Intestinal-type gastric
adenocarcinomas usually are preceded by chronic
atrophic gastritis. Studies of
gastric cancer prevention often rely on identification of this condition. In a clinical trial, we sought to determine the best serological screening method for chronic
atrophic gastritis and compared our findings to the published literature. Test characteristics of potential screening tests (
antibodies to Helicobacter pyloni or CagA, elevated
gastrin, low
pepsinogen, increased age) alone or in combination were examined among consecutive subjects enrolled in a study of H. pylori and preneoplastic gastric lesions in Chiapas, Mexico; 70% had chronic
atrophic gastritis. English-language articles concerning screening for chronic
atrophic gastritis were also reviewed. Sensitivity for chronic
atrophic gastritis was highest for
antibodies to H. pylori (92%) or CagA, or
gastrin levels >25 ng/l (both 83%). Specificity, however, was low for these tests (18, 41, and 22%, respectively).
Pepsinogen levels were highly specific but insensitive markers of chronic
atrophic gastritis (for
pepsinogen I <25 microg/l, sensitivity was 6% and specificity was 100%; for
pepsinogen I:
pepsinogen II ratio <2.5, sensitivity was 14% and specificity was 96%). Combinations of markers did not improve test characteristics. Screening test characteristics from the literature varied widely and did not consistently identify a good screening strategy. In this study, CagA
antibodies alone had the best combination of test characteristics for chronic
atrophic gastritis screening. However, no screening test was both highly sensitive and highly specific for chronic
atrophic gastritis.