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

• Published in: Alimentary pharmacology & therapeutics Vol. 46; no. 7; pp. 657 - 667
• Main Authors: Zagari, R. M., Rabitti, S., Greenwood, D. C., Eusebi, L. H., Vestito, A., Bazzoli, F.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.10.2017
• Subjects: Antibodies; Cost-Benefit Analysis; Diagnosis; Gastric cancer; Gastrin; Gastrins - blood; Gastritis; Gastritis, Atrophic - diagnosis; Gastritis, Atrophic - diagnostic imaging; Helicobacter Infections - epidemiology; Helicobacter pylori; Helicobacter pylori - immunology; Hematologic Tests; Humans; Immunoglobulins; Meta-analysis; Pepsinogen A - blood; Prevalence; Reproducibility of Results; Sensitivity and Specificity; Stomach Neoplasms - diagnosis
• ISSN: 0269-2813; 1365-2036; 1365-2036
• DOI: 10.1111/apt.14248

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 s 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. Linked ContentThis article is linked to Graham, Zagari and Greenwood, Rugge and Dinis‐Ribeiro and Malfertheiner papers. To view these articles visit https://doi.org/10.1111/apt.14339, https://doi.org/10.1111/apt.14369, https://doi.org/10.1111/apt.14383 and https://doi.org/10.1111/apt.14340.