GastroPanel: Evaluation of the usefulness in the diagnosis of gastro-duodenal mucosal alterations in children

Abstract

Background The combined evaluation of serum pepsinogens A (PGA) and C (PGC), gastrin-17 (G17) and anti- H. pylori antibodies (anti- H. pylori)(GastroPanel) has recently been proposed as a useful aid for investigating H. pylori-associated gastric mucosal inflammation. Our aim was to evaluate whether GastroPanel can correctly classify children who need or not endoscopy (EGD). Methods GastroPanel was performed in 554 consecutive children subjected to EGD. Results PGC and anti- H. pylori were sensitive (82.5% and 73.1%) and specific (58.1% and 84.0%) indices of H. pylori infection. Antral H. pylori colonization density, inflammation and activity grades were correlated with PGC. PGC and G17 were significantly higher in children with celiac disease (14.9 ± 0.88 µg/L and 5.6 ± 0.79 pmol/L) than in controls (8.5 ± 0.38 µg/L and 2.4 ± 0.24 pmol/L). The best cut-offs to distinguish H. pylori infected children from controls were 7.45 µg/L for PGC, 4.2 pmol/L for G17, 18 U for anti- H. pylori and 25 µg/L for PGA. With these cut-offs, GastroPanel had a NPV of 89.6% and a PPV of 66.8%. Conclusions A negative GastroPanel result in children with upper abdominal non alarm symptoms, should allow the paediatrician to reasonably rule out the presence of major gastro-duodenal diseases and therefore avoid EGD.