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A comparative study of two methods of serological screening of atrophic gastritis.

Introduction

Prevention of gastric cancer has been practiced in many countries in the latest years. In world literature, there is information that 5,229 people in Germany and 2,184 people in China have undergone serological screening in order to detect gastric cancer; in Japan, in the prefecture of Kyoto 1,011 men and 1,848 women have been examined for markers of gastric precancerous changes, 1,000 people have been examined in Sweden, 4,256 people in Finland [1-6]. In Magdeburg, 6,215 people have undergone serological screening [3]. In addition to that, from among those who have undergone serological screening, in the group of patients with gastric precancerous changes with following gastrointestinal endoscopy observation, early gastric cancer was detected among two out of 2,184 Chinese. In Japan early gastric cancer was detected over a period of several years among 33 men out of 1,011 and 28 women out of 1,848 with endoscopic observation of patients with gastric precancerous changes [4,5]. During serological screening, several markers of gastric precancerous changes are used. It is reported that in Germany such serological markers as pepsinogen-1 (PG-1) less than 70 ng/ml and pepsinogen-1/pepsinogen-2 ratio (PG-1/PG-2) less than three have been successfully used in the diagnostics of atrophic gastritis among 5,229 men and women [6]. On the basis of histological and serological comparison, 458 patients in China have been given a high estimation of such serological markers of gastric precancerous changes as gastrin-17 (G-17), PG-1 and PG-2 [7]. British scientists from Glasgow, having examined 255 patients, propose to use the PG-1/PG-2 ratio to estimate gastric antral atrophy [8]. Italians definitely propose to use G-17 as the criterion of gastric antral atrophy when its level is decreasing [9]. Germana et al. also regard G-17 as the criterion of gastric antral atrophy and pepsinogen as the criterion of gastric corpus atrophy [10].

The studies of different authors, conducted over a period of two decades, have corroborated that gastric corpus atrophy can successfully be detected by means of the detection of serum concentrations PG-1 or of the ratio PG-1/PG-2 [11-16]. Pasechnikov et al. have proposed to use postprandial serum G-17 as a highly sensitive and highly specific marker of gastric antral atrophy, and PG-1 as the criterion of gastric corpus atrophy [17-20].

Materials and Methods

Ethics

This work has been carried out in accordance with the Declaration of Helsinki (2000) of the World Medical Association. This study was approved ethically by the Ethical committee of North Caucasian humanitarian-technological academy (Protocol No. 2. Date--18.03.2014). All patients provided informed written consent.

Materials

As a result of the work on serological screening of atrophic gastritis for markers of mucosal atrophy of the body and antrum of the stomach, as well as the ratio pepsinogen-1/pepsinogen-2, 1,072 people have been examined in the Republic of Karachaevo-Cherkessia. People who applied for any reason to clinics and health centers of Cherkessk and other areas of the Karachaevo-Cherkessia Republic were sent to serological screening in accordance with the following selection criteria: age 40 and older, and the presence of informed consent for clinical research.

Methods

Markers of mucosal atrophy of the corpus and antrum of the stomach, as well as the ratio pepsinogen-1 (PG-1)/pepsinogen-2 (PG-2), were determined using a test panel for immunoassay "GastroPanel". The set "Gastropanel" (produced by the Finnish company "Biohit") included: a marker of mucosal atrophy antrum--gastrin-17 (G-17), a marker of mucosal atrophy of the corpus of the stomach--Pepsinogen-1 (PG-1), a marker of mucosal atrophy--the ratio pepsinogen-1/ pepsinogen-2 (PG-1/PG-2). As a result of screening to determine the following groups of patients: severe antral mucosa atrophy, moderate antral mucosa atrophy, mild antral mucosa atrophy, severe corpus mucosa atrophy, and other respondents of noninvasive screening of atrophic gastritis, the following criteria were used (Tables 1 and 2).

The pathology of the gastroduodenal area was detected on the basis of a complex of patients' complaints, specific evidence of anamnesis, results of objective and supplementary laboratory examination. The structure of the symptoms of the examined patients is shown in Figure 1.

In order to identify the content of (PG-1) and (PG-2) fasting blood sampling was carried out. The amount of gastrin-17 (G-17) after eating was identified in blood serum samples, which were taken 20 min after ingestion of protein dissolved in a beverage (one portion contains 10 g of protein). The samples were subject to centrifugation at 1,500 xg for 10 min and were thereupon stored at the temperature -20[degrees]C until the conduction of analysis.

