Comparison between serology and histology in the diagnosis of advanced gastric body atrophy: a study in a Dutch primary community

GOALS: To assess serologically diagnosed gastric body atrophy (GBA) by histology in a sample of the general population. BACKGROUND: GBA is a precursor lesion in gastric cancer. Data on GBA in a primary health care community in the Netherlands have not been reported. STUDY: Thirty-four subjects of 997 consecutive adults from a Dutch family practice had serologic GBA, according to hypergastrinemia (>100 ng/L), hypopepsinogenemia A ( <17 microg/L), and a low pepsinogen A/C ratio ( <1.6). Two years later, 25 subjects of this group, agreed in serologic retesting and gastroscopy with biopsies for histologic assessment according to the Sydney system. RESULTS: At serologic retesting, 20 of 25 subjects again fulfilled the serologic criteria of GBA. Histologic examination of the corpus biopsies showed advanced GBA in 18 subjects (75%) of 24 (1 subject had no corpus biopsies) and 17 of 19 (89%) subjects with repeated positive serology. After disclosure of serology results, reexamination of the biopsies revealed GBA also in the 2 patients with initially insufficient evidence of GBA, giving a concordance of 100% (19/19). One subject with normal serum gastrin at retesting had both antral and body atrophy giving a concordance between serologic and histologic GBA of 95% (19/20). No adenomatous polyps, tumors, or dysplastic alterations were found. CONCLUSIONS: Identification by serology of asymptomatic patients with advanced GBA in primary care is adequately possible and useful in selecting for endoscopy