The Korean journal of internal medicine

  • 제31권5호
  • /
  • Pages.835-844
  • /
  • 2016
  • /
  • 1226-3303(pISSN)
  • /
  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

Endoscopic gastritis, serum pepsinogen assay, and Helicobacter pylori infection

  • Lee, Sun-Young (Department of Internal Medicine, Konkuk University School of Medicine)
  • 투고 : 2016.05.08
  • 심사 : 2016.08.08
  • 발행 : 2016.09.01
⟨ 이전 논문 다음 논문 ⟩

초록

Endoscopic findings of the background gastric mucosa are important in the Helicobacter pylori-seroprevalent population. It is strongly correlated not only with the risk of gastric cancer, but also with the excretion ability of gastric mucosa cells. In noninfected subjects, common endoscopic findings are regular arrangement of collecting venules, chronic superficial gastritis, and erosive gastritis. In cases of active H. pylori infection, nodularity on the antrum, hemorrhagic spots on the fundus, and thickened gastric folds are common endoscopic findings. The secreting ability of the gastric mucosa cells is usually intact in both noninfected and actively infected stomachs, and the intragastric condition becomes hyperacidic upon inflammation. Increased serum pepsinogen II concentration correlates well with active H. pylori infection, and also indicates an increased risk of diffuse-type gastric cancer. In chronic inactive H. pylori infection, metaplastic gastritis and atrophic gastritis extending from the antrum (closed-type chronic atrophic gastritis) toward the corpus (open-type chronic atrophic gastritis) are common endoscopic findings. The intragastric environment is hypoacidic and the risk of intestinal-type gastric cancer is increased in such conditions. Furthermore, there is a decrease in serum pepsinogen I concentration when the secreting ability of the gastric mucosa cells is damaged. Serologic and endoscopic changes that occur upon H. pylori infection are important findings for estimating the secreting ability of the gastric mucosa cells, and could be applied for the secondary prevention of gastric cancer.

