Serum pepsinogen I: an early marker of pernicious anemia in patients with type 1 diabetes.

Pernicious anemia (PA) is an autoimmune organ disease much more common in type 1 diabetic patients (DM1) than in nondiabetic subjects, but it is clinically silent until its end stage.
This study aimed to determine biochemical markers of latent PA in a population of DM1 patients attending the endocrinology outpatient clinic of a university hospital.
The population studied consisted of 186 unselected patients (32.4 +/- 8.7 yr) and 118 healthy controls (30.9 +/- 9.4 yr).
Plasma gastrin and pepsinogen I were determined in patients and controls, whereas hemoglobin A1c, serum cobalamin, hemoglobin, and organ-specific antibodies were determined only in patients. Latent PA was defined as serum pepsinogen I less than 30 microg/liter. In patients with low pepsinogen I concentrations and hypergastrinemia, esophagogastroduodenoscopy (EGD) was performed.
DM1 patients showed significantly lower pepsinogen I concentrations (P < 0.001) and higher gastrinemia than controls. Latent PA was present in 12.4% of patients vs. 0.9% of controls. Among patients, more women than men showed low plasma pepsinogen I concentrations (P = 0.002) and thyroperoxidase antibody positivity (P < 0.001). Only the highest parietal cell antibody titers (> or =1:640) identified patients with significantly higher levels of plasma gastrin (P < 0.001) and lower levels of pepsinogen I (P < 0.001). The histopathological EGD findings confirmed different degrees of gastric body mucosa atrophy in all cases.
The high prevalence of latent PA found in our DM1 patients leads us to recommend its screening using serum pepsinogen I concentrations. In patients with hypergastrinemia and high parietal cell antibody titers, EGD should be considered to confirm gastric mucosa atrophy.
AuthorsNúria Alonso, M Luisa Granada, Isabel Salinas, Ana M Lucas, Jordi L Reverter, Jordi Juncà, Albert Oriol, Ana Sanmartí
JournalThe Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 90 Issue 9 Pg. 5254-8 (Sep 2005) ISSN: 0021-972X [Print] United States
PMID16030155 (Publication Type: Journal Article)
Chemical References
  • Autoantibodies
  • Biomarkers
  • Pepsinogen A
  • Adult
  • Anemia, Pernicious (blood, complications, epidemiology, pathology)
  • Autoantibodies (blood)
  • Biomarkers (blood)
  • Case-Control Studies
  • Diabetes Mellitus, Type 1 (blood, complications)
  • Endoscopy, Gastrointestinal
  • Female
  • Gastrointestinal Tract (pathology)
  • Humans
  • Male
  • Parietal Cells, Gastric (immunology)
  • Pepsinogen A (blood)
  • Prevalence
  • Sex Factors

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