Olga Sjomina1, Jelizaveta Pavlova2, Ilva Daugule2, Pavel Janovic3, Ilze Kikuste4, Aigars Vanags5, Ivars Tolmanis5, Dace Rudzite2, Inese Polaka6, Ilona Kojalo2, Inta Liepniece-Karele7, Sergejs Isajevs7, Daiga Santare2, Valdis Pirags6, Jelena Pahomova8, Vilnis Dzerve8, Lilian Tzivian9, Andrejs Erglis10, Marcis Leja11. 1. Institute of Clinical and Preventive Medicine, University of Latvia;Faculty of Medicine, University of Latvia, Riga, Latvia. olga_sjomina@inbox.lv or sjomina. olga@gmail.com. 2. Institute of Clinical and Preventive Medicine, University of Latvia; Faculty of Medicine, University of Latvia, Riga, Latvia. 3. Faculty of Medicine, University of Latvia, Riga, Latvia. 4. Institute of Clinical and Preventive Medicine, University of Latvia; Department of Research, Riga East University Hospital, Riga, Latvia. 5. Department of Research, Riga East University Hospital, Riga, Latvia. 6. Institute of Clinical and Preventive Medicine, University of Latvia; Institute of Information Technology, Riga Technical University, Riga, Latvia. 7. Institute of Clinical and Preventive Medicine, University of Latvia; Faculty of Medicine, University of Latvia;Academic Histology Laboratory, Riga, Latvia. 8. Institute of Information Technology, Riga Technical University; P. Stradins Clinical Hospital, Riga, Latvia. 9. Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia. 10. Institute of Clinical and Preventive Medicine, University of Latvia; Institute of Information Technology, Riga Technical University; P. Stradins Clinical Hospital, Riga, Latvia. 11. Institute of Clinical and Preventive Medicine, University of Latvia; Digestive Diseases Centre Gastro, Riga, Latvia.
Abstract
AIMS: The aim of the study was to evaluate the rationale of blood pepsinogen (PG) testing in population based screening settings. METHODS: Participants from a cross-sectional population-based study of cardiovascular risk factors in Latvia were invited to participate in the current study. Pepsinogen I and II were measured in blood samples taken during the initial study and at follow-up; upper gastrointestinal endoscopy was performed. There were three groups of patients: with moderately decreased (PG I< 70 ng/ml and PG I/PG II ratio < 3), with strongly decreased (PG I< 30 ng/ml and PG I/PG II ratio < 2), and with normal PG level. Biopsy with H. pylori detection was performed (updated Sydney system). RESULTS: Results from 259 patients were analyzed. Pepsinogens were decreased in 133 (51.4%), H. pylori was positive in 177 (66.0%) cases. Mean age was significantly lower in patients with normal compared to strongly decreased PG level group (52.8 vs. 64.1 years, p<0.001). Prevalence of severe corpus atrophy was higher in the strongly decreased compared to the normal PG test group: 7.0% vs. 0%; the same tendency was noted in the distribution of OLGA stages III-IV - 10.5% and 0.0%, OLGIM stages III-IV - 3.5% and 0%, and low-grade dysplasia - 15.8% and 2.4% (p<0.05). Two cases of gastric cancer were found; both presented decreased PG levels. A strong association between H. pylori eradication and PG ratio dynamics was found (p<0.05). CONCLUSIONS: All high-risk lesions were found in the decreased PG test groups; two cancer cases were revealed. However, PG demonstrated low specificity and low value of repeated testing. The value of PG as a sole test for gastric cancer risk is limited.
AIMS: The aim of the study was to evaluate the rationale of blood pepsinogen (PG) testing in population based screening settings. METHODS:Participants from a cross-sectional population-based study of cardiovascular risk factors in Latvia were invited to participate in the current study. Pepsinogen I and II were measured in blood samples taken during the initial study and at follow-up; upper gastrointestinal endoscopy was performed. There were three groups of patients: with moderately decreased (PG I< 70 ng/ml and PG I/PG II ratio < 3), with strongly decreased (PG I< 30 ng/ml and PG I/PG II ratio < 2), and with normal PG level. Biopsy with H. pylori detection was performed (updated Sydney system). RESULTS: Results from 259 patients were analyzed. Pepsinogens were decreased in 133 (51.4%), H. pylori was positive in 177 (66.0%) cases. Mean age was significantly lower in patients with normal compared to strongly decreased PG level group (52.8 vs. 64.1 years, p<0.001). Prevalence of severe corpus atrophy was higher in the strongly decreased compared to the normal PG test group: 7.0% vs. 0%; the same tendency was noted in the distribution of OLGA stages III-IV - 10.5% and 0.0%, OLGIM stages III-IV - 3.5% and 0%, and low-grade dysplasia - 15.8% and 2.4% (p<0.05). Two cases of gastric cancer were found; both presented decreased PG levels. A strong association between H. pylori eradication and PG ratio dynamics was found (p<0.05). CONCLUSIONS: All high-risk lesions were found in the decreased PG test groups; two cancer cases were revealed. However, PG demonstrated low specificity and low value of repeated testing. The value of PG as a sole test for gastric cancer risk is limited.