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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2017, Vol. 11 Issue (1) : 20-31    https://doi.org/10.1007/s11684-016-0493-4
REVIEW
Detection of digestive malignancies and post-gastrectomy complications via gastrointestinal fluid examination
Lei Huang1,2(),Aman Xu1,3()
1. Department of Gastrointestinal Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
2. German Cancer Research Center (DKFZ), Heidelberg, Germany
3. Department of General Surgery, the Fourth Affiliated Hospital of Anhui Medical University, Hefei 230022, China
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Abstract

To date, gastric carcinoma (GC) is one of the common and fatal digestive malignancies worldwide. The prognosis of GC is not always satisfactory because of late diagnosis. Scholars are keen on discovering novel accurate and economical biomarkers in body liquids for GC screening to detect and evaluate the lesion before the results of imaging techniques are obtained. While traditional serum assays have limited sensitivity and specificity, gastrointestinal juice may provide relevant specific biomarkers because of its close contact with the tumor. Herein, the current progress in the relationship between gastrointestinal fluid analyses and GC is systematically and comprehensively reviewed. The detection of gastric juice pH, fluorescence spectrum, cytology, Helicobacter pylori-associated markers, nitrosamines, conventional tumor markers, amino acids, proteomics, microRNAs, long noncoding RNAs, protein-coding genes, vitamin C, etc., and combination tests of different category markers could provide important diagnostic and prognostic clues for gastrointestinal diseases. Particularly, early GC may be efficiently screened using gastric juice. Gastrointestinal fluid examination could also predict the adverse effects of postgastrectomy, such as pancreatic leakage, fistula, and abscess. Gastric fluid markers should be further studied to reveal the early predicators of malignancy and complications. The methods for obtaining the samples of gastrointestinal juice with minimum incision should also be comprehensively investigated.

Keywords gastrointestinal fluid      gastric carcinoma      biomarker      diagnosis      prognosis      gastrectomy      adverse events     
Corresponding Author(s): Lei Huang,Aman Xu   
Just Accepted Date: 28 December 2016   Online First Date: 20 February 2017    Issue Date: 20 March 2017
 Cite this article:   
Lei Huang,Aman Xu. Detection of digestive malignancies and post-gastrectomy complications via gastrointestinal fluid examination[J]. Front. Med., 2017, 11(1): 20-31.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-016-0493-4
https://academic.hep.com.cn/fmd/EN/Y2017/V11/I1/20
Fig.1  The screening of digestive diseases via gastrointestinal fluid examination.
Fig.2  Gastrointestinal juice examination for predicting postgastrectomy adverse effects that might require reoperation.
Fig.3  Gastric juice detection for GC screening. P1 FI, fluorescence intensity of the first peak; FS, fluorescence spectroscopy; HPLC, high-performance liquid chromatography; IA, immunoassay; RT-qPCR, real-time quantitative polymerase chain reaction; miR, microRNA; RIA, radioimmunoassay; EGF, epithelial growth factor; TGF-a, tumor growth factor a.
Marker Disease/condition Sensitivity (%) Specificity (%) References
Pre-surgery
Pepsinogen I<40 ng/ml Gastric cancer 72.4 65.8 [10]
Pepsinogen I≤107.1 μg/ml Gastric cancer 73.5 71.4 [46]
Pepsinogen II≤78.4 μg/ml Gastric cancer 98.0 22.5 [46]
Pepsinogen I/II<2.2 Gastric cancer 78.2 61.0 [10]
Pepsinogen I/II≤2.05 Gastric cancer 61.2 91.8 [46]
pH>5.5 Gastric cancer 76.0 67.9 [10]
Nitrite>20 μmol/L Gastric cancer 71.2 69.2 [10]
P1FI≥76.5 Gastric cancer 83.2 80.7 [12]
cag genes Gastric cancer 92.3 60.0 [15]
Mt 21-42 AGOM 96.3 85.7 [16]
Gastrin/pepsinogen AGOM 40.7 98.4 [16]
Intrinsic factor antibodies AGOM 3.7 100.0 [16]
Parietal cells antibodies AGOM 33.3 94.7 [16]
Vitamin B12 AGOM 22.2 99.5 [16]
Folate AGOM 11.1 99.5 [16]
Tyrosine>5.45 μg/ml Advanced gastric cancer 83.3 68.6 [28]
Phenylalanine>9.68 μg/ml Advanced gastric cancer 81.8 75.7 [28]
Tryptophan>1.94 μg/ml Advanced gastric cancer 84.8 68.6 [28]
Total protein>2.34 μg/ml Advanced gastric cancer 75.8 74.3 [28]
Tyrosine>5.88 μg/ml Early gastric cancer 75.5 71.4 [28]
Phenylalanine>11.74 μg/ml Early gastric cancer 75.5 81.4 [28]
Tryptophan>5.67 μg/ml Early gastric cancer 61.2 97.1 [28]
Total protein>2.66 μg/ml Early gastric cancer 59.2 81.4 [28]
α1-antitrypsin>717 μg/dl Gastric malignancy 96 92 [31]
α1-antitrypsin string test Gastric malignancy 74 88 [31]
Proteome Gastric cancer 88 93 [35]
miR-21 ΔCq >−2.73 Gastric cancer 85.7 97.8 [37]
miR-106a ΔCq >2.61 Gastric cancer 73.8 89.3 [37]
miR-129-1-3p ΔCq>10.17 Gastric cancer 45.2 83.8 [38]
miR-129-2-3p ΔCq>11.495 Gastric cancer 42.9 85.9 [38]
miR-421 ΔCq>5.21 Gastric cancer 71.4 71.7 [39]
lncRNA-AA174084 ΔCq>11.62 Gastric cancer 57 73 [40]
lncRNA-AA174084 ΔCq>0.88 Early gastric cancer 46 93 [40]
lncRNA-ABHD11-AS1 ΔCq>6.53 Gastric cancer 41.0 93.4 [41]
Telomerase expression Gastric cancer 80 84 [44]
Melanoma-associated gene Gastric cancer 53.1 95.9 [46]
Post-gastrectomy
Amylase>175 U/L Pancreatic leakage 76.0 74.5 [50]
Lipase>450 U/L Pancreatic leakage 72.0 69.8 [50]
Amylase>1190 IU/L Pancreas abscess 77.8 77.3 [53]
Amylase>1000 IU/L Grades B & C pancreatic fistula 94.1 72.4 [53]
Amylase>720 U/L Intra-abdominal abscess 85.7 62.8 [54]
Bacterial culture Intra-abdominal abscess 42.9 96.5 [54]
Tab.1  Sensitivity and specificity of gastrointestinal fluid markers for gastric diseases
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