Gastric mucosal status in populations with a low prevalence of Helicobacter pylori in Indonesia.

Muhammad Miftahussurur,Hanik Badriyah Hidayati,Maria Inge Lusida,Pangestu Adi,Titong Sugihartono,Ari Fahrial Syam,Muhammad Luthfi Parewangi,Fardah Akil,Yoshio Yamaoka,Iswan Abbas Nusi,Langgeng Agung Waskito,Yudith Annisa Ayu Rezkitha,I Dewa Nyoman Wibawa,Ummi Maimunah,Tomohisa Uchida,Herry Purbayu,Phawinee Subsomwong,I Ketut Mariadi,Niyaz Ahmed

doi:10.1371/journal.pone.0176203

Abstract

In Indonesia, endoscopy services are limited and studies about gastric mucosal status by using pepsinogens (PGs) are rare. We measured PG levels, and calculated the best cutoff and predictive values for discriminating gastric mucosal status among ethnic groups in Indonesia. We collected gastric biopsy specimens and sera from 233 patients with dyspepsia living in three Indonesian islands. When ≥5.5 U/mL was used as the best cutoff value of Helicobacter pylori antibody titer, 8.6% (20 of 233) were positive for H. pylori infection. PG I and II levels were higher among smokers, and PG I was higher in alcohol drinkers than in their counterparts. PG II level was significantly higher, whereas PG I/II ratios were lower in H. pylori-positive than in H. pylori-negative patients. PG I/II ratios showed a significant inverse correlation with the inflammation and atrophy scores of the antrum. The best cutoff values of PG I/II were 4.05 and 3.55 for discriminating chronic and atrophic gastritis, respectively. PG I, PG II, and PG I/II ratios were significantly lower in subjects from Bangli than in those from Makassar and Surabaya, and concordant with the ABC group distribution; however, group D (H. pylori negative/PG positive) was the lowest in subjects from Bangli. In conclusion, validation of indirect methods is necessary before their application. We confirmed that serum PG level is a useful biomarker determining chronic gastritis, but a modest sensitivity for atrophic gastritis in Indonesia. The ABC method should be used with caution in areas with a low prevalence of H. pylori.

Highlights

Helicobacter pylori has a unique capacity to persistently colonize the extremely acidic environment of the stomach and cause progressive gastric mucosal inflammation
By using the cutoff value from the manufacturer’s instructions, we found the sensitivity and specificity of the enzyme-linked immunosorbent assay (ELISA) kit for H. pylori infection to be 66.7% and 97.2%, respectively, compared with histology confirmed by immunohistochemistry as a gold standard
We found that the cutoff of !5.5 U/mL was the best value to determine H. pylori positivity, with an area under curve (AUC) of 0.913

Summary

Introduction

Helicobacter pylori has a unique capacity to persistently colonize the extremely acidic environment of the stomach and cause progressive gastric mucosal inflammation. Long-term infection induces a multistep histological cascade, from chronic non-atrophic gastritis that progresses to chronic atrophic gastritis, intestinal metaplasia, and adenocarcinoma [1]. Chronic atrophic gastritis characterized by chronic inflammation with loss of gastric glandular cells is an established precursor lesion to gastric adenocarcinoma [2]. Gastric mucosal biopsy is the reference method for determining the grade and topographical distribution of gastritis [3], this method is uncomfortable and expensive for patients. Recent reports confirmed that serum pepsinogens (PGs) are a valuable biomarker of the gastric mucosal status, including inflammation, atrophic gastritis, and gastric cancer [4], even before the discovery of H. pylori [5]

Methods

Results

Discussion

Conclusion