키워드

과제정보

연구 과제 주관 기관 : Konkuk University

참고문헌

  1. Chu S, Schubert ML. Gastric secretion. Curr Opin Gastroenterol 2012;28:587-593. https://doi.org/10.1097/MOG.0b013e328358e5cc
  2. Ghosh T, Lewis DI, Axon AT, Everett SM. Review article: methods of measuring gastric acid secretion. Aliment Pharmacol Ther 2011;33:768-781. https://doi.org/10.1111/j.1365-2036.2010.04573.x
  3. Sipponen P, Graham DY. Importance of atrophic gastritis in diagnostics and prevention of gastric cancer: application of plasma biomarkers. Scand J Gastroenterol 2007;42:2-10. https://doi.org/10.1080/00365520600863720
  4. Rehfeld JF, Bardram L, Hilsted L, Poitras P, Goetze JP. Pitfalls in diagnostic gastrin measurements. Clin Chem 2012;58:831-836. https://doi.org/10.1373/clinchem.2011.179929
  5. Miki K. Gastric cancer screening using the serum pepsinogen test method. Gastric Cancer 2006;9:245-253. https://doi.org/10.1007/s10120-006-0397-0
  6. Park HK, Kim N, Lee SW, et al. The distribution of endoscopic gastritis in 25,536 heath check-up subjects in Korea. Korean J Helicobacter Up Gastrointest Res 2012;12:237-243. https://doi.org/10.7704/kjhugr.2012.12.4.237
  7. Yoon H, Kim N, Lee HS, et al. Helicobacter pylori-negative gastric cancer in South Korea: incidence and clinicopathologic characteristics. Helicobacter 2011;16:382-388. https://doi.org/10.1111/j.1523-5378.2011.00859.x
  8. Toh BH. Diagnosis and classification of autoimmune gastritis. Autoimmun Rev 2014;13:459-462. https://doi.org/10.1016/j.autrev.2014.01.048
  9. Reed C, Woosley JT, Dellon ES. Clinical characteristics, treatment outcomes, and resource utilization in children and adults with eosinophilic gastroenteritis. Dig Liver Dis 2015;47:197-201. https://doi.org/10.1016/j.dld.2014.11.009
  10. Hayashi S, Imamura J, Kimura K, Saeki S, Hishima T. Endoscopic features of lymphoid follicles in Helicobacter pylori- associated chronic gastritis. Dig Endosc 2015;27:53-60. https://doi.org/10.1111/den.12335
  11. Lee OJ, Lee EJ, Kim HJ. Correlations among gastric juice pH and ammonia, Helicobacter pylori infection and gastric mucosal histology. Korean J Intern Med 2004;19:205-212. https://doi.org/10.3904/kjim.2004.19.4.205
  12. Kitamura Y, Yoshihara M, Ito M, et al. Diagnosis of Helicobacter pylori-induced gastritis by serum pepsinogen levels. J Gastroenterol Hepatol 2015;30:1473-1477. https://doi.org/10.1111/jgh.12987
  13. Di Mario F, Cavallaro LG, Moussa AM, et al. Usefulness of serum pepsinogens in Helicobacter pylori chronic gastritis: relationship with inflammation, activity, and density of the bacterium. Dig Dis Sci 2006;51:1791-1795. https://doi.org/10.1007/s10620-006-9206-1
  14. Kitamura S, Yasuda M, Muguruma N, et al. Prevalence and characteristics of nodular gastritis in Japanese elderly. J Gastroenterol Hepatol 2013;28:1154-1160. https://doi.org/10.1111/jgh.12180
  15. Yoshida T, Kato J, Inoue I, et al. Cancer development based on chronic active gastritis and resulting gastric atrophy as assessed by serum levels of pepsinogen and Helicobacter pylori antibody titer. Int J Cancer 2014;134:1445-1457. https://doi.org/10.1002/ijc.28470
  16. Choi HS, Lee SY, Kim JH, et al. Combining the serum pepsinogen level and Helicobacter pylori antibody test for predicting the histology of gastric neoplasm. J Dig Dis 2014;15:293-298. https://doi.org/10.1111/1751-2980.12144
  17. Bornschein J, Selgrad M, Wex T, Kuester D, Malfertheiner P. Serological assessment of gastric mucosal atrophy in gastric cancer. BMC Gastroenterol 2012;12:10. https://doi.org/10.1186/1471-230X-12-10
  18. Lee SY. Future candidates for indications of Helicobacter pylori eradication: do the indications need to be revised? J Gastroenterol Hepatol 2012;27:200-211. https://doi.org/10.1111/j.1440-1746.2011.06961.x
  19. Asaka M, Mabe K, Matsushima R, Tsuda M. Helicobacter pylori eradication to eliminate gastric cancer: the Japanese Strategy. Gastroenterol Clin North Am 2015;44:639-648. https://doi.org/10.1016/j.gtc.2015.05.010
  20. Ahn SY, Lee SY, Hong SN, et al. Endoscopic diagnosis of open-type atrophic gastritis is related to the histological diagnosis of intestinal metaplasia and Cdx2 expression. Dig Dis Sci 2011;56:1119-1126. https://doi.org/10.1007/s10620-010-1531-8
  21. Testoni PA, Bonassi U, Bagnolo F, Colombo E, Scelsi R. In diffuse atrophic gastritis, routine histology underestimates Helicobacter pylori infection. J Clin Gastroenterol 2002;35:234-239. https://doi.org/10.1097/00004836-200209000-00007
  22. Korstanje A, van Eeden S, Offerhaus JA, et al. Comparison between serology and histology in the diagnosis of advanced gastric body atrophy: a study in a Dutch primary community. J Clin Gastroenterol 2008;42:18-22. https://doi.org/10.1097/01.mcg.0000248008.70396.90