Immunoenzymatic assay was conducted with the aid of serological analysis with the application of the set of reagents GastroPanel[R] (Finland Biohit Plc, Helsinki), identifying the values of G-17 and PG-1, as well as pG-2.

All patients were diagnosed with severe antral mucosa atrophy, moderate antral mucosa atrophy, mild antral mucosa atrophy, severe corpus mucosa atrophy, moderate corpus mucosa atrophy, and mild corpus mucosa atrophy with the technique of Pasechnikov et al. [19]. The necessity of the detection of severe antral atrophy gastritis and severe corpus gastritis is attributed to the fact that precisely severe corpus atrophic gastritis and severe corpus atrophic gastritis possess a high risk of the development of stomach cancer.

The techniques for the detection of antral mucosal atrophy and corpus mucosa atrophy with no account taken of its severity, as well as severe antral mucosa atrophy and severe corpus mucosa atrophy, are taken as a standard, as they have been verified by a large number (450 patients) of comparative histological analyses.

The technique for the detection of antral mucosal atrophy and corpus mucosa atrophy of various severities with markers of atrophy is presented in Tables 1 and 2.

The method for the early detection of atrophic gastritis with the ratio PG-1/PG-2 was compared to the method for the early detection of atrophic gastritis with markers of atrophy: G-17 for antrum stomach and PG-1 for corpus stomach (the standard method). The standard method for the early detection of atrophic gastritis with the markers of atrophy: G-17 for antrum stomach and PG-1 for corpus stomach is highly sensitive, Se--89% and highly specific, Sp--99% [18]. In addition to that, for the identification of the optimal ratio PG-1/PG-2, which characterizes the detected atrophy mucosa, the ratio PG-1/ PG-2 in the range from 1 to 10 was calculated, compared, and analyzed.

Thereby, the exploratory procedures that were applied by us have provided a complex approach to the solving of assigned tasks, which has allowed us to obtain desired results and to formulate valid conclusions.

Statistical analysis was used to calculate the statistical significance of received data: Spearman's correlation coefficient (r), positive predictive value (PPV), and negative predictive value (NPV) of diagnosis by Biohit GastroPanel[R].

Results

We compared method of detection of antral atrophic gastritis based on the ratio of PG-1/PG-2 with reference method based on gastrin-17 level which has histological validation. The ratio range PG-1/PG-2 was taken in this case from 1 to 10. In Table 3, data are presented on the number of patients with severe antral atrophic gastritis that was detected with two methods: G-17 and ratio PG-1/PG-2 simultaneously, as well as those with severe antral atrophic gastritis that was not detected with either of the mentioned methods. Besides, data are presented on the number of patients with severe antral atrophic gastritis that was detected only with the standard method with G-17 and could not be detected with the ratio PG-1/PG-2 (false-negative results). Likewise, data are presented on the number of patients with severe antral atrophic gastritis that could not be detected with the standard method G-17, though it was detected with the ratio PG-1/PG-2 (false-positive results).

The change in sensitivity (Se) and specificity (Sp) of the method for the detection of severe antral atrophic gastritis with the ratio PG-1/PG-2, when compared with the standard method with G-17, depending on the selected value of the ratio PG-1/PG-2 is shown in Figure 2. Multidirectional tendencies attract attention. Evidently, Se and Sp do not allow to put into practice the method for the detection of severe atrophic antral gastritis with the ratio PG-1/PG-2 with any value of the ratio PG-1/PG-2 from 1 to 10. Acceptable values of Se are always combined with very low values of Sp. And vice versa, acceptable values of Sp, with any value of the ratio PG-1/PG-2, are always combined with very low values of Se.

The PPV of the method for the detection of severe atrophic antral gastritis with the ratio PG-1/PG-2, when compared with the PPV of the method for the detection with G-17, has very low indices with any value of the ratio PG-1/PG-2 from 1 to 10.

Only the NPV of the method for the detection of severe atrophic antral gastritis with the ratio PG-1/PG-2, when compared with the NPV of the method for the detection with G-17, is at a good level with any value of the ratio PG-1/PG-2 from 1 to 10.

To sum up, all the examined evaluation criteria of the method for the detection of severe atrophic antral gastritis with the ratio PG-1/PG-2 do not allow to recognize it as suitable for the diagnostics of severe atrophic antral gastritis.

