Usefulness of Serum Pepsinogen I as a Biomarker in Early Diagnosis of Aetiology of Dyspepsia.

BACKGROUND: Dyspepsia, according to Rome III criteria, is defined as pain or discomfort centred in the upper abdomen in addition to symptoms like early satiety, postprandial fullness, bloating and nausea. Pepsinogens which are secreted by chief cells of the stomach play an important role in its physiology. They could determine the functional state of the mucosa in health and in diseased conditions. Serum levels of pepsinogen have aided the diagnosis of gastric pathologies such as atrophic gastritis, peptic ulcer disease and gastric cancer. Pepsinogen assay, being a simple, non-invasive procedure, can aid in determining the aetiology of dyspepsia especially in a resource poor setting. OBJECTIVE: This was to evaluate the diagnostic significance of serum pepsinogen I in patients with dyspepsia. METHODS: The study involved 112 adult patients with dyspepsia and an equal number of controls. A questionnaire was used to obtain biodata, clinical features and other relevant information. The patients had abdominal ultrasound scan, urea breath test and upper gastrointestinal endoscopy (UGIE), while the controls had only abdominal ultrasound scan. Sera prepared from 10ml of venous blood from each participant were stored at -20ºC and later analysed for pepsinogen I (PG I). RESULTS: Females predominated in both groups (F:M = 1.4:1). The mean age of cases was 51±15.9 years and was similar to that of controls 51.4±16.5. The most frequent symptom was epigastric pain in 101 (90.2%) patients. Median pepsinogen I level in patients (28.5ng/ml) was significantly lower than in controls (68.8ng/ml) (p<0.001). The most frequent endoscopic finding was gastritis. Serum PG I level at a cut-off point of 79.5ng/ml had a specificity of 88.8% and sensitivity of 40% in identifying dysplasia. CONCLUSION: Serum PG I level was lower in patients with dyspepsia than controls. It showed high specificity in identifying dysplasia and could be a biomarker for early gastric cancer.

CONTEXTE: La dyspepsie, selon les critères de Rome III, est définie comme une douleur ou une gêne centrée sur la partie supérieure de l'abdomen, en plus de symptômes tels qu'une satiété précoce, une plénitude postprandiale, des ballonnements et des nausées. Les pepsinogènes, sécrétés par les cellules principales de l'estomac, jouent un rôle important dans sa physiologie. Ils peuvent déterminer l'état fonctionnel de la muqueuse, qu'elle soit saine ou malade. Les taux sériques de pepsinogène ont facilité le diagnostic de pathologies gastriques telles que la gastrite atrophique, l'ulcère gastroduodénal et le cancer gastrique. Le dosage du pepsinogène, qui est une procédure simple et non invasive, peut aider à déterminer l'étiologie de la dyspepsie, en particulier dans un contexte de ressources limitées. OBJECTIF: Évaluer l'importance diagnostique du pepsinogène I sérique chez les patients souffrant de dyspepsie. MÉTHODES: L'étude a porté sur 112 patients adultes souffrant de dyspepsie : L'étude a porté sur 112 patients adultes souffrant de dyspepsie et un nombre égal de témoins. Un questionnaire a été utilisé pour obtenir les données biologiques, les caractéristiques cliniques et d'autres informations pertinentes. Les patients ont subi une échographie abdominale, un test respiratoire à l'urée et une endoscopie gastro-intestinale supérieure, tandis que les témoins n'ont subi qu'une échographie abdominale. Les sérums préparés à partir de 10 ml de sang veineux de chaque participant ont été conservés à -20ºC et analysés ultérieurement pour le pepsinogène I (PG I). RÉSULTATS: Les femmes prédominaient dans les deux groupes (F:M = 1,4:1). L'âge moyen des cas était de 51±15.9 ans et était similaire à celui des témoins 51.4±16.5. Le symptôme le plus fréquent était la douleur épigastrique chez 101 (90,2 %) patients. Le taux médian de pepsinogène I chez les patients (28,5 ng/ml) était significativement plus bas que chez les témoins (68,8 ng/ml) (p<0,001). Le résultat endoscopique le plus fréquent était la gastrite. Le taux sérique de PG I à un seuil de 79,5 ng/ml avait une spécificité de 88,8 % et une sensibilité de 40 % dans l'identification de la dysplasie. CONCLUSION: Le taux de PG I sérique était plus faible chez les patients souffrant de dyspepsie que chez les témoins. Il a montré une spécificité élevée dans l'identification de la dysplasie et pourrait être un biomarqueur pour le cancer gastrique précoce. Mots-clés: Dyspepsie, Pepsinogène I sérique, Helicobacter pylori, Biomarqueur.

