Background
The combination of pepsinogen, gastrin-17 and anti-H. pylori antibodies serological assays (panel test) is a non-invasive tool for the diagnosis of atrophic gastritis. However, the diagnostic reliability of this test is still uncertain.

Aim
To assess the diagnostic performance of the serum panel test for the diagnosis of atrophic gastritis.

Methods
Medline via PubMed, Embase, Scopus, Cochrane Library databases and abstracts of international conferences proceedings were searched from January 1995 to December 2016 using the primary keywords “pepsinogens,” “gastrin,” “atrophic gastritis,” “gastric precancerous lesions.” Studies were included if they assessed the accuracy of the serum panel test for the diagnosis of atrophic gastritis using histology according to the updated Sydney System as reference standard.

Results
Twenty studies with a total of 4241 subjects assessed the performance of serum panel test for the diagnosis of atrophic gastritis regardless of the site in the stomach. The summary sensitivity was 74.7% (95% confidence interval (CI), 62.0-84.3) and the specificity was 95.6% (95%CI, 92.6-97.4). With a prevalence of atrophic gastritis of 27% (median prevalence across the studies), the negative predictive value was 91%. Few studies with small sample size assessed the performance of the test in detecting the site of atrophic gastritis.

Conclusions
The combination of pepsinogen, gastrin-17 and anti-H. pylori antibodies serological assays appears to be a reliable tool for the diagnosis of atrophic gastritis. This test may be used for screening subjects or populations at high risk of gastric cancer for atrophic gastritis; however, a cost-effectiveness analysis is needed.

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Systematic review with meta-analysis: diagnostic performance of the combination of pepsinogen, gastrin-17 and anti-Helicobacter pylori antibodies serum assays for the diagnosis of atrophic gastritis.

Gastric cancer (GC) is one of the most widespread types of cancer worldwide. Helicobacter pylori infection has been clearly correlated with gastric carcinogenesis. At present and in the near future, the most important challenge is and will be the significant reduction of mortality due to GC. That goal can be achieved through the identification of higher-risk patients, such as those with atrophic gastritis, intestinal metaplasia and dysplasia. In this review we intend to discuss the importance of diagnosing H. pylori infection and chronic atrophic gastritis in preventing gastric cancer, using a new non-invasive test called GastroPanel. This test is a classification algorithm including four biochemical parameters pepsinogen I and II (PGI and PGII), gastrin-17 (G17), and anti-Helicobacter pylori antibodies (Ig G anti-Hp) measured in fasting sera, which allows to classify patients as having atrophic or non-atrophic gastritis and to find whether gastritis is associated or not with H. pylori infection. GastroPanel is not a "cancer test", but it can and should be used in the screening and diagnosis of subjects with a high cancer risk; still, a careful diagnostic made by superior digestive endoscopy is compulsory to find possible precancerous or cancerous lesions at an early and curable stage.

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Helicobacter pylori Infection, Gastric Cancer and Gastropanel

Background and aim Atrophic gastritis is a precancerous gastric lesion, therefore its early detection is a priority in preventing gastric cancer. The aim of the present paper is to develop a narrative synthesis of the present knowledge on diagnostic methods of chronic atrophic gastritis. Methods A literature search was carried out on main databases: PubMed, Hinari, SpringerLink and Scopus (Elsevier) for the period 2000-2020. The searched keywords were: chronic atrophic gastritis, intestinal metaplasia and dysplasia + diagnosis. Inclusion criteria were focused on the articles about the invasive and non-invasive diagnosis of chronic atrophic gastritis and of precancerous gastric lesions, intestinal metaplasia and dysplasia; exclusion criteria were articles published before 2000 and those that did not include the proposed theme. Results The search returned 575 papers addressing the topic of precancerous lesions. From these, 60 articles were qualified representative for the materials published on the topic of this synthesis article, being those that met the inclusion criteria. The data emphasize the need to use upper digestive endoscopy with biopsies for the diagnosis of chronic atrophic gastritis. However serological diagnosis is available as alternative mainly recommended in follow up. Conclusions There are two main methodological approaches for the evaluation of chronic atrophic gastritis as a precancerous gastric lesions: invasive examination, which requires histological analysis of biopsy samples taken during upper digestive endoscopy, being the "gold standard" for diagnosis, and non-invasive serological examination using markers of gastric function.

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Chronic atrophic gastritis: an update on diagnosis.