In Table 4, data are presented on the number of patients with antral atrophic gastritis with no account taken of its severity that was detected with the use of two methods with G-17 and with the ratio PG-1/PG-2 simultaneously, as well as on patients with antral atrophic gastritis with no account taken of its severity that cannot be detected with either of the mentioned methods. Besides, data are presented on the number of patients with antral atrophic gastritis with no account taken of its severity that was detected only with the standard method with G-17 and could not be detected with the ratio PG-1/PG-2 (false-negative results). Likewise, data are presented on the number of patients with antral atrophic gastritis with no account taken of its severity that cannot be detected with the use of the standard method with G-17, though it was detected with the ratio PG-1/PG-2 (false-positive results).

The change in Se and Sp of the method for the detection of antral atrophic gastritis with no account taken of its severity with the ratio PG-1/PG-2, when compared with the standard method with G-17, depending on the selected value of the ratio PG-1/PG-2 is reflected in Figure 3. Likewise, multidirectional tendencies attract attention. Attention is drawn by the fact that Se and Sp do not allow to put into practice the method for the detection of antral atrophic gastritis with no account taken of its severity with the ratio PG-1/PG-2 with any value of the ratio PG-1/PG-2 from 1 to 10. Acceptable values of Se are always combined with very low values of Sp. And vice versa, acceptable values of Sp, with any value of the ratio PG-1/PG-2, are always combined with very low values of Se.

The PPV of the method for the detection of atrophic antral gastritis with no account taken of its severity with the ratio PG-1/PG-2, when compared with the PPV of the method for the detection with G-17, has low indices with any value of the ratio PG-1/PG-2 from 1 to 10.

Likewise, the NPV of the method for the detection of atrophic antral gastritis with no account taken of its severity with the ratio PG-1/ PG-2, when compared with the NPV of the method for the detection with G-17, is at a low level with any value of the ratio PG-1/PG-2 from 1 to 10.

To sum up, all the examined evaluation criteria of the method for the detection of atrophic antral gastritis with no account taken of its severity with the ratio PG-1/PG-2 do not allow to recognize it as suitable for the diagnostics of atrophic antral gastritis with no account taken of its severity.

In order to identify the value of the ratio PG-1/PG-2, which most accurately reflects the presence of atrophic corpus gastritis as well as the severity of atrophic corpus gastritis, a comparison has been drawn with the standard that has histological validation, notably with the level of PG-1 for atrophic corpus gastritis. The ratio range PG-1/PG-2 was taken in this case from 1 to 10. In Table 5 data are presented on the number of patients with severe atrophic corpus gastritis that was detected with the use of two methods with PG-1 and with the ratio PG-1/PG-2 simultaneously, as well as those with severe atrophic corpus gastritis that cannot be detected with either of the mentioned methods. Besides, data are presented on the number of patients with severe atrophic corpus gastritis that was detected only with the standard method with PG-1 and could not be detected with the ratio PG-1/PG-2 (false-negative results). Likewise, data are presented on the number of patients with severe atrophic corpus gastritis that could not be detected with the standard method with PG-1, though with the ratio PG-1/PG-2 it was detected--false-positive results (Table 5). Besides, such important evaluation criteria of the method for the detection of severe atrophic corpus gastritis were identified, as Se, Sp, PPV, and NPV (Figure 4).

Attention is attracted by the total absence of false-negative results despite the increase of the value of the ratio PG-1/PG-2 from 1 to 10 when detecting severe atrophic corpus gastritis. The number of false-positive results in this case grows. With the values of the ratio PG-1/PG-2 from 1 to 3 the number of false-positive results does not exceed 10% from the number of examined patients. This indicates a high quality of this method for the detection of severe atrophic corpus gastritis.

The change in Se and Sp of the method for the detection of severe atrophic corpus gastritis with the ratio PG-1/PG-2, when compared with the standard method with PG-1, depending on the selected value of the ratio PG-1/ PG-2 is reflected in Figure 4. Se is high at all values of the ratio PG-1/PG-2. With the values of the ratio PG-1/PG-2 from 1 to 3, Sp does not decrease lower than 90%, which characterizes the method for the detection of severe atrophic corpus gastritis with the ratio PG-1/PG-2 as highly sensitive and highly specific. With any value of the ratio PG-1/PG-2, a very high level of NPV of the method for the detection of severe atrophic corpus gastritis with the ratio PG-1/PG-2 is registered (100%) in comparison with the method for the detection with PG-1.

