Functional Dyspesia: Functional Dyspepsia and serology

Functional Dyspesia

Functional Dyspepsia and serology

Authors

  • Pellegrino Crafa Department of Medicine and Surgery, University of Parma, Parma, Italy
  • Marilisa Franceschi Endoscopy Unit, Department of Medicine, ULSS7 Pedemontana, Hospital AltoVicentino, Santorso (VI), Italy
  • Kryssia Isabel Rodriguez Castro Endoscopy Unit, Department of Medicine, ULSS7 Pedemontana, Hospital AltoVicentino, Santorso (VI), Italy
  • Alberto Barchi Department of Medicine and Surgery, University of Parma, Parma, Italy
  • Michele Russo Department of Medicine and Surgery, University of Parma, Parma, Italy
  • Lorella Franzoni Department of Medicine and Surgery, University of Parma, Parma, Italy
  • Antonio Antico Laboratory of Clinical Pathology, ULSS7 Pedemontana, Hospital AltoVicentino, Santorso (VI), Italy
  • Gianluca Baldassarre Endoscopy Unit, Department of Medicine, ULSS7 Pedemontana, Hospital AltoVicentino, Santorso (VI), Italy
  • Maria Piera Panozzo Laboratory of Clinical Pathology, ULSS7 Pedemontana, Hospital AltoVicentino, Santorso (VI), Italy
  • Francesco Di Mario Department of Medicine and Surgery, University of Parma, Parma, Italy

Keywords:

Dyspepsia, pepsinogens, gastrin, helicobacter pylori, gastritis, noninvasive markers

Abstract

Dyspepsia is a functional GI disorder consisting in a wide range of symptoms. The main diagnostic challenge has been whether to perform an EGD or an abdominal US in order not to miss organic lesions, but to avoid unnecessary and sometimes invasive tests. Pepsinogen serology has been proposed as an useful non-invasive test to explore the status of the gastric mucosa, suggesting this strategy as an adequate approach in management of dyspepsia. In a primary care setting, 266 dyspeptic patients were investigated to establish the proper diagnosis. The workup included upper GI endoscopy with biopsies, a structured questionnaire including type and severity of symptoms, serological determination of serum pepsinogens, gastrin 17 and IgG against Hp. Inclusion criteria were dyspeptic symptoms (epigastric pain, nausea and/or vomiting, post prandial fullness, early satiation) lasting more than 1 year and the association between symptoms and food ingestion.. Helicobacter pylori infection was present in 114 subjects, characterized by high levels of pepsinogen II and IgG against Hp. Twenty subjects were classified according with the diagnosis of chronic body atrophic gastritis. Nausea and post prandial fullness were the most frequent symptoms (48% and 41%, respectively) in the studied population, followed by epigastric pain and early satiation (37% and 26% respectively). A diagnosis of normality by serological diagnosis was found in half of patients experiencing epigastric pain and in about 60% of subjects with the three other symptoms (nausea, post prandial fullness, and early satiation). In conclusion, this experience confirms the clinical usefulness of serology in dyspepsia, contributing to correctly diagnosing CAG and H.p. infection in such patients and providing a good correlation with the clinical picture.

