Atrophic Gastritis (ag) and Its Clinical Sequels among Elderly People in Finland and Estonia. a Comparative Study Using Gastropanel and B12- Vitamin Testing of the Residents in Assisted-housing Facilities

Objective: Atrophic gastritis (AG) is associated with severe clinical sequels, including malabsorption of vitamin-B12, calcium, iron, magnesium, and zinc, with potential to develop irreversible neurological complications (e.g. dementia). To assess the prevalence of AG and its clinical sequels by serum biomarker testing and B12-vitamin measurement in elderly people in Estonia and Finland. Methods: In total, 209 residents of assisted-housing facilities (mean age 82 years) were screened by GastroPanel (Biohit Oyj, Finland) and active B12-vitamin test, the results linked with their medical history. Results: Study subjects in Tampere (n=106) and Tartu (n=103) differed in many characteristics of their medical history, including previously diagnosed B12-vitamin deficiency (p=0.006). Data requested for GastroPanel testing disclosed significantly less use of PPI medication and B12-vitamin supplementation in Tartu (p=0.0001). GastroPanel diagnostic profile (5 categories) was significantly different (p=0.0001), most markedly the HP-prevalence (all cases) (52.4%% vs 24.5%). AG in Finland (12.3%) and Estonia (15.6%) was not different (p=0.494), but manifest B12-vitamin deficiency was more common in Tartu (23.3% vs. 3.8%)(p=0.0001). Of all known complications of AG, only i) the diagnosed vitamin B12 deficiency (OR=3.5), and ii) diagnosed pernicious anaemia (OR=9.4) were significantly associated with AG. Conclusions: In Estonia, the majority (92%) of B12-vitamin deficient cases remained undiagnosed as compared to Finland (23.5%). To prevent irreversible complications, early diagnosis and adequate supplementation of vitamin B12 deficiency is essential. This is best done by detecting the subjects at risk (AG patients) by targeted GastroPanel screening, even years before the development of protean clinical manifestations.