The PPV of the method for the detection of severe atrophic corpus gastritis with the ratio PG-1/PG-2, when compared with the method for the detection with PG-1, has satisfactory indices with the value of the ratio PG-1/PG-2 from 1 to 3. The NPV of the method for the detection of severe atrophic corpus gastritis with the ratio PG-1/PG-2, when compared with the method for the detection with PG-1, is at a very good level with any value of the ratio PG-1/PG-2. To sum up, all the examined evaluation criteria of the method for the detection of severe atrophic corpus gastritis with the ratio PG-1/PG-2 allow to recognize it as highly sensitive, highly specific and absolutely applicable for the diagnostics of severe atrophic corpus gastritis with the values used in practice (2-2,5-3).

In order to identify the value of the ratio PG-1/PG-2, which most accurately reflects the presence of atrophic corpus gastritis with no account taken of its severity, a comparison has been drawn with the standard that has histological validation, notably with the level of PG-1 for atrophic corpus gastritis. The ratio range PG-1/ PG-2 was taken in this case from 1 to 10.

In Table 6, data are presented on the number of patients with atrophic corpus gastritis with no account taken of its severity that was detected with the use of two methods with PG-1 and with the ratio PG-1/PG-2 simultaneously, as well as on patients with atrophic corpus gastritis with no account taken of its severity that cannot be detected with either of the mentioned methods. Besides, data are presented on the number of patients with atrophic corpus gastritis with no account taken of its severity that was detected only with the standard method with PG-1 and could not be detected with the ratio PG-1/PG-2 (false-negative results). Likewise, data are presented on patients with atrophic corpus gastritis with no account taken of its severity that could not be detected with the use of the standard method with PG-1, though it was detected with the ratio PG-1/PG-2--false-positive results (Table 6).

When comparing the two methods for the detection of atrophic corpus gastritis with no account taken of its severity, such evaluation criteria of the method for the detection of atrophic corpus gastritis with no account taken of its severity with the ratio PG-1/PG-2 were identified, as Se, Sp, PPV, and NPV (Figure 5).

A very small number of false-negative results attract attention. With the values of the ratio PG-1/PG-2 from 1 to 3 the number of false-positive results does not exceed 8% from the total number of examined patients. This indicates a high quality of this method for the detection of atrophic corpus gastritis with no account taken of its severity.

The change in Se and Sp of the method for the detection of atrophic corpus gastritis with no account taken of its severity with the ratio PG-1/ PG-2, when compared with the standard method with PG-1, depending on the selected value of the ratio PG-1/PG-2 is reflected in Figure 5.

With the value of the ratio PG-1/PG-2 from 1 to 3 Sp does not decrease lower than 90%, Se approaches 100%, which characterizes the method for the detection of atrophic corpus gastritis with no account taken of its severity with the ratio PG-1/PG-2 as highly sensitive and highly specific. With any value of the ratio PG-1/ PG-2 a very high level of NPV of the method for the detection of atrophic corpus gastritis with no account taken of its severity with the ratio PG-1/ PG-2 is registered, when compared with the method for the detection with PG-1.

The PPV of the method for the detection of atrophic corpus gastritis with no account taken of its severity with the ratio PG-1/PG-2, when compared with the PPV of the method for the detection with PG-1, has good indices with the value of the ratio PG-1/PG-2 from 1 to 3. To sum up, all the examined evaluation criteria of the method for the detection of atrophic corpus gastritis with no account taken of its severity with the ratio PG-1/PG-2 allow to recognize it as highly sensitive, highly specific and absolutely applicable for the diagnostics of atrophic corpus gastritis with no account taken of its severity with the values used in practice (2-2,5-3).

