Diagnostics
Agency for Research on Cancer (IARC). H. pylori prevalence rises significantly in those with gastric cancer, reaching 84 per cent, and it is nearly ubiquitous in noncardia gastric cancer cases. This association extends to younger patients – under the age of 40 – and is linked to both intestinal and diffuse forms of noncardia gastric cancer, with the diffuse type being more prevalent in early-onset gastric cancer. The clear link between H. pylori infection and gastric cancer demonstrates the importance of rapid screening to enable timely treatment.10,14
Rapid case selection through targeted screening The GastroPanel test is a non-invasive blood test that aids rapid screening for gastritis by measuring all four of these parameters – the three stomach-specific biomarkers for gastric atrophy: pepsinogen I, pepsinogen II and gastrin-17; as well as anti-H. pylori IgG antibodies. Results can be used to help triage patients with dyspepsia that exhibit no alarm symptoms, with a positive result indicating a progression towards gastric adenocarcinoma (see Figure 1). This allows clinicians to fast track higher risk individuals to endoscopy and surveillance programmes based on the BSG guidelines.
Forming a new patient pathway Incorporating the GastroPanel test into clinical practice allows clinicians to stratify patients based on their risk for gastric adenocarcinoma, enabling the development of a new, more efficient pathway for detection, diagnosis and patient management (Figure 2). Approximately 90
Figure 1.
per cent of patients with negative GastroPanel test results and dyspeptic symptoms can initially be managed through conservative measures such as lifestyle modifications and proton pump inhibitors (PPIs). Patients who exhibit abnormal GastroPanel
test results will require image-enhanced endoscopy, taking systematic biopsies from key locations – including the antrum, incisura, lesser and greater curvature (Figure 3) – for histological diagnosis. This protocol ensures a thorough examination of the gastric mucosa to confirm the presence of atrophic gastritis, intestinal metaplasia, dysplasia, or other pathological changes that may indicate an increased risk of gastric cancer, and direct cases to appropriate follow-up and treatment. Individuals with a low pepsinogen I/II ratio
will then require further careful surveillance for lesions, such as those caused by atrophic gastritis involving the corpus and pangastritis, as outlined in the BSG guidelines. Incorporating GastroPanel into clinical
pathways before endoscopy not only enhances the precision of gastric cancer risk assessment but also supports personalised medicine approaches. It allows proactive monitoring, early intervention, and potentially improved outcomes by initiating appropriate therapies or surveillance measures based on individual risk profiles and diagnostic findings.
Summary
Gastric cancer is one of the more common malignancies worldwide and is often diagnosed at a late, incurable stage, which is evident in its
Figure 2. 58
www.clinicalservicesjournal.com I November 2024
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