References

1) Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P, Malagelada JR, Stanghellini V. Functional Gastroduodenal Disorders Gastroenterology. 2006 Apr;130(5):1466-79
2) Stanghellini V., 1 , Chan F.K. .L 2 , Hasler W. L et al. Gastroduodenal Disorders. Gastroenterology 2016 May;150 (6):1380-92.
3) Malfertheiner P., Megraud F., O’Morain C. et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007 Jun; 56(6):772-81.
4) Malfertheiner P., Megraud F., O’Morain C. et al. Management of Helicobacter pylori infection—the Maastricht V/Florence consensus report. Gut 2017 66: 6-30.
5) Tack J., Talley J.N., Camilleri M. et al. Functional gastroduodenal disorders. Gastroenterology 2006; 130.5: 1466-1479.
6) Igarashi M., Nagano J., Tsuda A., et al. Correlation between the Serum Pepsinogen I Level and the Symptom Degree in Proton Pump Inhibitor-Users Administered with a Probiotic. Pharmaceuticals (Basel). 2014 Jun 25;7(7):754-64.
7) Monkemuller K., Neumann H., Nocon M. et al. Serum gastrin and pepsinogens do not correlate with the different grades of severity of gastro-oesophageal reflux disease: A matched case-control study. Aliment. Pharmacol. Ther. 2008, 28, 491–496.
8) Väänänen H, Vauhkonen M, Helske T, et al. Nonendoscopic diagnosis of atrophic gastritis with a blood test. Correlation between gastric histology and serum levels of gastrin-17 and pepsinogen I: a multicentre study. Eur J Gastroenterol Hepatol, 2003 15: 885-891.
9) Germanà, B., Di Mario, F., Cavallaro L.G. et al. Clinical usefulness of serum pepsinogens I and II, gastrin-17 and anti-Helicobacter pylori antibodies in the management dyspeptic patients in primary care. Dig. Liver Dis. 2005, 37, 501–508.
10) IARC monographs on the evaluation of carcinogenic risks to humans. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Schistosomes, liver flukes and Helicobacter pylori. Lyon: International Agency for Research on Cancer, 1994; 61: 218-220
11) Valle J, Kekki M, Sipponen P, Ihamaki T, Siurala M. Longterm course and consequences of Helicobacter pylori gastritis. Results of a 32-year follow-up study. Scand J Gastroenterol 1996; 31: 546-550
12) Maaroos HI, Vorobjova T, Sipponen P, et al. An 18-year follow-up study of chronic gastritis and Helicobacter pylori association of CagA positivity with development of atrophy and activity of gastritis. Scand J Gastroenterol 1999; 34: 864-869
13) Sipponen P, Kekki M, Haapakoski J, Ihamaki T, Siurala M. Gastric cancer risk in chronic atrophic gastritis: statistical calculations of cross-sectional data. Int J Cancer 1985; 35:173-177
14) Uemura N, Okamoto S, Yamamoto S, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 2001; 345: 784-789
15) Correa P, Haenszel W, Cuello Cet al. Gastric precancerous process in a high-risk population: cohort follow-up. Cancer Res 1990; 50: 4737-4740
16) Filipe MI, Munoz N, Matko I, et al. Intestinal metaplasia types and the risk of gastric cancer: a cohort study in Slovenia. Int J Cancer 1994; 57: 324-329
17) Ohata H, Kitauchi S, Yoshimura N, et al. Progression of chronic atrophic gastritis associated with Helicobacter pylori infection increases risk of gastric cancer. Int J Cancer 2004; 109: 138-143
18) Wong BC, Lam SK, Wong WM, et al. Helicobacter pylori to prevent gastric cancer in high risk region of China: a randomized control trial. Jama 2004; 291: 187-194
19) Sipponen P, Seppala K, Aarynen M, Helske T, Kettunen P. Chronic gastritis and gastroduodenal ulcer: a case control study on risk of coexisting duodenal or gastric ulcer in patients with gastritis. Gut 1989; 30: 922-929
20) Sugano K, Tack J, Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015 Sep;64(9):1353-67.
21) Rugge M, 1 , Meggio A., Pennelli G., et al. Gastritis Staging in Clinical Practice: The OLGA Staging System Gut 2007;56:631-636
22) Oksanen A, Sipponen P, Miettinen A, Sarna S and Rautelin H. Evaluation of bood tests to normal gastric mucosa. Scand J Gastroenterol, 2000 35: 791-795.
23) Syrjänen KJ, Sipponen P, Härkönen M, Peetsalu A and Korpela S. Accuracy of Gastropanel testing in detection of atrophic gastritis. Eur J Gastroenterol Hepatol, 2015 27: 102-104.
24) Syrjänen K. A Panel of Serum Biomarkers (Gastropanel®) in Non-invasive Diagnosis of Atrophic Gastritis. Systematic Review and Meta-analysis. Anticancer Res. 2016 Oct;36(10):5133-5144.
25) Agréus L, Kuipers EJ, Kupcinskas L, et al. Rationale in diagnosis and screening of atrophic gastritis with stomach-specific plasma biomarkers. Scand J Gastroenterol, 2012 47: 136-147.
26) Zagari RM1, Rabitti S1, Greenwood DC2, Eusebi LH1, Vestito A3, Bazzoli F1. Systematic review with meta-analysis: diagnostic performance of the combination of pepsinogen, gastrin-17 and anti-Helicobacter pylori antibodies serum assays for the diagnosis of atrophic gastritis. Aliment Pharmacol Ther. 2017 Oct;46(7):657-667
27) Samloff IM, Varis K, Ihamaki T, Siurala M and Rotter JI. Relationships among serum pepsinogen I, serum pepsinogen II, and gastric mucosal histology. A study in relatives of patients with pernicious anemia. Gastroenterol, 1982 83: 204-209.
28) Chawla YK, Irshad M, Chawla TC, Nundy S, Tandon BN. Urinary uropepsinogen in patients with dyspepsia. J Assoc Physicians India. 1986 Dec;34(12):851-2.
29) Aggarwal SP1, Walia DJ, Chawla LS. Serum pepsinogen levels in patients with gastro-duodenal lesions. J Assoc Physicians India. 1994 Sep;42(9):713-4
30) Song H1, Held M2, Sandin S3,et al. Increase in the Prevalence of Atrophic Gastritis Among Adults Age 35 to 44 Years Old in Northern Sweden Between 1990 and 2009. Clin Gastroenterol Hepatol. [Epub 2015 Apr 6] 2015 Sep;13(9):1592-600.e1
31) Reshetnikov OV, Kurilovich SA, Bobak M, Maliutina SK, Pylenkova ED. Gastrointestinal symptoms in adult population of Novosibirsk city: prevalence and risk factors Ter Arkh. 2009;81(2):11-6.
32) Iijima K1, Abe Y, Kikuchi R, et al..Serum biomarker tests are useful in delineating between patients with gastric atrophy and normal, healthy stomach World J Gastroenterol 2009 February 21; 15(7): 853-859
33) Tahara T, Shibata T, Okubo M, et al. Examination of serum pepsinogen in functional dyspepsia. Hepatogastroenterology. 2012 Nov-Dec;59(120):2516-22.
34) Kawamura Y1, Funaki Y2, Yoshimine T1, et al. Characteristics and Predictive Factor of Helicobacter pylori-Associated Functional Dyspepsia in Japanese Patients. Digestion. 2019;100(4):277-285.
35) Benberin V, Bektayeva R, Karabayeva R et al.Prevalence of H. pylori infection and atrophic gastritis among asymptomatic and dyspeptic adults in Kazakhstan. A Hospital-Based screening with a panel of serum biomarkers. Anticancer Res, 2013 33: 4595-4602

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Published

07-09-2020

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ORIGINAL ARTICLES

How to Cite

1.
Crafa P, Franceschi M, Rodriguez Castro KI, et al. Functional Dyspesia: Functional Dyspepsia and serology. Acta Biomed. 2020;91(3):e2020069. doi:10.23750/abm.v91i3.10150