Discussion

The method for the early detection of atrophic gastritis with the ratio PG-1/PG-2 does not adequately reflect the condition of atrophic antral gastritis and does not in any way characterize the presence and severity of atrophic antral gastritis. The method is an insensitive and nonspecific method for the diagnostics of atrophic antral gastritis. The method for the early detection of atrophic gastritis with the ratio PG-1/PG-2 does not allow detect severe atrophic antral gastritis, which possesses a high risk of the development of stomach cancer. The ratio PG-1/PG-2, as a method for the diagnostics of atrophic corpus gastritis, has no advantages over the method for the early detection of atrophic corpus gastritis only with PG-1, without the identification of PG-2 and the calculation of their ratio. In the absence of typical specific clinical symptoms of atrophic gastritis, the method for the diagnostics of atrophic gastritis with the aid of the ratio PG-1/ PG-2 cannot be considered effective, as it does not allow to diagnose the severity and stage of atrophic gastritis and to prognosticate the risk of the development of stomach cancer. In order to implement the early detection of atrophic gastritis among the population, to identify its severity in every part of the stomach and the stage of the disease, it is recommended to apply the method for the diagnostics by means of identifying G-17 for atrophic antral gastritis and PG-1 for atrophic corpus gastritis. The detection of atrophic gastritis among the population, identification of its severity in every part of the stomach and the stage of the disease by means of identifying the ratio PG-1/PG-2 is less effective. Many authors in different countries have conducted examinations of several thousand patients with the aid of the ratio PG-1/PG-2 [1-6]. As a result, false-negative results were obtained with several hundred patients. Likewise, false-positive results were obtained with several hundred patients. This means that patients with false-negative results will not be sent to endoscopic examination, and stomach cancer will not be timely detected. Later its treatment will be impossible. Patients with false-positive results will be unreasonably undergoing endoscopic examination. If such a screening program will operate across the country, a very large number of people will not be diagnosed with early stomach cancer and will die. A large number of people with false-positive results of the examination will undergo endoscopic examination to no purpose [17-20].

Conclusion

In practice, the ratio PG-1/PG-2 is not applicable to detect antral atrophic gastritis. For the detection of atrophic corpus gastritis it is enough to apply the method for the identification of the level PG-1. It will be most correct to examine the population with the aid of the markers of atrophic gastritis: gastrin-17 and pepsinogen-1.

References

[1.] Li YH, Zhang XH, Huang B, Wang JL, Mi JM, et al. (2006) Studies on the cut-off value of serum pepsinogen abnormality for screening chronic atrophic gastritis and gastric carcinoma. Zhonghua Liu Xing Bing Xue Za Zhi 27(10): 840-844.

[2.] Storskrubb T, Aro P, Ronkainen J, Sipponen P, Nyhlin H, et al. (2008) Serum biomarkers provide an accurate method for diagnosis of atrophic gastritis in a general population: The Kalixanda study. Scandinavian Journal of Gastroenterology 43(12): 1448-1455.

[3.] Telaranta-Keerie A, Kara R, Paloheimo L, Harkonen M, Sipponen P (2010) Prevalence of undiagnosed advanced atrophic corpus gastritis in Finland: an observational study among 4,256 volunteers without specific complaints. Scandinavian Journal of Gastroenterology 45(9): 1036-1041.

[4.] Mizuno S, Miki I, Ishida T, Yoshida M, Onoyama M, et al. (2010) Prescreening of a high-risk group for gastric cancer by serologically determined Helicobacter pylori infection and atrophic gastritis. Digestive Disease and Sciences 55(11): 3132-3137.

[5.] Liu CY, Wu CY, Lin JT, Lee YC, Yen AM, et al. (2006) Multistate and multifactorial progression of gastric cancer: results from community-based mass screening for gastric cancer. Journal of Medical Screening 13(Suppl 1): S2-S5.

[6.] Adamu MA, Weck MN, Rothenbacher D, Brenner H (2011) Incidence and risk factors for the development of chronic atrophic gastritis: five year follow-up of a population-based cohort study. International Journal of Cancer 128(7): 1652-1658.

[7.] Cao Q, Ran ZH, Xiao SD (2007). Screening of atrophic gastritis and gastric cancer by serum pepsinogen, gastrin-17 and Helicobacter pylori immunoglobulin G antibodies. Journal of Digestive Diseases 8(1): 15-22.

[8.] Peitz U, Wex T, Vieth M, Stolte M, Willich S, et al. (2011) Correlation of serum pepsinogens and gastrin-17 with atrophic gastritis in gastroesophageal reflux patients: a matched-pairs study. Journal of Gastroenterology Hepatology 26(1): 82-89.

[9.] di Mario F, Cavallaro LG (2008) Non-invasive tests in gastric diseases. Digestive and Liver Disease 40(7): 523-530.

[10.] Germana B, Di Mario F, Cavallaro LG, Moussa AM, Lecis P, et al. (2005) Clinical usefulness of serum pepsinogens I and II, gastrin-17 and anti-Helicobacter pylori antibodies in the management of dyspeptic patients in primary care. Digestive and Liver Disease 37(7): 501-508.

