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

Abstract

CONTEXT:

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.

• Authors: Núria Alonso, M Luisa Granada, Isabel Salinas, Ana M Lucas, Jordi L Reverter, Jordi Juncà, Albert Oriol, Ana Sanmartí
• Journal: The 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
• PMID: 16030155 (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