  23. Derakhshan MH, El-Omar E, Oien K, et al. Gastric histology, serological markers and age as predictors of gastric acid secretion in patients infected with Helicobacter pylori. J Clin Pathol 2006;59:1293-1299. https://doi.org/10.1136/jcp.2005.036111
  24. Kim DH, Kim GH, Kim JY, et al. Endoscopic grading of atrophic gastritis is inversely associated with gastroesophageal reflux and gastropharyngeal reflux. Korean J Intern Med 2007;22:231-236. https://doi.org/10.3904/kjim.2007.22.4.231
  25. Lee JY, Kim N, Lee HS, et al. Correlations among endoscopic, histologic and serologic diagnoses for the assessment of atrophic gastritis. J Cancer Prev 2014;19:47-55. https://doi.org/10.15430/JCP.2014.19.1.47
  26. Takao T, Ishikawa T, Ando T, et al. Multifaceted assessment of chronic gastritis: a study of correlations between serological, endoscopic, and histological diagnostics. Gastroenterol Res Pract 2011;2011:631461.
  27. Yang JH, Lee SY, Hong SN, et al. Changing trends of serum pepsinogen I/II ratio in asymptomatic subjects. Korean J Helicobacter Up Gastrointest Res 2012;12:96-102. https://doi.org/10.7704/kjhugr.2012.12.2.96
  28. Kono S, Gotoda T, Yoshida S, et al. Can endoscopic atrophy predict histological atrophy? Historical study in United Kingdom and Japan. World J Gastroenterol 2015;21:13113-13123. https://doi.org/10.3748/wjg.v21.i46.13113
  29. Rugge M, Meggio A, Pennelli G, et al. Gastritis staging in clinical practice: the OLGA staging system. Gut 2007;56:631-636. https://doi.org/10.1136/gut.2006.106666
  30. Sugano K, Tack J, Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut 2015;64:1353-1367. https://doi.org/10.1136/gutjnl-2015-309252
  31. Song HJ, Jang SJ, Yun SC, et al. Low levels of pepsinogen I and pepsinogen I/II ratio are valuable serologic markers for predicting extensive gastric corpus atrophy in patients undergoing endoscopic mucosectomy. Gut Liver 2010;4:475-480. https://doi.org/10.5009/gnl.2010.4.4.475
  32. Nomura S, Ida K, Terao S, et al. Endoscopic diagnosis of gastric mucosal atrophy: multicenter prospective study. Dig Endosc 2014;26:709-719. https://doi.org/10.1111/den.12286
  33. Storskrubb T, Aro P, Ronkainen J, et al. A negative Helicobacter pylori serology test is more reliable for exclusion of premalignant gastric conditions than a negative test for current H. pylori infection: a report on histology and H. pylori detection in the general adult population. Scand J Gastroenterol 2005;40:302-311.
  34. Kang HY, Kim N, Park YS, et al. Progression of atrophic gastritis and intestinal metaplasia drives Helicobacter pylori out of the gastric mucosa. Dig Dis Sci 2006;51:2310-2315. https://doi.org/10.1007/s10620-006-9276-0
  35. Yoo JY, Kim N, Park YS, et al. Detection rate of Helicobacter pylori against a background of atrophic gastritis and/or intestinal metaplasia. J Clin Gastroenterol 2007;41:751-755. https://doi.org/10.1097/MCG.0b013e31802c347d
  36. Kim CG, Choi IJ, Lee JY, et al. Biopsy site for detecting Helicobacter pylori infection in patients with gastric cancer. J Gastroenterol Hepatol 2009;24:469-474. https://doi.org/10.1111/j.1440-1746.2008.05679.x
  37. Masuyama H, Yoshitake N, Sasai T, et al. Relationship between the degree of endoscopic atrophy of the gastric mucosa and carcinogenic risk. Digestion 2015;91:30-36. https://doi.org/10.1159/000368807
  38. Yanaoka K, Oka M, Mukoubayashi C, et al. Cancer high-risk subjects identified by serum pepsinogen tests: outcomes after 10-year follow-up in asymptomatic middle-aged males. Cancer Epidemiol Biomarkers Prev 2008;17:838-845. https://doi.org/10.1158/1055-9965.EPI-07-2762
  39. Imagawa S, Yoshihara M, Ito M, et al. Evaluation of gastric cancer risk using topography of histological gastritis: a large-scaled cross-sectional study. Dig Dis Sci 2008;53:1818-1823. https://doi.org/10.1007/s10620-007-0077-x
  40. Shichijo S, Hirata Y, Sakitani K, et al. Distribution of intestinal metaplasia as a predictor of gastric cancer development. J Gastroenterol Hepatol 2015;30:1260-1264. https://doi.org/10.1111/jgh.12946
  41. Shiotani A, Iishi H, Uedo N, et al. Histologic and serum risk markers for noncardia early gastric cancer. Int J Cancer 2005;115:463-469. https://doi.org/10.1002/ijc.20852
  42. Ohkusa T, Miwa H, Nomura T, et al. Improvement in serum pepsinogens and gastrin in long-term monitoring after eradication of Helicobacter pylori: comparison with H. pylori-negative patients. Aliment Pharmacol Ther 2004;20 Suppl 1:25-32.
  43. Pimanov SI, Makarenko EV, Voropaeva AV, Matveenko ME, Voropaev EV. Helicobacter pylori eradication improves gastric histology and decreases serum gastrin, pepsinogen I and pepsinogen II levels in patients with duodenal ulcer. J Gastroenterol Hepatol 2008;23:1666-1671. https://doi.org/10.1111/j.1440-1746.2007.04983.x
