Research Applications

How GastroPanel and GastroSoft can be used in Research

GastroPanel is performed on a blood sample to reveal the status and function of the gastric mucosa. This novel method is non-invasive, risk free, and patient-friendly. GastroPanel gives the same results as gastroscopy and gastric biopsy, but due to the biochemical nature of the tests, the results cover the entire stomach area.

GastroPanel comprises tests for Helicobacter pylori -antibodies, pepsinogen I and II and gastrin-17, which are performed on a plasma sample with sensitive enzyme immunoassay methods.

H. pylori gastritis and atrophic gastritis are risk conditions for gastric cancer and peptic ulcer diseases. The more severe the atrophic gastritis in the mucosa of the corpus of the stomach, the lower is the measured concentration of pepsinogen I and pepsinogen I and II ratios in the blood sample. Correspondingly, the more severe the atrophic gastritis in the mucosa of the antrum of the stomach, the lower is the measured gastrin-17 concentration. The measured concentrations of pepsinogens (I and II) and gastrin-17 represent quantitatively the overall condition of the mucosa of the entire stomach, its functional status and the severity of atrophy. In a healthy stomach, high secretion of hydrochloric acid is a risk factor for GERD, Barrett´s esophagus, and other acid related diseases.   

GastroPanel (results easily interpreted by GastroSoft) detects the presence of H.pylori infection and atrophic gastritis, and can be used in assessment of the type, grade and extent of the lesions in the stomach. In subjects with a normal and healthy stomach (GastroPanel PGI, PGII and H. pylori results are normal), fasting plasma levels of gastrin-17 can be used as an indicator of intragastric acidity.

The GastroSoft program shows the test results and reference ranges and gives a clear diagnosis, together with the recommendations for the doctor, when necessary, to consider eradication of H. pylori based on the Maastricht 2 (2000) guidelines, and to consider gastroscopy and biopsy examination, and possible assessment of high stomach acidity risks.

GastroPanel results and their interpretation: See Interpretation of the results -page.

Examples of Issues of Interest

1. Is it true that the patients with atrophic gastritis and intestinal metaplasia can be found by the GastroPanel ?

There are studies available that indicate that this statement is correct. GastroPanel finds patients with advanced (moderate or severe) atrophic gastritis and intestinal metaplasia if the GastroPanel results are compared with the findings from the gastroscopy and biopsy specimen examinations and biopsy. The accuracy of the GastroPanel examination is around 80%, based on correlation with results from gastroscopy and biopsy specimen examinations. Therefore, it is possible that the accuracy is higher. A proper diagnosis of atrophic gastritis is indicated because of recent observations which suggest that atrophic gastritis tends to heal if the H.pylori infection is successfully eradicated.

2. Is it possible and feasible to discover patients with high gastric cancer risk with the GastroPanel ?

Advanced atrophic gastritis and intestinal metaplasia are risk conditions for gastric cancer. The available studies show that GastroPanel can be used in screening of patients with atrophic gastritis and at risk for cancer. The population-based screenings with GastroPanel indicate that gastric cancer can be found in 2.5-5 % of patients with advanced atrophic gastritis. These cancers, found by the gastroscopy and biopsy specimen examinations performed after the GastroPanel screening are early cancers or dysplasias of high grade.

3. Is it possible to use GastroPanel in screening of relatives of cancer patients ?

Why not? GastroPanel is simple and non-invasive blood test. There are available studies with good results.

4. GastroPanel can be used in the identification of elderly subjects at risk for malabsorption of vitamin B12?

At least one available study indicates that this is the case. Atrophic corpus gastritis results in lack of secretion of intrinsic factor, leading to malabsorption of dietary vitamin B12. In the elderly population (age 50 years or more), this risk occurs in 2-3% of people at least. It is not only the "autoimmune" atrophic gastritis that causes vitamin B12 malabsorption. H.pylori related atrophic gastritis is associated with vitamin B12 deficiency in 70-80% of the cases.

5.  GastroPanel examination in conjunction with the risks caused by homocysteine

The deficiency of vitamin B12 is one common reason of hyperhomocysteinemia which is a risk factor for atherosclerosis, strokes, hearth attacks, and for various neurodegenerative disorders. Atrophic corpus gastritis with or without H.pylori infection is one important and conceivable cause of this disorder. One can argue that GastroPanel could be a useful tool to diagnose and find these patients.

6.  GastroPanel can identify those patients at highest risk for peptic ulcer disease?

H.pylori gastritis is strongly "antrum predominant" in subjects with peptic ulcer disease (duodenal ulcer disease in particular). The corpus mucosa is non-atrophic (acid secretion is normal or high) but extensive gastritis and/or antrum-limited atrophic gastritis with intestinal metaplasia occurs in these patients typically. GastroPanel can detect these subjects.

