SEROLOGICAL TESTING IN MANAGEMENT OF DYSPEPTIC PATIENTS AND IN SCREENING OF GASTRIC CANCER RISKS

The two major risk factors of gastric cancer (GC) are Helicobacter pylori (HP) infection and Atrophic gastritis (AG). It is currently possible to diagnose HP gastritis and AG reliably by using serological testing with a marker panel (GastroPanel, Biohit Oyj, Finland) of pepsinogen-I (PGI), pepsinogen-II (PGII), gastrin-17 (G-17) and HP-antibodies. In this short review, the authors make an introduction to the GastroPanel test as the first non-invasive diagnostic tool of stomach health and disease. The major areas of the test application, i.e., 1. In the first-line diagnosis of dyspeptic symptoms, and 2. In screening of the GC risks (HP and AG) are presented. ??A short reference is made to the most recent studies validating the use of GastroPanel in different settings, including a summary of a timely meta-analysis summarizing the whole GastroPanel literature. ??Pepsinogen levels and their ratio is decreased in corpus atrophy, accompanied by elevated G-17. G-17 level also gives indication of gastric acid secretion, being low with high acid output and high when stomach is acid-free (due to PPI treatment or AG). In antrum atrophy, G-17 is low and does not respond to protein stimulation (lack of G-cells). The two main indications of GastroPanel test are: 1. First-line diagnostic test for dyspeptic complaints, and 2. Screening of asymptomatic subjects for risks of GC (HP and AG). ??GastroPanel is a test for stomach health, with excellent longitudinal negative predictive value. On the other hand, abnormal test results implicating AG do predict a significantly increased long-term risk for GC. The first meta-analysis of GastroPanel literature corroborates the statement of an international expert panel, advocating the use of GastroPanel in diagnosis and screening of AG. Noteworthy, the risk of autoimmune AG is markedly increased in patients suffering from other autoimmune diseases, including type-I diabetes, autoimmune thyroiditis, rheumatoid arthritis, inflammatory bowel disease (IBD), celiac disease and systemic lupus erythematosus. Altogether, 95 million people are estimated to suffer from these diseases in Europe alone.