  44. Massarrat S, Haj-Sheykholeslami A, Mohamadkhani A, et al. Pepsinogen II can be a potential surrogate marker of morphological changes in corpus before and after H. pylori eradication. Biomed Res Int 2014;2014:481607.
  45. Ito M, Haruma K, Kamada T, et al. Helicobacter pylori eradication therapy improves atrophic gastritis and intestinal metaplasia: a 5-year prospective study of patients with atrophic gastritis. Aliment Pharmacol Ther 2002;16:1449-1456. https://doi.org/10.1046/j.1365-2036.2002.01311.x
  46. Kokkola A, Sipponen P, Rautelin H, et al. The effect of Helicobacter pylori eradication on the natural course of atrophic gastritis with dysplasia. Aliment Pharmacol Ther 2002;16:515-520. https://doi.org/10.1046/j.1365-2036.2002.01214.x
  47. Kang JM, Kim N, Shin CM, et al. Predictive factors for improvement of atrophic gastritis and intestinal metaplasia after Helicobacter pylori eradication: a three-year follow-up study in Korea. Helicobacter 2012;17:86-95. https://doi.org/10.1111/j.1523-5378.2011.00918.x
  48. Kawanaka M, Watari J, Kamiya N, et al. Effects of Helicobacter pylori eradication on the development of metachronous gastric cancer after endoscopic treatment: analysis of molecular alterations by a randomised controlled trial. Br J Cancer 2016;114:21-29. https://doi.org/10.1038/bjc.2015.418
  49. Yanaoka K, Oka M, Ohata H, et al. Eradication of Helicobacter pylori prevents cancer development in subjects with mild gastric atrophy identified by serum pepsinogen levels. Int J Cancer 2009;125:2697-2703. https://doi.org/10.1002/ijc.24591
  50. Shiotani A, Uedo N, Iishi H, et al. Predictive factors for metachronous gastric cancer in high-risk patients after successful Helicobacter pylori eradication. Digestion 2008;78:113-119. https://doi.org/10.1159/000173719
  51. Miki K, Fujishiro M, Kodashima S, Yahagi N. Longterm results of gastric cancer screening using the serum pepsinogen test method among an asymptomatic middle-aged Japanese population. Dig Endosc 2009;21:78-81. https://doi.org/10.1111/j.1443-1661.2009.00839.x
  52. Venerito M, Malfertheiner P. Preneoplastic conditions in the stomach: always a point of no return? Dig Dis 2015;33:5-10. https://doi.org/10.1159/000369185
  53. Choi IJ. Current evidence of effects of Helicobacter pylori eradication on prevention of gastric cancer. Korean J Intern Med 2013;28:525-537. https://doi.org/10.3904/kjim.2013.28.5.525
  54. Bang CS, Baik GH. Time to learn from the past and prepare for the future in Helicobacter pylori eradication. Korean J Intern Med 2015;30:789-791. https://doi.org/10.3904/kjim.2015.30.6.789
  55. Graham DY. Roadmap for elimination of gastric cancer in Korea. Korean J Intern Med 2015;30:133-139. https://doi.org/10.3904/kjim.2015.30.2.133
  56. Kim GH, Bang SJ, Ende AR, Hwang JH. Is screening and surveillance for early detection of gastric cancer needed in Korean Americans? Korean J Intern Med 2015;30:747-758. https://doi.org/10.3904/kjim.2015.30.6.747
  57. Kokkola A, Kosunen TU, Puolakkainen P, et al. Spontaneous disappearance of Helicobacter pylori antibodies in patients with advanced atrophic corpus gastritis. APMIS 2003;111:619-624. https://doi.org/10.1034/j.1600-0463.2003.1110604.x
  58. Camorlinga-Ponce M, Flores-Luna L, Lazcano-Ponce E, et al. Age and severity of mucosal lesions influence the performance of serologic markers in Helicobacter pylori-associated gastroduodenal pathologies. Cancer Epidemiol Biomarkers Prev 2008;17:2498-2504. https://doi.org/10.1158/1055-9965.EPI-08-0289
  59. Kishikawa H, Nishida J, Ichikawa H, et al. Fasting gastric pH of Japanese subjects stratified by IgG concentration against Helicobacter pylori and pepsinogen status. Helicobacter 2011;16:427-433. https://doi.org/10.1111/j.1523-5378.2011.00868.x
  60. Watabe H, Mitsushima T, Yamaji Y, et al. Predicting the development of gastric cancer from combining Helicobacter pylori antibodies and serum pepsinogen status: a prospective endoscopic cohort study. Gut 2005;54:764-768. https://doi.org/10.1136/gut.2004.055400
  61. Zhang X, Xue L, Xing L, et al. Low serum pepsinogen I and pepsinogen I/II ratio and Helicobacter pylori infection are associated with increased risk of gastric cancer: 14-year follow up result in a rural Chinese community. Int J Cancer 2012;130:1614-1619. https://doi.org/10.1002/ijc.26172
  62. Mizuno S, Miki I, Ishida T, et al. Prescreening of a highrisk group for gastric cancer by serologically determined Helicobacter pylori infection and atrophic gastritis. Dig Dis Sci 2010;55:3132-3137. https://doi.org/10.1007/s10620-010-1154-0