[11.] Borch K, Axelsson CK, Halgreen H, Damkjaer Nielsen MD, Ledin T, et al. (1989) The ratio of pepsinogen A to pepsinogen C: a sensitive test for atrophic gastritis. Scandinavian Journal of Gastroenterology 24(7): 870-876.

[12.] Asaka M, Sugiyama T, Nobuta A, Kato M, Takeda H, et al. (2001) Atrophic gastritis and intestinal metaplasia in Japan: results of a large multicenter study. Helicobacter 6(4): 294-299.

[13.] Miki K, Ichinose M, Ishikawa KB, Yahagi N, Matsushima M, et al. (1993) Clinical application of serum pepsinogen I and II levels for mass screening to detect gastric cancer. Japanese Journal of Cancer Research 84(10): 1086-1090.

[14.] Yoshihara M, Sumii K, Haruma K, Kiyohira K, Hattori N, et al. (1998) Correlation of ratio of serum pepsinogen I and II with prevalence of gastric cancer and adenoma in Japanese subjects. American Journal of Gastroenterology 93(7): 1090-1096.

[15.] Graham DY, Nurgalieva ZZ, El-Zimaity HM, Opekun AR, Campos A, et al. (2006) Noninvasive versus histologic detection of gastric atrophy in a Hispanic population in North America. Clinical Gastroenterology and Hepatology 4(3): 306-314.

[16.] Samloff IM, Varis K, Ihamaki T, Siurala M, Rotter JI (1982) Relationships among serum pepsinogen I, serum pepsinogen II, and gastric mucosal histology. A study in relatives of patients with pernicious anemia. Gastroenterology 83(1Pt2): 204-209.

[17.] Pasechnikov VD, Chukov SZ, Kotelevets SM, Mostovov AN, Mernova VP, et al. (2005) Invasive and non-invasive diagnosis of Helicobacter pylori-associated atrophic gastritis: a comparative study. Scandinavian Journal of Gastroenterology 40(3): 297-301.

[18.] Pasechnikov VD, Chukov SZ, Kotelevets SM, Chabannaya TA (2005) Morpho-functional comparisons in Helicobacter pylori-associated chronic atrophic gastritis. Rocz Akad Med Bialymst 50: 183-187.

[19.] Pasechnikov VD, Chukov SZ, Kotelevets SM, Mostovov AN, Mernova VP, et al. (2004) Possibility of non-invasive diagnosis of gastric mucosal precancerous changes. World Journal of Gastroenterology 10(21): 3146-3150.

[20.] Pasechnikov VD, Chukov SZ, Kotelevets SM, Mostovov AN, Polyakova MB, et al. (2004) The non-invasive diagnosis of precancerous changes of stomach mucosa. Rocz Akad Med Bialymst 49: 66-71.

Sergey Mikhailovich Kotelevets (1) *, Sergey Anatolievich Chekh (2)

(1) Department of Therapy, Medical Institute, North Caucasus State Academy of Humanities and Technology, 369000, Cherkessk, Stavropolskaya Street 41, Russian Federation.

(2) Department of Information Systems, North Caucasus State Academy of Humanities and Technology, 369000, Cherkessk, Stavropolskaya Street 41, Russian Federation.

* Corresponding author

Received: 1st Dec 2014; Accepted: 31st Dec 2014; Published: 10th Jan 2015

Table 1: Serological criteria of atrophic antral gastritis.

Atrophic antral gastritis                    Gastrin-17
Nonatrophic antral gastritis         10 [less than or equal to]
                                               pmol/l
Mild atrophic antral gastritis       7 [less than or equal to]
                                            pmol/l < 10
Moderate atrophic antral gastritis   4 [less than or equal to]
                                             pmol/l < 7
Severe atrophic antral gastritis     0 [less than or equal to]
                                             pmol/l < 4

Table 2: Serological criteria of atrophic corpus gastritis.

Atrophic corpus gastritis                    Pepsinogen-1
Nonatrophic corpus gastritis               25 [less than or
                                         equal to] [micro]g/l
Mild atrophic corpus gastritis        15 [less than or equal to]
                                           [micro]g/l < 25
Moderate atrophic corpus gastritis    9 [less than or equal to]
                                           [micro]g/l < 15
Severe atrophic corpus gastritis      0 [less than or equal to]
                                            [micro]g/l < 9

Table 3: Identification of severe antral atrophic gastritis
with G-17 and with the ratio PG-1/PG-2.

