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Feasibility of combined screening for upper gastrointestinal adenocarcinoma risk by serology and Cytosponge testing: the SUGAR study
  1. Yiwang Xu1,
  2. Ahmad Miremadi2,
  3. Alexander Link3,
  4. Peter Malfertheiner3,
  5. Rebecca C Fitzgerald1,
  6. Jan Bornschein1,4
  1. 1 MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
  2. 2 Histopathology Department, Cambridge University Hospitals NHS Trust, Cambridge, UK
  3. 3 Dept. of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University, Magdeburg, Germany
  4. 4 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
  1. Correspondence to Dr Jan Bornschein, Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Oxford OX3 9DU, UK; jan.bornschein{at}


Aims Aim was to assess the feasibility of serum markers to identify individuals at risk for gastro-oesophageal adenocarcinoma to reduce the number of individuals requiring invasive assessment by endoscopy.

Methods Blood samples from 56 patients with Barrett’s oesophagus and 202 non-Barrett controls who previously took part in a trial assessing the accuracy of the Cytosponge for Barrett’s oesophagus were assessed for serum pepsinogen (PG) 1 and 2, gastrin-17, trefoil factor 3 (TFF3) and Helicobacter pylori infection.

Results PG1 was pathological (<50 ng/mL) in 26 patients (10.1%), none of whom had Barrett’s oesophagus (p<0.001). Smoking and drinking had no influence on these results. Pathological PG1 was associated with stomach pain (p=0.029), disruption of sleep (p=0.027) and disruption of diet by symptoms (p=0.019). Serum TFF3 was not associated with any clinical parameter.

Conclusions Assessment of serum PG1 could be combined with a test for Barrett’s oesophagus to identify additional patients requiring endoscopy.

  • pepsinogens
  • TFF3
  • barrett’s oesophagus
  • gastric atrophy
  • gastric cancer

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  • Handling editor Tahir S Pillay.

  • Contributors JB and AM designed and coordinated the study. YX did the laboratory and data analysis at the Cambridge site. AL coordinated and supervised the laboratory analysis at the Magdeburg site. PM and RCF supervised the project and gave valuable input for data analysis and interpretation. JB drafted the manuscript which was reviewed by the other authors.

  • Funding RCF receives core funding form the Medical Research Council and infrastructure support from the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre (BRC).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the local ethics committee (Rec. No. 10.H0308.71).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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