Abstract
Objective: We have previously shown that the presence of abnormal macroscopical findings at earlier gastrocopy was among the best indicators of abnormal macroscop ical findings at regastroscopy. In the present study we evaluated whether serum tests could help to select patients with for regastroscopy. Materials and Methods: Serum H. pylori antibodies of the IgG class, pepsinogens I and II, and gastrin -17 were analyzed for 190 patients without alarm symptoms undergoing regastroscopy. For 126 patients, an earlier gastroscopy report showing a normal finding was available. Associations between serum tests and macroscopical and histological findings at gastroscopy were analyzed. Results: If patients with normal earlier gastroscopy had been selected for regastroscopy on basis of positive H. pylori serology or low pepsinogen I, 82 of the 126 gastroscopies performed (65%) would have been saved. However, in that case 19/25 patients with an abnormal macroscopical finding and four of 17 patients with moderate or severe atrophic gastritis had been missed. If patients had been selected for regastroscopy on the basis of positive H. pylori antibodies, low pepsinogen I, or low serum gastrin-17, 57 gastroscopies (45%) had been saved, but still 13/25 with an abnormal macroscopical finding and two of 17 patients with atrophic gastritis would have been missed. Macroscopical findings and isolated atrophic gastritis of the antrum could not be detected by serum tests. Conclusions: Among typical patients in Western countries, with a low prevalence of H. pylori infection and atrophic gastritis, usefulness of serum tests to select patients for regastroscopy is limited.
Highlights
Various strategies, such as those based on patients’ symptoms or serum test results, have been developed to screen dyspeptic patients for gastroscopy
Objective: We have previously shown that the presence of abnormal macroscopical findings at earlier gastrocopy was among the best indicators of abnormal macroscopical findings at regastroscopy
If patients had been selected for regastroscopy on the basis of positive H. pylori antibodies, low pepsinogen I, or low serum gastrin-17, 57 gastroscopies (45%) had been saved, but still 13/25 with an abnormal macroscopical finding and two of 17 patients with atrophic gastritis would have been missed
Summary
Various strategies, such as those based on patients’ symptoms or serum test results, have been developed to screen dyspeptic patients for gastroscopy. Pepsinogen I (PG I) is secreted in the corpus mucosa in oxynthic glands, whereas pepsinogen II (PG II) is secreted from both the oxynthic glands and from the pyloric glands in the antrum[4]. Oxynthic glands disappear in atrophic corpus gastritis, and low serum PG I level or decreased PG. I/II ratio reveal severe atrophic gastritis of the corpus. Low serum G-17 levels have been associated with atrophic gastritis of the antrum[5,6]. The combination of positive H. pylori serology, low PG I and low G-17 has been introduced to screen patients before gastroscopy[7]
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