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Accuracy of GastroPanel for the diagnosis of atrophic gastritis.

McNicholl AG, Forné M, Barrio J, De la Coba C, González B, Rivera R, Esteve M, Fernandez-Bañares F, Madrigal B, Gras-Miralles B, Perez-Aisa A, Viver-Pi-Sunyer JM, Bory F, Rosinach M, Loras C, Esteban C, Santolaria S, Gomollon F, Valle J, Gisbert JP, Helicobacter pylori Study Group of Asociación Española de Gastroenterología (AE - Eur J Gastroenterol Hepatol (2014)

Bottom Line: Helicobacter pylori antibody levels were higher in H. pylori-infected patients (251 vs. 109 EIU, P=0.01; AUC=70).The accuracy of GastroPanel for the diagnosis of CAG was as follows: sensitivity 50%; specificity 80%; positive 25% and negative 92% predictive values; and positive 2.4 and negative 0.6 likelihood ratios.GastroPanel is not accurate enough for the diagnosis of CAG; thus, its systematic use in clinical practice cannot be recommended.

View Article: PubMed Central - PubMed

Affiliation: aHospital of La Princesa, and Instituto de Investigación Sanitaria Princesa bCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain Gastroenterology Units of cHospital Mutua de Terrassa, Terrassa dHospital del Mar, Barcelona eHospital Rio Hortega, Valladolid fHospital de Cabueñes, Gijon gHospital Costa del Sol, Malaga hHospital San Jorge, Huesca iHospital Clínico de Zaragoza, Zaragoza jHospital Virgen de la Salud, Toledo.

ABSTRACT

Background: It has been suggested that GastroPanel might be a useful tool for the diagnosis of chronic atrophic gastritis (CAG) measuring four biomarkers in blood: basal gastrin-17 (G17), pepsinogen I and II (PGI and PGII), and Helicobacter pylori antibodies.

Aim: To determine the accuracy of GastroPanel for the diagnosis of CAG.

Methods: This was a prospective, blinded, multicenter study that included dyspeptic patients. G17, PGI, and PGII were determined by enzyme immunoassays. Three antrum and two corpus biopsies were obtained for standard histological analysis and rapid urease test. Biopsies were analyzed by a single blinded expert pathologist.

Results: Ninety-one patients were included (77% women, mean age 44 years, 51% H. pylori positive, 17% with CAG). G17 was reduced in patients with antrum CAG (5.4 vs. 13.4 pmol/l; P<0.01) and increased in patients with corpus CAG (11 vs. 24 pmol/l; P<0.05), but its accuracy was only acceptable in the case of corpus localization [area under the receiver operating characteristic curve (AUC), 74%]; PGII difference was almost statistically significant only when testing for corpus atrophy (33 vs. 21 μg/l; P=0.05; AUC=72%). The PGI and PGI/PGII ratio showed no significant differences (AUCs were all unacceptably low). Helicobacter pylori antibody levels were higher in H. pylori-infected patients (251 vs. 109 EIU, P=0.01; AUC=70). The accuracy of GastroPanel for the diagnosis of CAG was as follows: sensitivity 50%; specificity 80%; positive 25% and negative 92% predictive values; and positive 2.4 and negative 0.6 likelihood ratios.

Conclusion: GastroPanel is not accurate enough for the diagnosis of CAG; thus, its systematic use in clinical practice cannot be recommended.

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Related in: MedlinePlus

Pepsinogen II: area under the ROC curve (AUC) for the diagnosis of (a) antral atrophy; (b) corpus atrophy; (c) any atrophy; and (d) multifocal atrophy. ROC, receiver operating characteristic.
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Figure 4: Pepsinogen II: area under the ROC curve (AUC) for the diagnosis of (a) antral atrophy; (b) corpus atrophy; (c) any atrophy; and (d) multifocal atrophy. ROC, receiver operating characteristic.

Mentions: PGII levels were not significantly different among groups on the basis of histological diagnosis. Only in the case of corpus atrophy was the difference almost statistically significant (33 μg/l in corpus atrophy patients vs. 21 μg/l in the rest; P=0.05, difference in the means 11.2 μg/l, 95% CI=22.4–0.1 μg/l). ROC curves were developed for the diagnosis of atrophy in antrum, corpus, multifocal, and any location. AUCs were, respectively, 0.54, 0.72, 0.54, and 0.65 (Fig. 4). The best cut-off point was studied for the diagnosis of corpus atrophy (21.2 μg/l): sensitivity 75% (95% CI=65–84%), specificity 69% (95% CI=58–79%), positive 20.7% (95% CI=12–30%) and negative 96.2% (95% CI=92–100%) predictive values, and positive 2.4 (95% CI=1.4–4.0) and negative 0.4 (95% CI=0.1–1.22%) likelihood ratios.


