Non-Invasive Diagnosis of Gastroesophageal Reflux Disease Using Gastrin- and Pepsinogen-Based Tests

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Abstract

Gastrin-17 (G-17), pepsinogen-1 (Pg1) and pepsinogen-2 (Pg2) reflect the functional state of gastric mucosa and are used for non-invasive diagnosis and screening of atrophic gastritis. The aim of the study was to clarify if erosive reflux disease (ERD) or non-ERD (NERD) can be distinguished from other dyspeptic conditions in patients, in a non-invasive manner using specific biomarkers. Levels of G-17, Pg1, and Pg2 were measured in 141 ERD patients (median age 48 years, males — 68), 122 NERD patients (median age 45 years, males — 32) and 410 control patients (median age 50 years, males — 97). Levels of biomarkers in ERD and NERD groups were compared to controls. Median levels of G-17 (1.94 vs 2.92 pmol/L, p = 0.036) and Pg2 (6.70 vs 7.79 µg/l, p = 0.046) were lower in the ERD group compared to control patients; no difference with respect to the control was found for the NERD group. After exclusion of the patients having at least one potential condition that might modify the levels of the biomarkers (gastric mucosa atrophy, Helicobacter pylori colonisation), no difference in levels of biomarkers was observed with respect to the control for both the ERD and NERD groups. G-17, Pg1, and Pg2 based tests cannot be used to distinguish ERD or NERD from other dyspeptic conditions in patients.

Abe, Y., Iijima, K., Koike, T., Asanuma, K., Imatani, A., Ohara, S., Shimosegawa, T. (2009). Barrett’s esophagus is characterized by the absence of Helicobacter pylori infection and high levels of serum pepsinogen I concentration in Japan. J. Gastroenterol. Hepatol., 24 (1), 129–134.

Collen, M. J., Johnson, D. A. (1992). Correlation between basal acid output and daily ranitidine dose required for therapy in Barrett’s esophagus. Digestive Dis. Sci., 37 (4), 570–576.

Dixon, M. F., Genta, R. M., Yardley, J. H., Correa, P. (1996). Classification and grading of gastritis. The updated Sydney System. International workshop on the histopathology of gastritis, Houston 1994. Amer. J. Surg. Pathol., 20 (10), 1161–1181.

Dockray, G. J. (2004). Clinical endocrinology and metabolism. Gastrin. Best Practice Res. Clin. Endocrin. Metab., 18 (4), 555–568.

Fujiwara, Y., Higuchi, K., Shiba, M., Yamamori, K., Watanabe, Y., Sasaki, E., Tominaga, K., Watanabe, T., Oshitani, N., Arakawa, T. (2005). Differences in clinical characteristics between patients with endoscopy-negative reflux disease and erosive esophagitis in Japan. Amer. J. Gastroenterol., 100 (4), 754–758.

Gritti, I., Banfi, G., Roi, G. S. (2000). Pepsinogens: Physiology, pharmacology pathophysiology and exercise. Pharmacol. Res., 41 (3), 265–281.

Iijima, K., Abe, Y., Kikuchi, R., Koike, T., Ohara, S., Sipponen, P. (2009). Serum biomarker tests are useful in delineating between patients with gastric atrophy and normal, healthy stomach. World J. Gastroenterol., 15 (7), 853–859.

Katz, P., Gerson, L. B., Vela, M. F. (2013). Guidelines for the diagnosis and management of gastroesophageal reflux disease. Amer. J. Gastroenterol., 108 (3), 308–328.

Kuipers, E. J. (2003). In through the out door: Serology for atrophic gastritis. Eur. J. Gastroenterol. Hepatol., 15 (8), 877–879.

Lundell, L. R., Dent, J., Bennett, J. R., Blum, A. L., Armstrong, D., Galmiche, J. P., Johnson, F., Hongo, M., Richter, J. E., Spechler, S. J., Tytgat, G. N., Wallin, L. (1999). Endoscopic assessment of eosophagitis: clinical and functional correlates and futher validation of the Los Angeles classification. Gut, 45 (2), 172–180.

