Abstract
BackgroundTo assess the value of serological biomarker testing as a substitute for esophagogastroduodenoscopy (EGDS) in pre-operative assessment of patients referred for bariatric surgery.MethodsSixty-five obese patients with a mean age of 43 years (range: 21–65) and a mean body mass index (BMI) of 44 (range: 36–59) were studied. The patients were tested with a four-biomarker panel: pepsinogen I and II, gastrin-17 (basal and stimulated), and Helicobacter pylori (HP) antibodies (GastroPanel®, Biohit Oyj, Finland). On the basis of the biomarker test, the patients were classified into the HS (healthy stomach) group (n = 22) with the normal biomarker profile and the NHS (non-healthy stomach) group (n = 43). The classification of patients into HS and NHS was evaluated against the gold standard, i.e. EGDS with biopsies.ResultsThe concordance (Cohen’s kappa) between the biomarker test and gastric histology was 0.68; 95% CI 0.504–0.854, with an overall agreement of 84.6% (95% CI 73.9–91.4%). In the NHS group, all 43 patients had biopsy-confirmed chronic gastritis: 39 non-atrophic HP-gastritis, 4 atrophic antrum gastritis (AGA) of moderate severity.In the HS group only 6 patients had mild superficial H.pylori negative gastritis. Of the 22 HS subjects with the normal biomarker profile, 20 (31% of all 65) had no complaints either, while the remaining two had reflux symptoms with esophagitis. In the NHS group 10 patients had esophagitis and 8 had also reflux symptoms.ConclusionsThe normal biomarker profile is an excellent surrogate for healthy stomach, implicating that pre-operative EGDS could have been avoided in 31% of our asymptomatic bariatric surgery patients who had the normal biomarker profile.
Highlights
To assess the value of serological biomarker testing as a substitute for esophagogastroduodenoscopy (EGDS) in pre-operative assessment of patients referred for bariatric surgery
The latest innovation in this technology represents a panel of 4 stomach-specific biomarkers (Pepsinogen I and II, Gastrin-17 and Helicobacter pylori (HP) antibody) known as the GastroPanel® test (Biohit, Oyj, Finland), which distinguishes between 8 diagnostic marker profiles [19]
Using the two-tier stratification (HS vs. Nonhealthy stomach (NHS)), based on biomarker testing, 22 (34%) of the patients were classified into the healthy stomach (HS) group, and 43 (66%) into the NHS group
Summary
To assess the value of serological biomarker testing as a substitute for esophagogastroduodenoscopy (EGDS) in pre-operative assessment of patients referred for bariatric surgery. Suumann et al BMC Obesity (2018) 5:9 remains, whether systematic EGDS could be replaced by another (non-invasive) diagnostic tools in this setting. The use of serological biomarker testing has gained increasing popularity as a non-invasive diagnostic tool for dyspeptic patients and asymptomatic subjects to diagnose both functional disorders and gastric diseases, including HP infection and atrophic gastritis (mucosal atrophy) (AG) [19]. The latest innovation in this technology represents a panel of 4 stomach-specific biomarkers (Pepsinogen I and II, Gastrin-17 and HP antibody) known as the GastroPanel® test (Biohit, Oyj, Finland), which distinguishes between 8 diagnostic marker profiles [19]. Today the validity for GastroPanel to diagnose and delineate the healthy stomach and H. pylori gastritis with or without atrophy has already been confirmed in many independent clinical investigations against the gold standard (endoscopy with endoscopic histology); this issue has been adressed in at least two systematic reviews [20, 21]
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