2)The patients were divided into A,B,C and D four groups, the ABC method, by combined assay for anti-Helicobacter pylori antibodies, serum pepsinogen and gastrin-17 levels. The incidence of the gastric precancerous condition of different groups was calculated. The high risk factors of gastric cancer, including smoking, drinking, H. pylori eradication and family tumor history, were recorded among the patients of low-risk group. We compared the histological diagnosis of premalignant gastric lesions in the patients with different gastric risk factors.(3)The patients who positive for H. pylorireceiving quadruple anti-H. pylori treatment. And the patient negative for H. pylori underwent protective agent for gastric mucosa. Serological test and endoscopic examination with biopsy was conduct after 6 months.Results:1 Relationship between endoscopic features and the histologic diagnosis of chronic gastritisAmong the 574 patients, the prevalence of mucosal atrophy, intestinal metaplasia and low grade intraepithelial neoplasia are 49.30%, 23.87% and 14.29%. And the histological diagnosis was found in the four kinds of endoscpic festures. The highest specificity for premalignant gastric lesions was the dominated white phase. Combining the dominated white phase with other endoscpic festures could increase accuracy for the diagnosis of premalignant gastric lesions.2 Screening of gastric precancerous condition by combined assay for serum anti-Helicobacter pylori antibodies, pepsinogen and gastrin-17(1)Baseline CharacteristicsA total of 331 patients were enrolled in the study, including 187 men and 144 women. We found mucosal atrophy in 184, intestinal metaplasia in 142, low grade intraepithelial neoplasia in 68 and high grade intraepithelial neoplasia in one patient. Serum anti-Helicobacter pylori antibodies and serum pepsinogen and gastrin-17 levels were not significantly different between both gender and age groups.(2)Serological markers in different histological diagnosis groups(1)Among the mucosal atrophy group, the patients with antrum atrophy had significantly lower serum gastrin-17 levels than the patients without mucosal atrophy(P=0.030), the patients with corpus atrophy had significantly lower serum PGR levels than the patients without mucosal atrophy( P=0.046), the patients with multifocalatrophy had significantly lower serum PGⅠ(P=0.036) and PGR(P=0.030) levels than the patients without mucosal atrophy.(2)Among the intestinal metaplasia group, the patients with antrum intestinal metaplasia had significantly lower serum gastrin-17 levels than the patients without intestinal metaplasia(P=0.021), the patients with multifocal intestinal metaplasia had significantly lower serum PGⅠlevels than the patients without intestinal metaplasia(P=0.015).(3)Among the intraepithelial neoplasia group, the patients with multifocal intraepithelial neoplasia had significantly lower serum PGⅠlevels than the patients without intraepithelial neoplasia(P=0.036).(3)Serum pepsinogen and gastrin-17 levels in different stage of gastric lesions(1)The serum PGⅠlevels were negative correlation between the degree of OLGA staging system, and it’s significantly low in stage Ⅳ(P=0.035). The serum gastrin-17 levels in stage Ⅱwere significantly lower than it in stage 0(P=0.028).(2)The serum PGⅠlevels were negative correlation between the degree of OLGIM staging system as well. It’s significantly low in stage Ⅳ(P=0.018). The serum gastrin-17 levels in stage Ⅱwere significantly lower than it in stage 0(P=0.019).(4)Screening result by the ABC methodIn different groups if the ABC method, the proportion of patients with chronic atrophic gastritis and intraepithelial neoplasia in groups B, C and D is higher than that in group A. But 74.4 percent of patients with chronic atrophy gastritis divided in group A. The prevalence of chronic atrophic gastritis in patients with family tumor history was significantly higher than it in patients without(P=0.021). And the prevalence was not significantly different between patients with dyspepsia, smoking and drinking or not. The prevalence of intraepithelial neoplasia in patients with the history of H. pylori eradication was significantly higher than it in patients without(P=0.025).(5)The serological markers and histological diagnosis changes after therapyWe studied 32 patients for 6 months. And in these patients, 15 H. pylori-positive who had undergone successful eradication therapy, 3 H. pylori-positive who had treatment failure and 14 H. pylori-negative patients. The histologic outcomes of mucosal gastritis and intraepithelial neoplasia showed regression in each group. But the number of chronic atrophic gastritis increased. The serum gastrin-17 levels of H. pylori-positive patients after successful treatment were significantly lower than it before treatment(P=0.008). The other serological markers became similar between the groups before and after therapy. In addition, the patients who underwent eradication therapy of H. pylori divided into different group of ABC merthod.Conclusions:During the endoscopy, white phase dominated is correlated rather well to mucosal atrophy, intestinal metaplasia and intraepithelial neoplasia. Besides, we need pay attention to the other endoscopic features. These premalignant gastric lesions may hide in the endoscopic features of hematin anderosions of acute inflammation. In conclusion, when we observe these endoscopic features by endoscopy, further pathological examination may be needed.Serum pepsinogen and gastrin-17 levels are related with the topographical location of mucosal atrophy and intestinal metaplasia. It can also reveal the stage of the OLGA staging and the OLGIM staging system. Serum gastrin-17 levels decrease after successful eradication therapy of H. pylori. The other serological markers became similar between the groups before and after therapy. The combination of serum pepsinogen and anti-Helicobacter pylori antibodies can be positioned as a screening for gastric cancer. But the sensitivity of serological test to diagnose premalignant gastric lesions is low. The grouping result of ABC method can be changed by eradication therapy of H. pylori. The patients who have a history of family tumor and H. pylori eradication need endoscopy, even if it is divided to the group of low risk of cancer.