Premalignant gastric lesions in patients included in National colorectal cancer screening

Abstract

Background. Gastric cancer is the fifth most common malignancy in the world with almost one million new cases annually. Helicobacter pylori infection cause 89% of all gastric cancers. Premalignant lesions (atrophy and intestinal metaplasia) develop after several decades of inflammation. Secondary prevention with gastroscopy is possible, but it is costly and has a low compliance rate. Alternative procedures like serology testings for pepsinogen I and II and pepsinogen I/II ratio are available to select patients for surveillance gastroscopies.

Patients and methods. In seven outpatient endoscopic units, 288 patients (154 men; 53.5%), average age 60.68 years, tested positive in National colorectal cancer screenning programme  SVIT, were included in the study.Gastropanel (BioHit, Finland) was used as a serologic biopsy method.

Results. We found 24 patients (12 men, mean age 63.7 years ) with pepsinogen pepsinogen I/II < 3 and/or pepsinogen I < 30µg/L). Premalignant changes were found on gastric  biopsies  in 21 patients (7.3% incidence). OLGIM (Operative Link on Gastric Intestinal Metaplasia Assessment) > 1 was found in 20 patients; OLGA (Operative Link for Gastritis Assessment) > 1 was found in 19 patients. Combined accuracy for preneoplastic lesions in Gastropanel positive patients was 87.5%. H. pylori seropositivity was found in 219 patients (76%). Only 24% of our population had normal results.

ConclusionGastropanel test has proven to be a reliable non-invasive test for advanced gastric preneoplastic lesions that can select patients for further gastroscopy. We found high  H. pylori seropositivity  in older age groups in Slovenia .

Key words: Gastropanel, Helicobacer pylori, atrophy, intestinal metaplasia, gastric cancer