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Screening Markers for Chronic Atrophic Gastritis in Chiapas, Mexico¹

Division of Epidemiology, Department of Health Research and Policy [C. L., J. P.], and Division of Infectious Diseases and Geographic Medicine, Department of Medicine [J. P.], Stanford University, Stanford, California 94305; Instituto Nacional de Cancerologia, Mexico City 14000 Mexico [A. M., R. H-G.]; Instituto de Investigaciones Biomedicas, UNAM, Mexico City 14000 Mexico [A. M.]; Infectious Diseases Pathology Activity, Centers for Disease Control and Prevention, Atlanta, Georgia 30333 [J. G.]; Division Poblacion y Salud, El Colegio de la Frontera Sur, San Cristobal de las Casas, Chiapas 29290 Mexico [L. S. F.]

Intestinal-type gastric adenocarcinomas usually are preceded by chronic atrophic gastritis. Studies of gastric cancer prevention often rely on identification of this condition. In a clinical trial, we sought to determine the best serological screening method for chronic atrophic gastritis and compared our findings to the published literature. Test characteristics of potential screening tests (antibodies to Helicobacter pylori or CagA, elevated gastrin, low pepsinogen, increased age) alone or in combination were examined among consecutive subjects enrolled in a study of H. pylori and preneoplastic gastric lesions in Chiapas, Mexico; 70% had chronic atrophic gastritis. English-language articles concerning screening for chronic atrophic gastritis were also reviewed. Sensitivity for chronic atrophic gastritis was highest for antibodies to H. pylori (92%) or CagA, or gastrin levels >25 ng/l (both 83%). Specificity, however, was low for these tests (18, 41, and 22%, respectively). Pepsinogen levels were highly specific but insensitive markers of chronic atrophic gastritis (for pepsinogen I<25 µg/l, sensitivity was 6% and specificity was 100%; for pepsinogen I:pepsinogen II ratio <2.5, sensitivity was 14% and specificity was 96%). Combinations of markers did not improve test characteristics. Screening test characteristics from the literature varied widely and did not consistently identify a good screening strategy. In this study, CagA antibodies alone had the best combination of test characteristics for chronic atrophic gastritis screening. However, no screening test was both highly sensitive and highly specific for chronic atrophic gastritis.

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