HELICOBACTER-PYLORI GASTRITIS AND SERUM PEPSINOGEN LEVELS IN A HEALTHY POPULATION - DEVELOPMENT OF A BIOMARKER STRATEGY FOR GASTRIC ATROPHYIN HIGH-RISK GROUPS

This study aimed to estimate the prevalence and type of chronic gastri tis is an asymptomatic working population and to determine whether a c ombination of serum pepsinogen levels and Helicobacter pylori serology could be used to identify a subgroup with atrophic gastritis at eleva ted risk of gastric carcinoma. A 10% subsample of 544 male volunteer f actory workers aged 18-63 years and participating in a larger study un derwent endoscopy and biopsy. Of these men, 29 were seropositive for H elicobacter pylori; all but three (89.7%) had chronic gastritis. Serum pepsinogen A levels increased with progression from a corpus predomin ant pattern of gastritis through pangastritis to an antral predominant pattern. Nine subjects had corpus atrophy, which was in most cases ac companied by fasting hypochlorhydria and hypergastrinaemia. A combinat ion of pepsinogen A below 80 ng ml(-1) and Helicobacter pylori seropos itivity detected corpus atrophy with sensitivity 88.9% and specificity 92.3%. A second screening stage, using a pepsinogen: A/C ratio of bel ow 2.5 as a cut-off, resulted in a reduction in numbers requiring furt her investigation but with some loss of sensitivity (77.8%). Applicati on of this two-stage screening programme to the original sample of 544 workers would have resulted in 11 (2.2%,) men being selected for foll ow-up, excluding 25 (5.1%) false negatives. Our results suggest that a combination of serum pepsinogen levels and Helicobacter py[ori serolo gy could be useful as a biomarker strategy for detection of individual s at increased risk of gastric carcinoma and for non-invasive investig ation of the natural history of Helicobacter pylori gastritis.