Accuracy of GastroPanel for the diagnosis of atrophic gastritis.

McNicholl AG, Forné M, Barrio J, De la Coba C, González B, Rivera R, Esteve M, Fernandez-Bañares F, Madrigal B, Gras-Miralles B, Perez-Aisa A, Viver-Pi-Sunyer JM, Bory F, Rosinach M, Loras C, Esteban C, Santolaria S, Gomollon F, Valle J, Gisbert JP, Helicobacter pylori Study Group of Asociación Española de Gastroenterología (AE - Eur J Gastroenterol Hepatol (2014)

Pepsinogen II: area under the ROC curve (AUC) for the diagnosis of (a) antral atrophy; (b) corpus atrophy; (c) any atrophy; and (d) multifocal atrophy. ROC, receiver operating characteristic.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232299&req=5

Figure 4: Pepsinogen II: area under the ROC curve (AUC) for the diagnosis of (a) antral atrophy; (b) corpus atrophy; (c) any atrophy; and (d) multifocal atrophy. ROC, receiver operating characteristic.
Mentions: PGII levels were not significantly different among groups on the basis of histological diagnosis. Only in the case of corpus atrophy was the difference almost statistically significant (33 μg/l in corpus atrophy patients vs. 21 μg/l in the rest; P=0.05, difference in the means 11.2 μg/l, 95% CI=22.4–0.1 μg/l). ROC curves were developed for the diagnosis of atrophy in antrum, corpus, multifocal, and any location. AUCs were, respectively, 0.54, 0.72, 0.54, and 0.65 (Fig. 4). The best cut-off point was studied for the diagnosis of corpus atrophy (21.2 μg/l): sensitivity 75% (95% CI=65–84%), specificity 69% (95% CI=58–79%), positive 20.7% (95% CI=12–30%) and negative 96.2% (95% CI=92–100%) predictive values, and positive 2.4 (95% CI=1.4–4.0) and negative 0.4 (95% CI=0.1–1.22%) likelihood ratios.

Bottom Line: Helicobacter pylori antibody levels were higher in H. pylori-infected patients (251 vs. 109 EIU, P=0.01; AUC=70).The accuracy of GastroPanel for the diagnosis of CAG was as follows: sensitivity 50%; specificity 80%; positive 25% and negative 92% predictive values; and positive 2.4 and negative 0.6 likelihood ratios.GastroPanel is not accurate enough for the diagnosis of CAG; thus, its systematic use in clinical practice cannot be recommended.

View Article: PubMed Central - PubMed

Affiliation: aHospital of La Princesa, and Instituto de Investigación Sanitaria Princesa bCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain Gastroenterology Units of cHospital Mutua de Terrassa, Terrassa dHospital del Mar, Barcelona eHospital Rio Hortega, Valladolid fHospital de Cabueñes, Gijon gHospital Costa del Sol, Malaga hHospital San Jorge, Huesca iHospital Clínico de Zaragoza, Zaragoza jHospital Virgen de la Salud, Toledo.

ABSTRACT

Background: It has been suggested that GastroPanel might be a useful tool for the diagnosis of chronic atrophic gastritis (CAG) measuring four biomarkers in blood: basal gastrin-17 (G17), pepsinogen I and II (PGI and PGII), and Helicobacter pylori antibodies.

Aim: To determine the accuracy of GastroPanel for the diagnosis of CAG.

Methods: This was a prospective, blinded, multicenter study that included dyspeptic patients. G17, PGI, and PGII were determined by enzyme immunoassays. Three antrum and two corpus biopsies were obtained for standard histological analysis and rapid urease test. Biopsies were analyzed by a single blinded expert pathologist.

Results: Ninety-one patients were included (77% women, mean age 44 years, 51% H. pylori positive, 17% with CAG). G17 was reduced in patients with antrum CAG (5.4 vs. 13.4 pmol/l; P<0.01) and increased in patients with corpus CAG (11 vs. 24 pmol/l; P<0.05), but its accuracy was only acceptable in the case of corpus localization [area under the receiver operating characteristic curve (AUC), 74%]; PGII difference was almost statistically significant only when testing for corpus atrophy (33 vs. 21 μg/l; P=0.05; AUC=72%). The PGI and PGI/PGII ratio showed no significant differences (AUCs were all unacceptably low). Helicobacter pylori antibody levels were higher in H. pylori-infected patients (251 vs. 109 EIU, P=0.01; AUC=70). The accuracy of GastroPanel for the diagnosis of CAG was as follows: sensitivity 50%; specificity 80%; positive 25% and negative 92% predictive values; and positive 2.4 and negative 0.6 likelihood ratios.

Conclusion: GastroPanel is not accurate enough for the diagnosis of CAG; thus, its systematic use in clinical practice cannot be recommended.

Show MeSH
Related in: MedlinePlus