ABSTRACT
BACKGROUND: Iran is a country with very high incidences of stomach cancer, especially in Northern parts. Here we assessed prognostic value of serum screening biomarkers among people >50 years old for early detection of precancerous lesions in a hot spot for gastric carcinoma in Guilan Province, North Iran. METHODS: A cross- sectional population-based survey was conducted on 1,390 residents of Lashtenasha city with the mean age (SD) of 61.8 (9.02) years old (50.8% females) to assess the association of gastrin and the pepsinogen (PG) I/II ratio with premalignant gastric lesions. Blood samples were taken for CBC, blood group, and serologic exams (PGI, PGII, and gastrin 17) from each subject. Expert gastroenterologists performed upper GI endoscopy and ROC curves were generated to determine appropriate cutoff points. RESULTS: Mean values of PGI, PGII, PGI/PGII and gastrin were significantly different between patients with and without atrophy or metaplasia (P<0.05). To diagnose atrophy and intestinal metaplasia, a significantly higher AUC was observed for the PGI/PGII ratio (70 and 72%, respectively) compared to the PGI (56, 55%), PGII (63, 64%) and gastrin (59, 61%) (all p<0.001). CONCLUSIONS: Biomarker tests such as the PGI/II ratio can be used in the screening and diagnosis of subjects at high gastric cancer risk in our region.
Subject(s)
Biomarkers, Tumor/blood , Gastrins/blood , Pepsinogen A/blood , Pepsinogen C/blood , Precancerous Conditions/diagnosis , Stomach Neoplasms/diagnosis , Aged , Aged, 80 and over , Biomarkers/analysis , Cross-Sectional Studies , Female , Follow-Up Studies , Gastric Mucosa/pathology , Gastritis, Atrophic/blood , Gastritis, Atrophic/diagnosis , Gastritis, Atrophic/pathology , Humans , Iran , Male , Metaplasia/blood , Metaplasia/diagnosis , Metaplasia/pathology , Middle Aged , Neoplasm Staging , Precancerous Conditions/blood , Precancerous Conditions/pathology , Prognosis , ROC Curve , Stomach Neoplasms/blood , Stomach Neoplasms/pathologyABSTRACT
BACKGROUND: Strongyloidiasis, a common intestinal parasitic infection, is endemic in tropical and subtropical regions and occurs sporadically in temperate areas. It is endemic in Guilan province, Iran, and especially affects the rural population. CASE REPORT: We report the case of a 43-year-old woman living in Anzali (in the north of Iran), with dyspepsia and epigastric pain for 2 years, unresponsive to H2 receptor antagonists and proton pump inhibitors. Upper gastrointestinal endoscopy was done and showed multiple small nodules at the stomach. The pathologist reported Strongyloides. Treatment with Ivermectin and antibiotic triple therapy was done. She responded well to treatment and 6 months later an upper gastrointestinal endoscopy revealed no significant lesions and all nodules had disappeared. Strongyloidiasis is usually not severe and frequently is nonspecific. For this reason, the infection is easily ignored by both the patients and physicians. CONCLUSIONS: Although gastric involvement shows nonspecific symptoms, the possibility should be carefully considered by clinicians who practice in endemic areas.