7. GastroPanel will identify those patients with normal and healthy gastric mucosa ?

Subjects with normal and healthy gastric mucosa are not at risk for gastric cancer or peptic ulcer, with some reservations (use of NSAIDs or familiar cancer syndromes). Therefore, the diagnosis "healthy and normal gastric mucosa" is important in clinical practice. GastroPanel can find these subjects - the testing of H.pylori alone is not reliable in this sense.

8. Low fasting levels of Gastrin-17 in serum is a biomarker of high acid output in subjects with normal and healthy gastric mucosa (normal GastroPanel result)?

Acid inhibits the release of gastrin-17 (G-17) from antral G cells. The Biohit G-17 monoclonal antiserum is highly specific for G-17, and the G-17 assay can be used as an indicator of the function of the antral G cells. The research over the decades on secretion of acid and gastrin has confirmed the feedback control links between the release of gastrin-17 from antral G cells and the level of intragastric acidity and output of hydrochloric acid from the gastric corpus.

9. Fasting levels of G-17 are an indirect marker of the basal acid output (BAO) ?

This is a logical statement and is likely to be true in subjects with normal and healthy gastric mucosa at least.

10. Low serum G-17 is a sign of increased risk of acid related diseases (duodenal ulcer disease, GERD and/or Barrett´s esophagus) ?

Some available cross-sectional studies indicate that the risk of long-segment Barrett is higher the lower the fasting level of serum G-17.

11. In subjects with healthy gastric mucosa and in those with H.pylori gastritis, serum levels of fasting G-17 can be used as a sign of proper acid inhibition in titration of the correct dose of the drug in patients with long-standing use of PPI's ?

PPI´s have a profound influence on acid output, intragastric acidity and will, therefore, also affect the levels of gastrin in the circulation. GastroPanel can be used to follow these phenomena.

12. Hypothesis: long-term use of PPI's will result in high levels of gastrin in circulation and may increase growth of neoplasian in the colon.

GastroPanel can be used in monitoring this risk (appropriate level of plasma G-17 vs. optimal dose of the drug).

13. The risk of acute gastric mucosal damage and bleeding is highest in subjects with high gastric acid output (high BAO and MAO). This can be assessed with the GastroPanel ?

This hypothesis is logical and probable.

14. NSAID patients with highest risk for gastroduodenal bleeding are those with high output of hydrochloric acid? These patients can be identified with the GastroPanel?

Again, this is a logical possibility if it is accepted that the fasting serum level of G-17 is a marker of high BAO and high intragastric acidity.

15. Do those patients with low or very low level of plasma G-17 benefit most from PPI treatment ?

It is logical that patients with low G-17 have a high acid output and, therefore, these patients benefit most from acid inhibition. GastroPanel helps in the identification of these subjects?

16. Long-term use of PPI´s causes atrophy of the corpus mucosa. Can GastroPanel used in monitoring of this phenomenon ?

GastroPanel (pepsinogen I or the pepsinogenI/pepsinogen II ratio) reflects reliably the status of the gastric corpus mucosa. A significant decrease in the plasma pepsinogen level could be an objective sign of the development of atrophy.

17. Simultaneous assays of plasma levels of gastrin-17 and total gastrin can be used in differential diagnosis of gastrinomas ?

Neoplastic gastrinomas tend to secrete gastrins of high molecular weight.  Therefore, high plasma level of total gastrin but low level of gastrin-17 suggests neoplastic gastrinoma. High level of both total gastrin and gastrin-17 indicates that the source of gastrin is not from a neoplastic tumor. GastroPanel examination does not contain total gastrin analysis.

18. According to research results and clinical experience, GastroPanel seems to be, before gastroscopy and “trial and error” treatments, justifiable from scientific, clinical and economic reasons:

1. In diagnosing of functional vs. organic dyspepsia, Helicobacter pylori infection and atrophic gastritis.
2. In follow-up of success for treatment of Helicobacter pylori infection and atrophic gastritis.
3. In follow-up of emerging of atrophic gastritis and its risks caused by Helicobacter pylori infection or/and autoimmune disease.

GastroPanel examination, when compared with gastroscopy and the examination of biopsy specimens, is more sensitive and discovers, therefore, considerably smaller changes (to better or worse direction) in the status of the mucosa of the stomach. Histological biopsy specimens do not give any information from the function of  the mucosa of the stomach.

If the biopsy specimens are taken from seriously damaged areas of the mucosa of the stomach one will not find the Helicobacter pylori -bacterium in the biopsy specimens examined. – More studies will be needed.