الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The fourth-leading cause of cancer-related death was gastric cancer. However, if it is discovered early from first likely-precancerous lesions, notably atrophic gastritis, a frequent progressive illness, it may be well treated and have a fair prognosis.
Therefore, it is important to adopt early diagnosis of the high-risk group with moderate and severe AG lesions in order to lower the chance of developing gastric cancer. by using suggested cutting-edge methods like guided biopsies or endoscopy. As a result, non-invasive methods for screening programmes for AG lesions have become necessary.
For identifying severe atrophic gastritis or stomach cancer, serum pepsinogens (Pg 1, Pg 2, and Pg 1/2) have been regarded as the most accurate non-invasive biomarker currently available. Its application is still debatable, nevertheless, since it is advised to proceed cautiously and its cut-off values differ from population to population.
Accordingly, we aimed to evaluate serum pepsinogen I and pepsinogen I to pepsinogen II ratio in patients with atrophic gastritis and cancer stomach and compare them to gold standard endoscopic examination in those patients, to detect the sensitivity and specify of these markers to evaluate their value as a future seromarker or tumor marker.
This was an observational case-control comparative study that included 60 patients diagnosed with atrophic gastritis and gastric carcinoma. The diagnosis was based on a clinical and endoscopic basis and confirmed by histopathological examination of gastric biopsies. Patients were classified into two groups; group 1 included 30 patients with atrophic gastritis and group 2 included 30 patients with gastric cancer. Thirty healthy volunteers were enrolled as a control group. Informed written consent will be taken from all patients.
The mean age in the AG group (49.47 ± 10.56 years) was statistically significantly lower than the age in gastric cancer (58.23 ± 9.25 years) and control groups (50.17 ± 11.82 years) (p1= 0.005 and p3= 0.011, respectively).
Regarding sex, there were 16 males (53.3%) and 14 females (46.7%) in the AG group. Also in the gastric cancer group, there were 16 males (53.3%) and 14 females (46.7%). While males and females were equal in the control group. There was no statistically significant difference between the three studied groups as regards sex (p= 0.956).
We found that the H. pylori test was positive in only half of the patients with AG and gastric cancer. There was no statistically significant difference between the three studied groups regarding the H. pylori test (p= 0.875).
Although the means of Pg 1 in AG (16.95 ± 1.12 ng/ml) and gastric cancer (17.83 ± 0.85 ng/ml) patients were comparable (p= .098), however, they were highly statistically significantly lower than healthy controls (47.23 ± 3.69 ng/ml) (p< 0.001 for both). Also, the mean of Pg 1/2 in the AG group (2.02 ± 0.08 ng/ml) was nearly equal to that in the gastric cancer group (2.05 ± 0.07 ng/ml) (p= 0.976), but, they were highly statistically significantly lower than healthy controls (4.53 ± 0.32 ng/ml) (p< 0.001 for both). These results suggest a possible relationship between Pg 1 and Pg 1/2 ratio in diagnosing AG and gastric cancer.
The most frequent manifestations of AG are heartburn, epigastric pain, and bloating followed by abdominal pain, anemia, and dyspepsia, representing 63.33%, 53.33%, 46.67%, 26.67%, 16.67%, and 13.33% respectively. On the other hand, the most frequent manifestations of gastric cancer were abdominal pain, representing 43.33% followed by vomiting, weight loss, dyspepsia, hematemesis, and dysphagia representing 26.67%, 23.33%, 16.67%, 16.67%, and 13.33% respectively.
There was no statistically significant association between Pg1 and Pg 1/2 and H. pylori whether in AG patients or gastric cancer patients. Also, there was no statistically significant association between Pg1 and Pg 1/2 and sex in AG patients or gastric cancer patients. However, highly significant negative correlations between Pg1 and age in AG patients and gastric cancer patients were reported (p<0.001 for both).
We found that serum pepsinogen had an excellent diagnostic value for the diagnosis of AG and gastric cancer. The best cut-off values for AG or gastric cancer diagnosis were PGI ≤18.96 and Pg 1/2 ≤2.25, which may return a sensitivity of 100 (94 – 100)%, a specificity of 100 (88.4 – 100)%, a positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 100%.