Relevance of pepsinogen, gastrin, and endoscopic atrophy in the diagnosis of autoimmune gastritis

Hiroshi Kishikawa,Keisuke Ojiro,Yukie Hayashi,Jiro Nishida,Soichiro Miura,Kyoko Arahata,Tadashi Katayama,Kenji Nakamura,Sakiko Takarabe,Aya Sasaki,Hitomi Hoshi,Takanori Kanai

doi:10.1038/s41598-022-07947-1

Abstract

Simple objective modalities are required for evaluating suspected autoimmune gastritis (AIG). This cross-sectional study aimed to examine whether pepsinogen, gastrin, and endoscopic findings can predict AIG. The diagnostic performance of endoscopic findings and serology in distinguishing AIG was evaluated. AIG was diagnosed in patients (N = 31) with anti-parietal cell antibody and/or intrinsic factor antibody positivity and histological findings consistent with AIG. Non-AIG patients (N = 301) were seronegative for anti-parietal cell antibodies. Receiver operating characteristic curve analysis of the entire cohort (N = 332) identified an endoscopic atrophic grade cutoff point of O3 on the Kimura–Takemoto classification (area under the curve [AUC]: 0.909), while those of pepsinogen-I, I/II ratio, and gastrin were 20.1 ng/mL (AUC: 0.932), 1.8 (AUC: 0.913), and 355 pg/mL (AUC: 0.912), respectively. In severe atrophy cases (≥ O3, N = 58, AIG/control; 27/31), the cutoff values of pepsinogen-I, I/II ratio, and gastrin were 9.8 ng/mL (AUC: 0.895), 1.8 (AUC: 0.86), and 355 pg/mL (AUC: 0.897), respectively. In conclusion, endoscopic atrophy is a predictor of AIG. High serum gastrin and low pepsinogen-I and I/II ratio are predictors even in the case of severe atrophy, suggesting their usefulness when the diagnosis of AIG is difficult or as serological screening tests.

Highlights

Simple objective modalities are required for evaluating suspected autoimmune gastritis (AIG)
The two diagnostic autoantibodies of this disease are the anti-parietal cell antibody (APCA) and anti-intrinsic factor antibody (AIFA)3; AIG cannot be diagnosed merely based on these autoantibodies, and they are not recommended for screening owing to lack of cost-effectiveness, the high false positive rate of APCA, and low sensitivity of A IFA7,8
We evaluated the relevance of several clinical findings in AIG diagnosis among [1] patients diagnosed by autoantibody positivity and characteristic histology and [2] non-AIG patients diagnosed based on autoantibody negativity whose H. pylori infection status was precisely evaluated

Summary

Introduction

Simple objective modalities are required for evaluating suspected autoimmune gastritis (AIG). The two diagnostic autoantibodies of this disease are the anti-parietal cell antibody (APCA) and anti-intrinsic factor antibody (AIFA); AIG cannot be diagnosed merely based on these autoantibodies, and they are not recommended for screening owing to lack of cost-effectiveness, the high false positive rate of APCA, and low sensitivity of A IFA7,8. Histological examination is another established diagnostic tool for A IG2,3; despite its high sensitivity, negative results cannot always rule out AIG because of the inherent limitations of biopsy in only a limited area of the gastric mucosa. We aimed to examine other potential predictors of AIG, focusing on endoscopic findings, PG, and gastrin

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Conclusion