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. 2019 Dec;72(12):825-829.
doi: 10.1136/jclinpath-2019-205700. Epub 2019 Jun 24.

Feasibility of combined screening for upper gastrointestinal adenocarcinoma risk by serology and Cytosponge testing: the SUGAR study

Yiwang Xu  1 , Ahmad Miremadi  2 , Alexander Link  3 , Peter Malfertheiner  3 , Rebecca C Fitzgerald  1 , Jan Bornschein  4   5
Affiliations

Feasibility of combined screening for upper gastrointestinal adenocarcinoma risk by serology and Cytosponge testing: the SUGAR study

Yiwang Xu et al. J Clin Pathol. 2019 Dec.

Abstract

Aims: Aim was to assess the feasibility of serum markers to identify individuals at risk for gastro-oesophageal adenocarcinoma to reduce the number of individuals requiring invasive assessment by endoscopy.

Methods: Blood samples from 56 patients with Barrett's oesophagus and 202 non-Barrett controls who previously took part in a trial assessing the accuracy of the Cytosponge for Barrett's oesophagus were assessed for serum pepsinogen (PG) 1 and 2, gastrin-17, trefoil factor 3 (TFF3) and Helicobacter pylori infection.

Results: PG1 was pathological (<50 ng/mL) in 26 patients (10.1%), none of whom had Barrett's oesophagus (p<0.001). Smoking and drinking had no influence on these results. Pathological PG1 was associated with stomach pain (p=0.029), disruption of sleep (p=0.027) and disruption of diet by symptoms (p=0.019). Serum TFF3 was not associated with any clinical parameter.

Conclusions: Assessment of serum PG1 could be combined with a test for Barrett's oesophagus to identify additional patients requiring endoscopy.

Keywords: TFF3; barrett’s oesophagus; gastric atrophy; gastric cancer; pepsinogens.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Comparison of serum values for PG1 (A) and TFF3 (B). Displayed is the distribution of serum values for PG1 (A) and TFF3 (B) for individuals with non-dysplastic Barrett’s oesophagus (NDBE), more advanced oesophageal lesions, including high-grade dysplasia and intramucosal cancer (HGD/IMC) and non-Barrett’s ‘controls’. Group comparison was done by Kruskal-Wallis test with significance being assumed for p<0.05.
Figure 2
Figure 2
Proportion of patients with pathological PG1 test in relation to smoking and drinking habits. Displayed is the proportion of patients with pathological PG1 test (<50 ng/L) in patients depending on the smoking and drinking habits. Indicated are current smokers as well as patients who considered themselves as heavy drinkers (ie, regular consumption of alcohol above the recommended limit). PG1 test results were not different between smokers and non-smokers (p=0.753), and there was a trend for a higher proportion for positive PG1 test results in patient who were not regular drinkers (p=0.54). PG1, pepsinogen I.
Figure 3
Figure 3
Comparison of serum PG1 in patient with or without regular PPI intake. Displayed is the distribution of serum values for PG1 for individuals with and without regular PPI intake. Group comparison was done by Mann-Whitney U test with significance being assumed for p<0.05. PPI, proton pump inhibitor.
Figure 4
Figure 4
Association of Barrett’s oesophagus and Helicobacter pylori infection. There was no statistically significant difference in the serological H. pylori status in patients with or without diagnosis of Barrett’s oesophagus (p=0.304; Fisher’s exact test).
See this image and copyright information in PMC

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