© 1993 British Society for Rheumatology
research-article |
THE FREQUENCY OF EXTREMELY LOW SERUM PEPSINOGEN, INDICATIVE OF CORPUS GASTRITIS WITH SEVERE ATROPHY, IN RHEUMATOID ARTHRITIS, OTHER CHRONIC RHEUMATIC DISEASES AND NON-RHEUMATIC DISEASES
*The Departments of Rheumatology, University Hospital Leiden, The Netherlands
The Departments of Clinical Epidemiology, University Hospital Leiden, The Netherlands
The Departments of Gastroenterology, University Hospital Leiden, The Netherlands
Correspondence to:
Correspondence to M. Janssen, University Hospital, Department of Rheumatology, Building 1, C2-Q, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
The aim of this study was to assess the frequency of corpus gastritis with severe atrophy (CGA), pernicious anaemia and combined severe atrophy of antrum and corpus by non-invasive methods (i.e. determination of low serum pepsinogen A (PgA) and serum gastrin) in outpatients with RA (n = 249), compared to outpatients with other rheumatic diseases (n = 181) and outpatients with chronic non-rheumatic diseases (n = 429). In addition we investigated whether NSAIDs could cause or prevent CGA. A low serum PgA level (< 17ug/1), indicating pentagastrin-refractory achlorhydria in patients without gastric resection, was found in 13 patients (5.2%;95% Confidence Interval (CI) 2.4–8.0) with RA, in 11 (6.1 %;95% CI 2.6–9.5) with other rheumatic diseases and in 12 patients (2.8%;95% CI 1.2–4.4) with chronic non-rheumatic diseases (NS). Low serum PgA values were more frequent in older patients (F<0.005) and females (/<0.05). Pernicious anaemia occurred in RA in 1.2% (95% CI0–2.6) of the patients while for other rheumatic diseases the frequency was 1.7% (95% CI 0–3.5) and for chronic non-rheumatic diseases 0.2% (95% CI 0–3.6) (NS). In patients with a serum PgA below 17 ug/l, normal serum gastrin levels (<90 ng/l) as an indication of combined severe atrophy of antrum and corpus, were found in 1/13 patients with RA, in 3/11 with other rheumatic diseases and 2/12 with chronic non-rheumatic diseases (NS). The frequency of low serum PgA levels was no different between patients on NSAIDs 17/355 (4.8%) and those without NSAIDs 19/502(3.8%).
We concluded that there were no significant differences in the frequency of severe CGA, pernicious anaemia and combined severe atrophy of corpus and antrum between patients with RA and those with other chronic rheumatic diseases or chronic non-rheumatic diseases. Furthermore the presence of CGA was not related to the use of NSAIDs.
KEY WORDS: Corpus gastritis, Pernicious anaemia, Serum pepsinogens, Rheumatoid arthritis, Non-steroidal anti-inflammatory drugs