Ei dian otsikkoa

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GastroPanel Examination
Prof. Pentti Sipponen, M.D., PhD Jorvi Hospital,
Finland
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Male, 54 years (KP) - dyspeptic symptoms. Some
help from PPI
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Male, 54 years (KP) - dyspeptic symptoms. Some
help from PPI Test results Hp-Ab 87
G-17basal 65 pmol/l G-17prand 124 pmol/l
PGI 2.6 mg/l Diagnosis Chronic H.pylori
gastritis with advanced, severe corpus atrophy
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Male, 54 years (KP) - dyspeptic symptoms. Some
help from PPI Test results Hp-Ab 87
G-17basal 65 pmol/l G-17prand 124 pmol/l
PGI 2.6 mg/l Diagnosis Chronic H.pylori
gastritis with advanced, severe corpus
atrophy Clinical considerations Acid output is
nil why the PPI? No risk for peptic ulcer,
but the cancer risk is increased. Gastroscopy is
mandatory!! Risk of low vitamin B12 and high
serum homocysteine. The treatment of H.pylori is
recommended (Maastricht 2000).
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Serum biomarkers - Biohit
GastroPanel
esophagus
Pepsinogen I or Pepsinogen I / II ratio -
biomarker of corpus (oxyntic mucosa)
Gastrin - 17 - biomarker of antrum (antral G
cells)
pylorus
Helicobacter pylori (IgG, IgA) - biomarker of
gastritis
THE ASSAYS FORM A PANEL
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Atrophy Loss of normal glands ________________
_ Corpus mucosa loss of oxyntic
glands loss of secretion
of Pepsinogens
acid and intrinsic factor,
loss of chief
cells Antral mucosa Loss of antral
Gastrin-17 (pyloric) glands, loss
of G cells loss
of secretion of gastrin-17 _______________________
_
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Gastrin Acid Feedback Control Mechanism
Gastrin-17

oxyntic glands

antral G cells
Acid
Food, amino acids
-


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Most of the patients with atrophic gastritis have
an on-going H.pylori infection
HIGH ACID
LOW ACID
H.pylori
large parietal
small parietal
cell mass
cell mass - IL1b
non-atrophic
non-atrophic
cancer risk
ulcer risk
atrophic
atrophic
Hp gt70
Hp 100
Antral predominant
Corpus predominant or
(atrophic) gastritis
multifocal (atrophic) gastritis
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Atrophic corpus gastritis Low acid output (PAO,
MAO) and low serum pepsinogen I
N S A1 A2-A3
N S A 1 A2-A3
Serum pepsinogen I mg/L
Peak acid output mEq/hr
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• Atrophic Gastritis (AG)
  Loss of cells - Loss of function -
  Loss of integrity
• Antrum-limited gastritis or antral AG - normal
  acid output ulcer risk cancer risk risk of GE
  reflux disease
• Corpus AG hypochlorhydria high gastrin (if
  antrum is non-atrophic) malabsorption of
  vitamin B12 low serum folate overgrowth of
  bacteria risk of intestinal infections cancer
  risk
• Corpus AG - low B12 high tissue
  homocysteine errors in methionine metabolism
  (The Methylation Cycle)

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Corpus-predominant gastritis
12
Antral-predominant gastritis
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• Atrophic Gastritis - Diagnosis
• Endoscopy - biopsies necessary for proper
  diagnosis
• Blood tests - Pepsinogen I and II, Gastrin-17,
  H.pylori Biohit GastroPanel

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Atrophic corpus gastritis Biohit GastroPanel
Stomach is hypo- or achlorhydric high risk for
cancer, pernicious anaemia, low vitamin B12 and
high homocysteine. No risk for peptic ulcer
Pepsinogen I or Pepsinogen I / II ratio - LOW
Gastrin - 17 - HIGH
Helicobacter pylori - PRESENT atrophic
gastritis is CAUSED BY
H.pylori
ABSENTatrophic gastritis is
AUTOIMMUNE
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Corpus limited atrophy High serum/plasma
gastrin
Total gastrin pmol/l
S-G-17prand pmol/l
300
N S A1 A2-A3
0
200
100
plt0.001
median 12
0
n 24 30
Normal Corpus atrophy