Comparative study of stool antigen test and serology for Helicobacter pylori among Nigerian dyspeptic patients--a pilot study.

OBJECTIVE: The purpose of this study was to compare the stool antigen (SAT) and immunoglobulin G (IgG) serology tests for Helicobacter pylori in dyspeptic patients in Nigeria, and determine their usefulness. METHOD: Forty six patients with dyspepsia and age and sex-matched healthy controls had their blood and stool collected and screened for H. pylori infection using the enzyme linked immunosorbent assay (ELISA) IgG serology and SAT respectively. Prevalence of H. pylori was 67.4% and 78.3%, among dyspeptics and controls respectively ((p = 0.48) with the SAT while the corresponding values for IgG serology were 67.4% and 91.3%, p = 0.005). RESULT: Patients aged > or = 50 years(8) were more positive to SAT (80%), compared with controls (13) which recorded more positivity in the age range 30-39 years (92.9%). The male gender had more positive SAT in patients (n = 15, 75%) but the SAT was more positive among the female controls 22 (84.6%). Controls in the age range < 30 years were more positive to H. pylori IgG while the patients were more positive at = 30 yrs 10 (100%). CONCLUSION: It is concluded that SAT and IgG serology for H. pylori are both useful in diagnosis of the infection, and are fairly comparable in their ability to detect infection, even in area of high endemicity.

Pitfalls in diagnosis of hepatitis B virus infection among adults Nigerians.

OBJECTIVE: Hepatitis B virus infection is common in Nigerians and its diagnosis is necessary for effective treatment and eradication. This study is aimed at highlighting the serological factors jeopardizing the diagnosis and treatment of the infection among Nigerians adults. PATIENTS AND METHODS: Three studies were carried out. The first study involved 56 Nigerian adults and it compared the assay of HBsAg by Haemagulation Method (HMA) with Enzyme linked immunoassay (ELISA). The second study was a comparison of Glaxo Welcome HB rapid test(GWHB) with ELISA in sero-assay of HBsAg and HBeAg among 25 Nigerian subjects while the third study was on the assay of the sera of HBsAg positive patients for HBeAg and anti-HBe in forty two Nigerian patients by ELISA. RESULTS: The sero - prevalence rates of HBsAg were 41.8% and 61.8% by HM and ELISA respectively with false HBsAg sero-positives and sero-negatives by HM of 5.4% and 25.5% respectively. Similarly, there was sero-detection of HBsAg in 84% and 80% by ELISA and GWHB respectively in 25 Nigerian adults. In addition, 19% and 64% of the 42 patients with HBsAg sero-positivity were also positive for HBeAg and anti-HBe respectively, while 31% of the patients were both HBeAg and anti-HBe sero-negative. CONCLUSION: Sero-diagnosis of HBsAg and other serological markers of infectivity in patients with HBV should be carried out by ELISA rather than HMA among adult Nigerians. Furthermore, high infectivity of the virus abounds among Nigerian with HBV infection.

Quality of life among primary liver cell carcinoma patients in Ibadan, Nigeria.

A descriptive prospective study was conducted to evaluate the quality of life of patients with primary liver cell carcinoma at the University College Hospital, Ibadan, Nigeria. Quality of life (QOL) was evaluated using a modified WHO QOL Field Trial version questionnaire of December 1996. The QOL parameters include body pains, energy and acceptability of bodily appearance among others. Thirty-four patients aged between 23-74 years with a mean age of 49.6 +/- 13.4 were assessed. There were 28 (82.4%) males and 6 (17.6% females) (M/F = 4.6:1). Only about thirty percent of the patients rated their quality of life as being good or very good, with 70% rating their quality of life as very poor, poor or neither poor nor good. Eighty five percent of the patients were dissatisfied with their health, with 44.1% describing their health as very dissatisfying and only less than 10% enjoying satisfactory health. Eighty two percent of the patients responded that physical pain prevented them from doing what they want to do from moderate to extreme extent. All responders believed they require medical treatment to function in their lives with 22 (64%) requiring it very much. Seventeen (50%) of the patients had not enough energy at all for their daily activities, while 21 (61.7%) found their bodily appearance unacceptable to them. Fourteen (41.2%) did not receive adequate information they required about their day-to-day life. We conclude that our patients with PLCC have a low QOL rating and measures such as pain relief, reduction of bodily disfigurement and information to patients need to be put in place in order to improve their QOL.