Systematic review with meta-analysis: diagnostic performance of the combination of pepsinogen, gastrin-17 and anti-Helicobacter pylori antibodies serum assays for the diagnosis of atrophic gastritis.

BACKGROUND: The combination of pepsinogen, gastrin-17 and anti-H. pylori antibodies serological assays (panel test) is a non-invasive tool for the diagnosis of atrophic gastritis. However, the diagnostic reliability of this test is still uncertain. AIM: To assess the diagnostic performance of the serum panel test for the diagnosis of atrophic gastritis. METHODS: Medline via PubMed, Embase, Scopus, Cochrane Library databases and abstracts of international conferences proceedings were searched from January 1995 to December 2016 using the primary keywords "pepsinogens," "gastrin," "atrophic gastritis," "gastric precancerous lesions." Studies were included if they assessed the accuracy of the serum panel test for the diagnosis of atrophic gastritis using histology according to the updated Sydney System as reference standard. RESULTS: Twenty studies with a total of 4241 subjects assessed the performance of serum panel test for the diagnosis of atrophic gastritis regardless of the site in the stomach. The summary sensitivity was 74.7% (95% confidence interval (CI), 62.0-84.3) and the specificity was 95.6% (95%CI, 92.6-97.4). With a prevalence of atrophic gastritis of 27% (median prevalence across the studies), the negative predictive value was 91%. Few studies with small sample size assessed the performance of the test in detecting the site of atrophic gastritis. CONCLUSIONS: The combination of pepsinogen, gastrin-17 and anti-H. pylori antibodies serological assays appears to be a reliable tool for the diagnosis of atrophic gastritis. This test may be used for screening subjects or populations at high risk of gastric cancer for atrophic gastritis; however, a cost-effectiveness analysis is needed.

Downward fluxes of particulate carbon, nitrogen and phosphorus in the north-western Adriatic sea.

Downward fluxes of particles, organic carbon, total nitrogen and total phosphorus and the composition of the settled particulate matter were determined in the north-western Adriatic Sea at two coastal sites influenced by the outflows of the Po and Adige rivers and one offshore site. Vertical fluxes were strongly influenced by resuspension processes in addition to the primary flux and advection. The resuspended material contributed on average 34-43% of the total matter sedimented in the near bottom traps in coastal waters. Net annual vertical fluxes (due to primary flux and advection) of organic carbon, total nitrogen and phosphorus in the coastal stations were: 71-97 g C m(-2) year(-1), 8-14 g N m(-2) year(-1) and 2.1-2.3 g P m(-2) year(-1), with the highest values recorded at the station off the Po river delta. The offshore site was characterised by net annual fluxes of particulates, C, N and P approximately one order of magnitude lower than the above. The carbon export to the bottom was limited in the warm seasons when it constituted only 2-9% of primary production, due to high recycling and utilisation in the upper layer of the water column, increasing up to 8-18% in winter because of the instability of the water column and low biological utilisation.