Irish journal of medical science · 2026
Beyond seropositivity: quantitative parietal cell antibody titers predict gastric intestinal metaplasia in a high helicobacter pylori prevalence setting.
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Durak İbrahim, Ucun Bekir, Sever Hayrettin, Alkim Huseyin
Аннотация
PURPOSE: Anti-gastric parietal cell antibody (APA) positivity is a recognized serological biomarker for autoimmune gastritis, but whether quantitative APA titer levels correlate with the severity of gastric intestinal metaplasia (GIM) in high Helicobacter pylori (H. pylori) prevalence settings remains unclear. This study aimed to evaluate the association between quantitative APA titer dilutions and histopathological GIM in a large endoscopic cohort.
METHODS: In this retrospective cohort study, medical records of adult patients who underwent APA testing at a tertiary referral center between November 2017 and November 2019 were reviewed. Of 1,104 screened patients, 453 met inclusion criteria after excluding those with repeated testing or missing data; following exclusion of 118 patients without gastroscopy or adequate biopsy sampling, 335 patients who underwent standardized topographical gastric biopsy mapping constituted the definitive analysis cohort. Associations between APA status/titer dilutions and histopathological findings were assessed using chi-squared tests and multivariate logistic regression.
RESULTS: GIM was present in 24.5% (n = 82) of the cohort. APA positivity was significantly associated with GIM (40.5% vs. 15.4% in APA-negative patients, p <0.001), with a titer-dependent dose-response relationship peaking at 50.0% in the 1:320 and >1:320 dilution subgroups. In multivariate analysis, each incremental step-up in APA titer dilution (OR 1.522, 95% CI 1.304-1.776) and advancing age (OR 1.043, 95% CI 1.021-1.066) independently predicted GIM, while active H. pylori infection was an independent negative predictor (OR 0.348, 95% CI 0.184-0.660).
CONCLUSION: Quantitative APA titers, rather than binary positivity, demonstrate a clear dose-response relationship with histopathological GIM. Titers of 1:320 or greater identify a clinically actionable threshold that may guide prioritization of endoscopic evaluation with standardized topographical biopsy mapping.
METHODS: In this retrospective cohort study, medical records of adult patients who underwent APA testing at a tertiary referral center between November 2017 and November 2019 were reviewed. Of 1,104 screened patients, 453 met inclusion criteria after excluding those with repeated testing or missing data; following exclusion of 118 patients without gastroscopy or adequate biopsy sampling, 335 patients who underwent standardized topographical gastric biopsy mapping constituted the definitive analysis cohort. Associations between APA status/titer dilutions and histopathological findings were assessed using chi-squared tests and multivariate logistic regression.
RESULTS: GIM was present in 24.5% (n = 82) of the cohort. APA positivity was significantly associated with GIM (40.5% vs. 15.4% in APA-negative patients, p <0.001), with a titer-dependent dose-response relationship peaking at 50.0% in the 1:320 and >1:320 dilution subgroups. In multivariate analysis, each incremental step-up in APA titer dilution (OR 1.522, 95% CI 1.304-1.776) and advancing age (OR 1.043, 95% CI 1.021-1.066) independently predicted GIM, while active H. pylori infection was an independent negative predictor (OR 0.348, 95% CI 0.184-0.660).
CONCLUSION: Quantitative APA titers, rather than binary positivity, demonstrate a clear dose-response relationship with histopathological GIM. Titers of 1:320 or greater identify a clinically actionable threshold that may guide prioritization of endoscopic evaluation with standardized topographical biopsy mapping.