Purpose: The study was conducted to investigate the relationship of serum pepsinogens PGI, PGII, gastrin-17, and Hp-IgG with colorectal cancer (CRC), aiming to explore the clinical significance of serum markers reflecting gastric function and H. pylori infection in CRC. Methods: A total of 569 CRC cases and 569 age and sex-matched controls were enrolled in this study between June 2012 and April 2016 from The First Hospital of China Medical University. The serum markers reflecting gastric function and H. pylori infection were detected using ELISA, including PGI, PGII, PGI/II ratio, G-17 and Hp-IgG. Information of clinicopathological parameters and tumor biomarkers was collected from the medical records of inpatients, including CEA, CA199, CA125, CA153 and AFP. Results: Serum PGII, G-17 levels and Hp-IgG were increased in CRC, while PGI and PGI/II ratio appeared no significant difference between CRC and controls. In subgroup analysis, PGII was more significant in males (P=0.014). Hp-IgG was demonstrated higher in age<60y (P=0.001). With respect to the association with serum tumor biomarkers, G-17 level was associated with the rise of CA125 (P=0.005, OR (95%CI): 4.89 (1.90-12.57)), Hp-IgG increasing was associated with the rise of CA125 (P=0.024, OR (95%CI): 4.10 (1.54-10.93)). Conclusions: Serum PGII, G-17 and Hp-IgG were associated with CRC risk. The serum levels of G-17 and Hp-IgG were associated with the rise of CA125 in patients with CRC.

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Clinical significance of serum markers reflecting gastric function and H. pylori infection in colorectal cancer.

Introduction: Infection to Helicobacter pylori has been associated to many gastrointestinal diseases including gastritis, peptic ulcer disease, gastroesophageal reflux disease, atrophic gastritis and gastric cancer. Chronic infections are frequent and severe in patients with diabetes mellitus (DMT2), probably due to the impairment of their immune status. The link between H. pylori infection and diabetes mellitus (DM) remains controversial. This study aimed at detection and comparison of anti H. pylori antibodies (IgG) in serum of diabetes mellitus type 2 (DMT2) and non-diabetic dyspepsia subjects and also to find if there exists any significant correlation between H. pylori infection and DMT2. Materials and methods: This case control study of 82 patients (51 diabetics and 31 non-diabetic subjects) was carried out in Yaounde Cameroon during the period January-April 2017. Clinical and sociodemographic information of both groups were recorded 5 ml of blood was aseptically collected for H. pylori IgG antibodies. Assay parameters were analysed using a software application GastroSoft (www.GastroPanel.com). Data was analysed using Epi info 7.0. All statistics were realized at 95% CI. Authorizations were obtained at the Yaounde Central Hospital, the Cite Verte District Hospital. Ethical clearance was also obtained from the National Ethics Committee. Results: Significantly raised Anti H. pylori antibodies (IgG) were found in diabetics (88.2%) than in the non-diabetic control group (67.7%), (P = 0.015) showing strong correlation between the association of H. pylori and DMT2. Dyspepsia was very common in anti H. pylori positive cases (83.6%). The most common diabetic complications observed in H. pylori positive diabetic subjects were retinopathy (81.0%), neuropathy (33.3%), diabetic foot (19.0%) and nephropathy (9.5%). The major diabetic risk factors in H. pylori positive subjects were obesity (39.5%), overweight (31.6%) and hypertension (31.7%). Significantly raised anti H. pylori antibodies were observed in almost all age groups in the diabetic groups. Conclusion: The result showed that diabetics are more prone to H. pylori infection and need continuous monitoring.

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Association of Helicobacter Pylori Infection and Diabetes Mellitus Type 2 Subjects in Yaounde Cameroon Using a Panel of Serum Biomarkers (PGII, HpIgG): A Case Control Study

Gastric colonization by Helicobacter pylori increases the risk of gastric disorders, including atrophic gastritis which can be diagnosed based on levels of serum biomarkers like Gastrin and Pepsinogen. We therefore examined the efficacy of a serological-based method namely GastroPanel Blood kit, in diagnosing and scoring gastritis associated to Helicobacter pylori infection. Patients with dyspeptic symptoms were prospectively recruited on voluntary basis at the Yaounde Central Hospital and University Teaching Hospital, from March to July 2011. The degree of atrophy was classified according to levels in patient serum of pepsinogens I and II (PGI and PGII) and Gastrin 17 (G17) and compared with histological profiles as reference method. A specific ELISA test was used for the detection of H. pylori IgG antibodies. In total, 86 volunteers from 21 to 83 years old (mean = 46.4 ± 3.3) were enrolled, including 74.4% of women and 25.6% of men. The prevalence of gastritis was statistically similar between Gastro Blood Panel test and histology used as reference method (89.5% versus 83.7%: p > 0.20). Diagnosis based on serum makers showed high sensitivity (93.1%) in comparison with the reference method. However, the serological based method has diagnosed more atrophic gastritis than the reference (17.4% versus 7.0%: p 0.05). Furthermore, the prevalence of H. pylori infection did not differ significantly between serological method (84.9%) and reference method (81.4%). These results suggest that diagnosis of atrophic gastritis and H. pylori infection obtained with an optional serological method (GastroPanel) is in a strong agreement with the biopsy findings, and thus can be a useful non endoscopic assessment of stomach mucosal atrophy in patients with dyspepsia.

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Eloumou Bagnaka

Papers

Assessing GastroPanel serum markers as a non-invasive method for the diagnosis of atrophic gastritis and Helicobacter pylori infection