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

AbstractCONTEXT:
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.
OBJECTIVE:
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.
STUDY SUBJECTS:
The population studied consisted of 186 unselected patients (32.4 +/- 8.7 yr) and 118 healthy controls (30.9 +/- 9.4 yr).
MEASUREMENTS AND INTERVENTIONS:
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.
RESULTS:
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.
CONCLUSION:
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
Topics
  • 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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