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Serum Pepsinogen I: An Early Marker of Pernicious Anemia in Patients with Type 1 Diabetes

Departments of Endocrinology and Nutrition (N.A., I.S., A.M.L., J.L.R., A.S.), Clinical Biochemistry (M.L.G.), and Hematology (J.J., A.O.), Hospital Universitari Germans Trias i Pujol, Badalona, 08916 Catalonia, Spain

Address all correspondence and requests for reprints to: Dr. Isabel Salinas, Department of Endocrinology and Nutrition, Hospital Universitari Germans Trias i Pujol, Ctra Canyet s/n, Badalona, 08916 Catalonia, Spain. E-mail: isalinas{at}ns.hugtip.scs.es.

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 A_1c, serum cobalamin, hemoglobin, and organ-specific antibodies were determined only in patients. Latent PA was defined as serum pepsinogen I less than 30 µg/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 (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.

This article has been cited by other articles:

				C. E. M. De Block, I. H. De Leeuw, and L. F. Van Gaal Autoimmune Gastritis in Type 1 Diabetes: A Clinically Oriented Review J. Clin. Endocrinol. Metab., February 1, 2008; 93(2): 363 - 371. [Abstract] [Full Text] [PDF]

				N. Alonso, M. L. Granada, I. Salinas, J. L. Reverter, L. Flores, I. Ojanguren, E. M. Martinez-Caceres, and A. Sanmarti Plasma ghrelin concentrations in type 1 diabetic patients with autoimmune atrophic gastritis Eur. J. Endocrinol., December 1, 2007; 157(6): 763 - 769. [Abstract] [Full Text] [PDF]