Blood Pepsin Determinations in Gastritis ‡

Study of groups of asymptomatic subjects with an increased likelihood of developing gastric cancer is a fundamental approach to the problem of gastric cancer. The selection of such groups, however, has remained a difficult task.' Pernicious anemia and its pathologic substrate, gastric atrophy, frequently associated with gastric cancer, may be an important precursor of gastric malignancy."8 Morson"` has specifically suggested that the "intestinalization" that frequently accompanies gastric atrophy is a pre-cancerous lesion, emphasizing that from this replacement of the normal gastric epithelium by goblet cells, paneth cells, and a striated border, may arise most gastric carcinomas. As the gastric glands atrophy, hypoacidity and ultimately anacidity develop, so that estimation of gastric secretory levels has been suggested as a logical means of uncovering groups of subjects with a greater than average chance of developing gastric cancer. Gastric secretory function tests evaluate the state of the gastric mucosa more accurately than does gastric biopsy.7 When the gastric acid response to an augmented histamine test is normal, the gastric mucosa is almost always normal, but depression of the gastric secretory response to histamine indicates the presence of mucosal abnormality.8 9 One of the more ambitious screening studies for gastric cancer has been that of the Minnesota group; more than 12,000 gastric analyses and annual roentgenologic examination in over 9,000 pateints have led to the detection of 21 gastric cancers.1 The effort involved in this study indicates the need for simpler, inexpensive, and more acceptable means of selecting a cancer-prone population.