Aim: Gastrin and chromogranin A (CgA) levels have been tested for the diagnosis of enterochromaffin-like cell hyperplasia (ECLH) in patients with type 1 diabetes and autoimmune atrophic gastritis but not for patients with Hashimoto's thyroiditis (HT). The aim of the study was to develop receiver operating characteristic (ROC) curves for gastrin and CgA levels and other clinical and biochemical parameters, as means for pretest probability of gastric ECLH in patients with HT. Methods: A total of 115 patients with HT were prospectively studied for a median period of 4 (2-7) years. Gastrin, CgA, vitamin B12, anti-parietal cell antibodies, free thyroxine, thyrotropin, and neuron-specific enolase levels were measured. Their predictive values were calculated according to the histological findings for ECLH diagnosis from esophagogastroduodenoscopy-obtained biopsies. Results: Thirteen patients (11.3%) had ECLH. The areas under the curve for gastrin and CgA level were 0.898 (p < 0.001) and 0.853 (p < 0.001), respectively. The product sensitivity × specificity was 0.803 and 0.653 for gastrin and CgA levels >89.5 and >89.1 ng/ml, respectively. Two and 4 patients with ECLH had normal gastrin and CgA levels, respectively. The most specific combined parameters predicting ECLH were gastrin >89.5 ng/ml with concomitant low B12 levels (96.1% specificity). Conclusion: Gastrin levels have high diagnostic accuracy for ECLH identification in patients with HT, and are highly specific when combined with low B12 levels. However, they should be interpreted with caution, as some patients may harbor gastric ECLH even if gastrin levels are not increased, necessitating further follow-up.

Sundler F, Hakanson R: Gastric endocrine cell typing at the light microscopic level; in Hakanson R, Sundler F (eds): The Stomach as an Endocrine Organ. Amsterdam, Elsevier Science, 1991, pp 9-26.
Maton PN, Lack EE, Collen MJ, Cornelius MJ, David E, Gardner HD, Jensen RT: The effect of Zollinger-Ellison syndrome and omeprazole therapy on gastric oxyntic endocrine cells. Gastroenterology 1990;99:943-950.
Waldum HL, Amestad JS, Brenna E, Elde I, Syversen U, Sandvik AK: Marked increase in gastric acid capacity after omeprazole treatment. Gut 1996;39:649-653.
Borch K, Stridsbeg M, Burman P, Renfeld JF: Basal chromogranin A and gastrin concentrations in circulation correlate to endocrine cell proliferation in type A gastritis. Scand J Gastroenterol 1997;32:198-202.
Kaltsas G, Besser M, Grossman A: The diagnosis and medical management of advanced neuroendocrine tumors. Endocr Rev 2004;25:458-511.
Sanduleanu S, De Bruine A, Stridsberg M, Jonkers D, Biemond I, Hameeteman W, Lundqvist G, Stockbrugger W: Serum chromogranin A as a screening test for gastric enterochromaffin-like cell hyperplasia during acid-suppressive therapy. Eur J Clin Invest 2001;31:802-811.
De Block CEM, Colpin G, Thielemans K, Coopmans W, Bogers JJPM, Pelckmans PA, Van Marck EAE, Van Hoof VV, Martin M, De Leeuw IH, Bouillon R, Van Gaal LF: Neuroendocrine tumor markers and enterochromaffin-like cell hyper/dysplasia in type 1 diabetes. Diabetes Care 2004;27:1387-1393.
Peracchi M, Gebbia C, Basilisco G, Quatrini M, Tarantino C, Vescarelli C, Massironi S, Conte D: Plasma chromogranin A in patients with autoimmune chronic atrophic gastritis, enterochromaffin-like cell lesions and gastric carcinoids. Eur J Endocrinol 2005;152:443-448.
Alexandraki IK, Nikolaou A, Thomas D, Syriou V, Korkolopoulou P, Sougioultzis S, Kaltsas G: Are patients with autoimmune thyroid disease and autoimmune gastritis at risk for gastric neuroendocrine tumours type 1? Clin Endocrinol (Oxf) 2014;80:685-690.
Spampatti MP, Massironi S, Rossi RE, Conte D, Sciola V, Ciafardini C, Ferrero S, Lodi L, Peracchi M: Unusually aggressive type 1 gastric carcinoid: a case report with a review of the literature. Eur J Gastroenterol Hepatol 2012;24:589-593.
Dixon MF, Genta RM, Yardley JH, Correa P: Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996;20:1161-1181.
Solcia E, Bordi C, Creutzfeldt W, Dayal Y, Dayan AD, Falkmer S, Grimellius L, Havu N: Histopathological classification of non-antral gastric endocrine growths in man. Digestion 1988;41:185-200.
Annibale B, Azzoni C, Corleto VD, di Giulio E, Caruana P, D'Ambra G, Bordi C, Delle Fave G: Atrophic body gastritis patients with enterochromaffin-like cell dysplasia are at increased risk for the development of type I gastric carcinoid. Eur J Gastroenterol Hepatol 2001;13:1449-1456.
Vannella L, Sbrozzi-Vanni A, Lahner E, Bordi C, Pilozzi E, Corelto VD, Osborn JF, Delle Fave G, Annibale B: Development of type I gastric carcinoid in patients with chronic atrophic gastritis. Aliment Pharmacol Ther 2011;33:1361-1369.
Centanni M, Marignani M, Gargano L, Corleto VD, Casini A, Delle Fave G, Andreoli M, Annibale B: Atrophic body gastritis in patients with autoimmune thyroid disease: an underdiagnosed association. Arch Intern Med 1999;159:1726-1730.
Miceli E, Lenti MV, Padula D, Luinetti O, Vattiato C, Monti CM, Di Stefano M, Corazza GR: Common features of patients with autoimmune atrophic gastritis. Clin Gastroenterol Hepatol 2012;10:812-814.
Delle Fave G, Kwekkenboom DJ, Van Cutsem E, Rindi G, Kos-Kudla B, Knigge U, Sassano H, Tomassetti P, Salazar R, Ruszniewski P; Barcelona Consensus Conference Participants: ENETS Consensus Guidelines for the management of patients with gastroduodenal neoplasms. Neuroendocrinology 2012;95:74-87.
Jianu CS, Fossmark R, Viset T, Ovigstad G, Sordal O, Marvik R, Waldum HL: Gastric carcinoids after long-term use of a proton pump inhibitor. Aliment Pharmacol Ther 2012;36:644-649.
Eissele R, Brunner G, Simon B, Solcia E, Arnold R: Gastric mucosa during treatment with lansoprazole: Helicobacter pylori is a risk factor for argyrophil cell hyperplasia. Gastroenterology 1997;112:707-717.
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