Ratio        G17 < 4     G17 [greater     G17 < 4     G17 [greater
PG-1/PG-2     pmol/l       than or        pmol/l      than or equal
             PG-1/PG-2   equal to] 4      (severe     to] 4 pmol/l
             (severe        pmol/l       atrophy)     (no atrophy)
             atrophy)     PG-1/PG-2      PG-1/PG-2     PG-1/PG-2
                         (no atrophy)       (no         (severe
                                         atrophy)       atrophy)
                                          false -       false +

<1               1           860            185            26
<2               6           828            180            58
<2.5            10           801            176            85
<3              14           767            172           119
<4              24           685            162           201
<5              44           583            142           303
<6              66           463            120           423
<7              90           361            96            525
<8              114          278            72            608
<9              134          202            52            684
<10             147          156            39            730

Table 4: Identification of antral atrophic gastritis with no
account taken of its severity with G-17 and with the
ratio PG-1/PG-2.

Ratio          G17 <     G17 [greater     G17 < 10     G17 [greater
PG-1/PG-2    10pmol/l      than or         pmol/l        than or
             PG-1/PG-2    equal to]      (atrophy)      equal to]
             (atrophy)     10pmol/l      PG-1/PG-2      10 pmol/l
                          PG-1/PG-2     (no atrophy)   (no atrophy)
                         (no atrophy)     false -       PG-1/PG-2
                                                        (atrophy)
                                                         false +

<1               3           552            493             24
<2              12           524            484             52
<2.5            31           512            465             64
<3              45           488            451             88
<4              81           432            415            144
<5              132          361            364            215
<6              199          286            297            290
<7              263          224            233            352
<8              315          169            181            407
<9              364          122            132            454
<10             398           97             98            479

Table 5: Identification of severe atrophic corpus gastritis with
PG-1 and with the ratio PG-1/PG-2.

Ratio         PG1 < 9     PG1 [greater     PG1 < 9      PG17 [greater
PG-1/PG-2    [micro]g/l     than or       [micro]g/l    than or equal
             PG-1/PG-2    equal to] 9      (severe      to] 9 [micro]
              (severe      mg/l PG-1/      atrophy)       g/l (no
              atrophy)      PG-2 (no      PG-1/PG-2      atrophy)
                            atrophy)     (no atrophy)    PG-1/PG-2
                                           false -        (severe
                                                          atrophy)
                                                          false +

<1               24          1,043            2              5
<2               24          1,008            0              40
<2.5             24           977             0              71
<3               24           939             0             109
<4               24           847             0             201
<5               24           725             0             323
<6               24           583             0             465
<7               24           457             0             591
<8               24           350             0             698
<9               24           254             0             794
<10              24           195             0             853

Table 6: Identification of atrophic corpus gastritis with no
account taken of its severity with PG-1 and with the ratio
PG-1/PG-2.

Ratio        PG17 < 25    PG17 [greater    PG17 < 25     PG17 [greater
PG-1/PG-2    [micro]g/l   than or equal    [micro]g/l    than or equal
             PG-1/PG-2     to] 25 mg/l     (atrophy)      to] 25 mg/l
             (atrophy)      PG-1/PG-2      PG-1/PG-2     (no atrophy)
                          (no atrophy)    (no atrophy)     PG-1/PG-2
                                            false -        (atrophy)
                                                            false +

<1               26           1,014            31              1
<2               45            996             12             19
<2.5             53            973             4              42
<3               54            936             3              79
<4               55            845             2              170
<5               55            723             2              292
<6               55            581             2              434
<7               55            455             2              560
<8               55            348             2              667
<9               56            253             1              762
<10              56            194             1              821

Figure 1: Prevalence of dyspeptic symptoms among observable patients.

Pain                83%
Heartburn           28%
Belching            52%
Vomiting            36%
Nausea              12%
Heaviness           84%
Discomfort          83%
before saturation   85%
flatulence          62%

Note: Table made from bar graph.
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Title Annotation:Research Article
Author:Kotelevets, Sergey Mikhailovich; Chekh, Sergey Anatolievich
Publication:Biology and Medicine
Article Type:Report
Date:Oct 1, 2014
Words:5055
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