피인용 문헌

  1. Ulcus duodeni, Ulcus ventriculi und Helicobacter pylori vol.50, pp.2, 2016, https://doi.org/10.1007/s00391-017-1190-x
  2. Link between Serum Pepsinogen Concentrations and Upper Gastrointestinal Endoscopic Findings vol.32, pp.5, 2016, https://doi.org/10.3346/jkms.2017.32.5.796
  3. Serological Changes after EquivocalHelicobacter pylori-serology Test Findings Dependent on Gastric Secreting Ability vol.70, pp.4, 2016, https://doi.org/10.4166/kjg.2017.70.4.181
  4. Characteristics of Helicobacter pylori -seropositive subjects according to the stool antigen test findings: a prospective study vol.33, pp.5, 2016, https://doi.org/10.3904/kjim.2016.353
  5. Gastric Cancer Screening by Combined Determination of Serum Helicobacter pylori Antibody and Pepsinogen Concentrations: ABC Method for Gastric Cancer Screening vol.131, pp.10, 2018, https://doi.org/10.4103/0366-6999.231512
  6. Identification of Nodular Gastritis among Patients Diagnosed with Lymphofollicular Gastritis on a Gastric Biopsied Specimen vol.71, pp.3, 2016, https://doi.org/10.4166/kjg.2018.71.3.143
  7. Change in the Prevalences and Risk Factors of Atrophic Gastritis and Intestinal Metaplasia in Korea: Multicenter Clinical Trials vol.18, pp.4, 2018, https://doi.org/10.7704/kjhugr.2018.18.4.247
  8. Correlation between serum vitamin B12 level and peripheral neuropathy in atrophic gastritis vol.24, pp.12, 2018, https://doi.org/10.3748/wjg.v24.i12.1343
  9. Effect of Alcohol Consumption on Seroconversion in Helicobacter pylori-Seronegative Koreans vol.93, pp.3, 2018, https://doi.org/10.3904/kjm.2018.93.3.277
  10. Changes in Gastric Microbiota during Gastric Carcinogenesis vol.18, pp.2, 2018, https://doi.org/10.7704/kjhugr.2018.18.2.95
  11. Diagnostic performance of serum pepsinogen assay for the prediction of atrophic gastritis and gastric neoplasms : Protocol for a systematic review and meta-analysis vol.98, pp.4, 2019, https://doi.org/10.1097/md.0000000000014240
  12. Functional Dyspepsia vol.73, pp.2, 2016, https://doi.org/10.4166/kjg.2019.73.2.77
  13. Correlations of the Gastric and Duodenal Microbiota with Histological, Endoscopic, and Symptomatic Gastritis vol.8, pp.3, 2019, https://doi.org/10.3390/jcm8030312
  14. Prediction of Chronic Atrophic Gastritis and Gastric Neoplasms by Serum Pepsinogen Assay: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy vol.8, pp.5, 2019, https://doi.org/10.3390/jcm8050657
  15. ABC Classification Is Less Useful for Older Koreans Born before 1960 vol.13, pp.5, 2016, https://doi.org/10.5009/gnl18399
  16. Serum pepsinogens as a gastric cancer and gastritis biomarker in South and Southeast Asian populations vol.15, pp.4, 2016, https://doi.org/10.1371/journal.pone.0230064
  17. Serum pepsinogen II levels are doubled with Helicobacter pylori infection in an asymptomatic population of 40,383 Chinese subjects vol.100, pp.27, 2016, https://doi.org/10.1097/md.0000000000026562
  18. Endoscopic Characteristics of Rugal Hyperplasia and Related Acid Condition in Helicobacter pylori-Infected Stomach vol.54, pp.1, 2016, https://doi.org/10.5946/ce.2020.020
  19. The Diagnostic Value of Serum Gastrin-17 and Pepsinogen for Gastric Cancer Screening in Eastern China vol.2021, pp.None, 2021, https://doi.org/10.1155/2021/6894248
  20. Diagnostic Value of 14C Urea Breath Test for Helicobacter pylori Detection Compared by Histopathology in Indonesian Dyspeptic Patients vol.14, pp.None, 2016, https://doi.org/10.2147/ceg.s306626
  21. Molecular Alterations in Gastric Intestinal Metaplasia vol.22, pp.11, 2016, https://doi.org/10.3390/ijms22115758
  22. Current and potential biomarkers in gastric cancer: a critical review of the literature vol.17, pp.25, 2016, https://doi.org/10.2217/fon-2021-0084