MAY SERUM TESTS HELP IN SELECTING PATIENTS FOR A REGASTROSCOPY?

Objective: We have previously shown that the presence of abnormal macroscopical findings at earlier gastrocopy was among the best indicators of abnormal macroscopical findings at regastroscopy. In the present study we evaluated whether serum tests could help to select patients with for regastroscopy. Materials and Methods: Serum H. pylori antibodies of the IgG class, pepsinogens I and II, and gastrin -17 were analyzed for 190 patients without alarm symptoms undergoing regastroscopy. For 126 patients, an earlier gastroscopy report showing a normal finding was available. Associations between serum tests and macroscopical and histological findings at gastroscopy were analyzed. Results: If patients with normal earlier gastroscopy had been selected for regastroscopy on basis of positive H. pylori serology or low pepsinogen I, 82 of the 126 gastroscopies performed (65%) would have been saved. However, in that case 19/25 patients with an abnormal macroscopical finding and four of 17 patients with moderate or severe atrophic gastritis had been missed. If patients had been selected for regastroscopy on the basis of positive H. pylori antibodies, low pepsinogen I, or low serum gastrin-17, 57 gastroscopies (45%) had been saved, but still 13/25 with an abnormal macroscopical finding and two of 17 patients with atrophic gastritis would have been missed. Macroscopical findings and isolated atrophic gastritis of the antrum could not be detected by serum tests. Conclusions: Among typical patients in Western countries, with a low prevalence of H. pylori infection and atrophic gastritis, usefulness of serum tests to select patients for regastroscopy is limited.