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Serum Ghrelin as a Marker of Atrophic Body Gastritis in Patients with Parietal Cell Antibodies

Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry (S.C., A.M., L.P., C.C., F.S., C.F., F.P.), and Department of Surgery and Bioengineering (G.C.), University of Siena, 53100 Siena, Italy

Address all correspondence and requests for reprints to: Furio Pacini, Section of Endocrinology, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Viale Bracci 1, 53100 Siena, Italy. E-mail: pacini8{at}unisi.it.

Aim: Autoimmune gastritis is frequently associated with autoimmune thyroiditis and other organ-specific autoimmune diseases, and may lead to atrophic body gastritis (ABG). We studied the diagnostic use of the measurement of serum ghrelin compared with other markers of gastric damage in predicting the presence of ABG in patients with autoimmune gastritis.

Methods: We studied 233 patients with autoimmune gastritis and 211 control subjects. All patients and control subjects were screened for circulating parietal cell antibodies (PCAs) and were tested for serum ghrelin, gastrin, pepsinogen I and II, and anti-Helicobacter pylori antibody levels. A total of 52 patients and 28 control subjects underwent a gastric endoscopy.

Results: In PCA/positive patients, mean (±SD) serum ghrelin levels were significantly lower (238 ± 107 pmol/liter), and mean (±SD) serum gastrin levels were significantly higher (81.2 ± 128.3 ng/ml), with respect to PCA/negative patients (282 ± 104 pmol/liter and 20.7 ± 13.3 ng/ml, respectively; P < 0.0001). Serum ghrelin and gastrin levels were inversely correlated (P = 0.004). A total of 40 patients had ABG documented by the gastric biopsy (90% in PCA/positive patients and 10% in PCA/negative patients). The receiver operating characteristic curve analysis revealed that a cutoff value for serum ghrelin of 188 pmol/liter was associated with the highest sensitivity and specificity (97.3 and 100%, respectively) in detecting gastric atrophy and was superior to gastrin (P = 0.012), PCA (P = 0.002), and the pepsinogen I/II ratio (P = 0.016) measurements.

Conclusions: Our study demonstrates that ghrelin secretion is negatively affected by autoimmune gastritis, and its serum level represents the most sensitive and specific noninvasive marker for selecting patients at high risk for ABG.