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Atrophic gastritis both in antrum and corpus
Multifocal atrophic gastritis Biohit GastroPanel
Stomach is hypo- or achlorhydric high risk for
cancer, pernicious anaemia, low vitamin B12 and
high homocysteine. No risk for peptic ulcer
Pepsinogen I or Pepsinogen I / II ratio - LOW
Gastrin - 17 - LOW
Helicobacter pylori - PRESENT atrophic
gastritis is CAUSED BY
H.pylori
ABSENTatrophic gastritis is
AUTOIMMUNE
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Atrophic antral gastritis Gastrin-17 tends
to decrease
75
Mean (SD) S 27.8 (26.7) A1 26.7
(40.6) A2 8.6 (11.9) A3 4.7 (4.4)
50
Serum gastrin-17prand pmol/l
25
0
N 70 21
6 3
S A1 A2 A3
Antral atrophy
Snon-atrophic gastritis, A1-A3mild, moderate or
severe atrophic gastritis
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Atrophic antral gastritis or Antrum predominant
gastritis Biohit GastroPanel
Stomach is normo- or hyperacid high risk for
peptic ulcer (DU in particular) disease and
cancer, risk of GE reflux disease
Pepsinogen I or Pepsinogen I / II ratio -
NORMAL
Gastrin - 17 - LOW
Helicobacter pylori - PRESENT ALWAYS atrophic
gastritis is CAUSED BY H.pylori
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Non-atrophic gastritis Biohit GastroPanel
Stomach is normo- or hyperacid low risk for
peptic ulcer disease or cancer
Pepsinogen I or Pepsinogen I / II ratio -
NORMAL
Gastrin - 17 - NORMAL
Helicobacter pylori - PRESENT
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Stomach is normal and healthy !!! Biohit
GastroPanel
No risk for peptic ulcer (if NSAIDs are not used)
or cancer
Pepsinogen I or Pepsinogen I / II ratio -
NORMAL
Gastrin - 17 - NORMAL
Helicobacter pylori - ABSENT
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Prospective Finnish Multicentre Study
S-G-17prand (Eur J Gastroenterol
Hepatol 2003)

Endoscopy and histology
R AC C

A
S N Tot
Panel A
10
4
0
29
0
11
4
AC
0
2
1
1
9
3
2
C
1
0
1
32
0
1
35
S
2
0
0
2
81
10
95
3
0
0
4
22
207
236
N
Tot
16
6
4
40
115
223
404
Abbreviations Amoderate or severe atrophy in
antrum alone ACmoderate or severe atrophy in
both antrum and corpus Cmoderate or severe
atrophy in corpus alone Snon-atrophic
gastritis Nnormal Rresected antrum
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Gastric cancer or praecancer is found in 5 of
elderly men with advanced atrophic
gastritisSetti-Study 1,344 men with S-PGI
lt25 mg/l
__________________________________________ Type
of lesion No ___________________________________
_______________ DYSPLASIA 49 78 low
grade 42 67 high grade 7 11 CARCINOMA 11 17 e
arly 7 11 advanced 4 6 CARCINOID
TUMOR 3 5 TOTAL 63 100 _________________________
__________________________
Varis et al. SJG 2000
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Atrophic corpus gastritis Output of intrinsic
factor will decrease malabsorption of vitamin
B12
N S A1 A2-A3
Intrinsic factor output U/kg/hr
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The Methylation Cycle
failures in methylation reactions in every cell ,
in brain and nerve cells in particular!!
methionine synthase needs vitamin B12 as a
cofactor !!
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Low vitamin B12 (and high serum homocysteine) is
found in half of the subjects with atrophic
corpus gastritis
Finnish male population at age of 51-65 years
corpus atrophy present
corpus atrophy absent
m
³
m
PGI lt25
g/l
PGI 50

g/l
2
2
7
28
17
48
B12 pmol/l
73
lt170
170-219
220-599
22
³

600
N 613
402
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Atrophic gastritis is a treatable disease with
serious clinical and biological consequences
!! Blood test (GastroPanel) is an alternative in
diagnosis of gastritis and atrophic gastritis if
endoscopy is not done
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Biohit GastroPanel provides the diagnosis of -
functional vs. Organic dyspepsia (healthy mucosa
or not) - H.pylori infection- atrophic
gastritis and its topographic type (atrophy in
antrum, corpus or both) GastroSoft report warns
the risks of - gastric cancer
-
peptic ulcer diseases
- gastroesophageal reflux
disease and Barrett - B-vitamin
malabsorption and high homocysteine
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• Biohit GastroSoft provides recommendations
• - treatment of H.pylori infection
  -
  endoscopy and biopsy in subjects at risk for
  serious gastric diseases
  
  - measurement of vitamin B12 and
  homocysteine - follow-ups with
  GastroPanel (healing of atrophy)
• GastroPanel and GastroSoft are applicable in
• - primary diagnostics, in primary care in
  particular
  -
  screening of subjects at risk for gastric
  diseases
  - preventing gastric diseases (cancer,
  peptic ulcer, vitamin B12 deficiency, and
  diseases related to high
  homocysteine) in risk groups