Minatsuki, C., Yamamichi, N., Shimamoto, T., Kakimoto, H., Takahashi, Y., Fujishiro, M., Sakaguchi, Y., Nakayama, C., Konno-Shimizu, M., Matsuda, R., Mochizuki, S., Asada-Hirayama, I., Tsuji, Y., Kodashima, S., Ono, S., Niimi, K., Mitsushima, T., Koike, K. (2013). Background factors of reflux esophagitis and non-erosive reflux disease: A cross-sectional study of 10,837 subjects on Japan. PLOS ONE, 8 (7). DOI: 10.1371/journal.pone.0069891.

Monkemuller, K., Neumann, H., Nocon, M., Vieth, M., Labenz, J., Willich, S. N., Stolte, M., Hocker, M., Jaspersen, D., Lind, T., Malftheiner, P. (2008). Serum gastrin and pepsiongens do not correlate with the different grades of severity of gastro-oesophageal reflux disease: A matched case-control study. Alimentary Pharmacol. Ther., 28 (4), 491–496.

Mulholland, N. M., Reid, B. J., Levine, D. S., Rubin, C. E. (1989). Elevated gastric acid secretion in patients with Barrett’s metaplastic epithelium. Digest. Dis. Sci., 34 (9), 1329–1334.

Narsollahzadeh, D., Aghcheli, K., Sotoudeh, M., Shakeri, R., Persson, E. C., Islami, F., Kamangar, F., Abnet, C. C., Boffetta, P., Engstrand, L., Dawsey, S. M., Malekzadeh, R., Ye, W. (2011). Accuracy and cut-off values of pepsinogens I, II and gastrin 17 for diagnosis of gastric fundic atrophy: Influence of gastritis. PLOS ONE, 6 (10). DOI: 10.1371/journal.pone.0026957.

Pasechnikov, V. D., Chukov, S. Z., Kotelevets, S. M., Mostovov, A. N., Mernova, V. P., Polyakova, M. B. (2005). Invasive and non-invasive diagnosis of Helicobacter pylori-associated atrophic gastritis: A comparative study. Scand. J. Gastroenterol., 40 (3), 297–301.

Peitz, U., Wex, T., Vieth, M., Stolte, M., Willich, S., Labenz, J., Jaspersen, D., Lind, T., Malfertheiner, P. (2011). Correlation of serum pepsinogens and gastrin-17 with atrophic gastritis in gastroesophageal reflux patients: A matched-pairs study. J. Gastroenterol. Hepatol., 26 (1), 82–89.

Sipponen, P., Vauhkonen, M., Helske, T., Kaariainen, I., Harkonen, M. (2005). Low circulating levels of gastrin-17 in patients with Barrett’s esophagus. World J. Gastroenterol., 11 (38), 5988–5992.

Tack, J., Talley, N. J., Camilleri, M., Holtmann, G., Hu, P., Malagelada, J.-R., Stanghellini, V. (2006). Functional gastroduodenal disorders. Gastroenterology, 130 (5), 1466–1479.

Vaananen, H., Vauhkonen, M., Helske, T., Kaariainen, I., Rasmussen, M., Tunturi-Hihnala, H., Koskenpato, J., Sotka, M., Turunen, M., Sandstrom, R., Ristikankare, M., Jussila, A., Sipponen, P. (2003). Non-endoscopic diagnosis of atrophic gastritis with a blood test. Correlation between gastric histology and serum levels of gastrin-17 and pepsinogen I: A multicentre study. Eur. J. Gastroenterol. Hepatol., 15 (8), 885–891.

Yoshikawa, I., Murata, I., Kume, K., Kanagawa, K., Hirohata, Y., Nakamura, H., Otsuki, M. (2002). Serum pepsinogen can predict response to H2-receptor antagonist in patients with functional dyspepsia. Alimentary Pharmacol. Ther., 16 (10), 1805–1809.

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CiteScore 2017: 0.22

SCImago Journal Rank (SJR) 2017: 0.127
Source Normalized Impact per Paper (SNIP) 2017: 0.211

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