Evaluation of blood tests to predict normal gastric mucosa

Background: To determine the accuracy of blood tests in predicting normal g astric mucosa confirmed by histological examination of gastric biopsy speci mens. Methods: In total, 207 consecutive patients referred for upper endosc opy were included. Two biopsy specimens each from the antrum and corpus wer e assessed histologically for the presence of Helicobacter pylori, gastriti s, and atrophy. Serum samples were studied for H. pylori antibodies by enzy me immunoassay (Pyloriset EIA-G and EIA-A) and by a rapid latex agglutinati on test (Pyloriset Dry); pepsinogen I was measured by an immunoenzymometric assay (Gastroset PGI), gastrin by radioimmunoassay, and parietal cell anti bodies by indirect immunofluorescence. Results: In 101 (49%) of 207 patient s, the gastric mucosa on histologic examination was normal. In the 63 patie nts aged 45 years or less, H. pylori IgG serology was negative in all 47 pa tients with normal gastric mucosa and none had low serum pepsinogen I level s. Among 144 patients over age 45 years, 72 had negative H. pylori IgG sero logy. Combining the serum pepsinogen I assay with the results of H. pylori IgG serology, 12 patients with normal serology but low serum pepsinogen I w ere found. Thus, 60 patients, 52 of whom showed normal gastric histology, h ad normal IgG serology and serum pepsinogen I. In the remaining eight patie nts with normal blood tests, the histologic changes were very mild. Conclus ions: Although negative H. pylori IgG serology alone in younger patients, a nd in combination with normal serum pepsinogen I levels in older patients, reliably predicted the presence of normal gastric mucosa, gastroscopy is st ill recommended for patients over 45 years.