Pepsinogen Testing for Evaluation of the Success of Helicobacter Pylori Eradication at 4 Weeks after Completion of Therapy

Background and objective: Pepsinogen levels in plasma are increased by inflammation in the gastric mucosa, including inflammation resulting from Helicobacter pylori infection. A decrease in pepsinogen II level has been suggested as a reliable marker to confirm the successful eradication of infection. The aim of our study was to evaluate the potential role of pepsinogens I and II, gastrin-17 and H. pylori antibodies in confirming successful eradication. Material and methods: Altogether 42 patients (25 women, 17 men), mean age 45 years (range 23-74), were enrolled. Pepsinogens I and II, gastrin-17 and H. pylori IgG antibodies were measured in plasma samples using an ELISA test (Biohit, Oyj., Finland) before the eradication and 4 weeks after completing the treatment. The success of eradication was determined by a urea breath test. Results: Eradication was successful in 31 patients (74%) and unsuccessful in 11 patients (26%). Pepsinogen II decreased significantly in both the successful (P = 0.029) and unsuccessful (P = 0.042) eradication groups. Pepsinogen I decreased significantly in the successful (P = 0.025) but not the unsuccessful (P = 0.29) eradication group. The pepsinogen I/II ratio increased in the successful eradication group (P = 0.0018) but not in the group in which treatment failed (P = 0.12). There were no differences in gastrin-17 or H. pylori antibody values. Conclusions: A decrease in pepsinogen II levels cannot be used as a reliable marker for the successful eradication of H. pylori 4 weeks after the completion of treatment. The increase in pepsinogen I/II ratio reflects differences in pepsinogen production following the eradication irrespective of improvement in atrophy. © 2014 Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o

Biopsy sampling in upper gastrointestinal endoscopy - a survey from ten tertiary referral centres across Europe

BACKGROUND: Guidelines give robust recommendations on which biopsies should be taken when there is endoscopic suggestion of gastric inflammation. Adherence to these guidelines often seems arbitrary. This study aimed to give an overview on current practice in tertiary referral centres across Europe. METHODS: Data was collected at ten tertiary referral centres. Demographic data, the indication for each procedure, endoscopic findings and the number and sampling site of biopsies were recorded. Findings were compared between centres and factors influencing the decision to take biopsies explored. RESULTS: Biopsies were taken in 56.6% of 9425 procedures, with significant variation between centres (p&lt;0.001). Gastric biopsies were taken in 43.8% of all procedures. Sampling location varied with the procedure indication (p&lt;0.001) without consistent pattern across the centres. Fewer biopsies were taken in centres which routinely applied the updated Sydney classification for gastritis assessment (46.0%), compared to centres where this was done only upon request (75.3%, p&lt;0.001). This was the same for centres stratifying patients according to the OLGA system (51.8% vs 73.0%, p&lt;0.001). More biopsies were taken in centres following the MAPS guidelines on stomach surveillance (68.1% vs 37.1%, p&lt;0.001). Biopsy sampling was more likely in younger patients in 8 centres (p&lt;0.05), but this was not true for the whole cohort (p=0.537). The percentage of procedures with biopsies correlated directly with additional costs charged in case of biopsies (r=0.709, p=0.022). CONCLUSION: Adherence to guideline recommendations for biopsy sampling at gastroscopy was inconsistent across the participating centres. Our data suggest that instead centre-specific policies are applied.</p