The participation of PDCD4 protein in molecular mechanisms of key importance in carcinogenesis makes the assessment of the level of its synthesis in tissues important for assessing the early diagnosis of malignant tumors. The aim of the presented study was to develop a method for evaluation of the results of immunohistochemical staining of the PDCD4 protein. Material and methods. The material for the study included 49 samples of human gastric adenocarcinoma tissue and 80 cases of endoscopic biopsy examination of the gastric mucosa of patients with dyspeptic complaints. Morphological changes in biopsies corresponded to chronic gastritis with varying degrees of inflammation. Rabbit monoclonal anti-PDCD4 antibodies (clone EP 102, abcam, USA) and a detection system (Diagnostic BioSystems, USA) were used to detect PDCD4 protein by immunohistochemical method. Results. The developed can be used for semi-quantitative visual assessment of synthesis of regulatory protein PDCD4 in histological sections of tissue by immunohistochemical method with detection in nucleus and cytoplasma. That is ensured by calculating an expression index of PDCD4 in tissues when summing up the nuclei expression and cytoplasm expression. Nuclear expression represents a product of staining frequency of nuclei (0–3 points) and semi-quantitative visual assessment of intensity of coloring nuclei (0–3 points). Cytoplasmic expression represents semi-quantitative visual assessment of intensity of cytoplasm (0–3 points). Conclusion. The proposed method makes it possible to evaluate the synthesis of the PDCD4 regulatory protein in tissues with greater sensitivity and specificity, which makes it possible to detect a violation of PDCD4 expression in epithelial cells at the early stages of tumor cell transformation.

Aim. To evaluate the activity of autophagy and apoptosis in the myocardium of rats with differentstress resistance after the modeling of myocardial contusion. Materials and Methods. The study was performed on 106 white male rats weighing 250-300 g. The rats were ranked according to stress tolerance, and medium-resistant individuals (n = 42) were excluded from the experiment. Control (n = 16) and experimental (n = 48) groups were formed from the remaining animals; the control group included subgroups with high and low stress resistance, and the experimental group included 6 subgroups (rats with high and low stress resistance; 6, 12, and 24-hour time points). Each of the subgroups included 8 animals. Myocardial contusion was modeled in the experimental group. At 6-, 12- and 24-hour time point, rat hearts have been excised and 5×5 mm myocardial fragments were dissected from the areas with the most prominent traumatic effects (interventricular septum, anterior walls of the left and right ventricles). Tissues were then sectioned and stained with antibodies to Beclin-1 and caspase-3. Results. We have documented a significant expression of Beclin-1 and Caspase 3 expression in rat hearts after myocardial contusion. From 6 to 24 hours upon the myocardial contusion, Beclin-1 expression has been increased in rats with high stress resistance but was reduced in rats with low stress resistance. Expression of caspase-3 expression was registered exclusively at 24-hour time point in rats with high stress resistant but increased along the time points in rats with low stress resistance. Conclusion. Expression of Beclin-1 and caspase-3 in rat myocardium indicated autophagy and apoptosis upon the myocardial contusion. Temporal patterns of Beclin-1 and caspase-3 expression were opposite in rats with high and low stress resistance.

Aim: to evaluate the possibility of the MMR-system status, microsatellite instability (MSI) usage in the differential diagnosis of gastric mucosa dysplasia, determination of the gastric adenocarcinoma development risk. Material and methods. The study included gastric mucosa specimens of 75 patients: 25 with high-grade dysplasia, 25 with low-grade dysplasia, 25 were indefinite for dysplasia. Gastrobiopsy specimens were examined histologically, immunohistochemically using mouse monoclonal antibodies (Diagnostic BioSystems, USA) to the MMR system proteins: MLH-1 (clone G168-15, dilution 1:50), MSH2 (clone DBM15.82, dilution 1:100), MSH6 (clone 44, dilution 1:50), PMS2 (clone A16-4, ready to use). MSI was studied with multiplex PCR evaluation of DNA microsatellites (NR-21, NR-24, NR-27, BAT-25, BAT-26) from paraffin sections, their analysis with capillary electrophoresis. The obtained data were processed with the Statistica 10.0 (StatSoft, USA), presented using descriptive, analytical statistics. VOSviewer (1.6.20) was used to visualize the bibliometric analysis. Results. MMR-deficient cases were found in low (2.8 %) and high-grade (2.8 %) dysplasia with the immunohistochemical evaluation of MMR-system proteins in gastric mucosa specimens. In all indefinite for dysplasia cases MMR-system proteins remained unaffected. Three MSI-positive cases (6.5 %) were detected by PCR with two low-grade dysplasia, one high-grade dysplasia cases. All identified cases were also immunohistochemically MSI-positive. Conclusion. Determination of MSI can be used as an auxiliary study within a panel of biomarkers aimed to support the decision-making of a pathologist in the alternative of “indefinite for dysplasia” or “definite dysplasia — obligate precancer”.

Chronic gastritis is a complex, polyetiological pathology with no clear clinical presentation. The most significant etiological factor of gastritis to date is H. pylori infection. A common clinical manifestation is the dyspepsia syndrome, which is caused by impaired motility. Symptoms can significantly affect a patient’s quality of life, necessitating rapid and effective pharmacotherapy. This paper discusses the algorithm of the physician actions in the case of a patient with uninvestigated dyspepsia. PPI has significant negative impact on the accuracy of H. pylori diagnostic test results. In this regard, it is proposed to use empirical therapy with prokinetics before diagnostic test would be performed. Among the prokinetics available on the Russian market, itopride hydrochloride stands out due to its high safety profile and proven efficacy. Current evidence supports the use of the prokinetic Ganaton® (itopride hydrochloride) as empirical therapy for dyspepsia of undetermined etiology, including patients with a preliminary diagnosis of gastritis. Due to its dual mechanism of action, itopride hydrochloride alleviates dyspeptic symptoms by improving gastric evacuation and can be used for an extended period. Several studies have shown the superiority of itopride in treating functional dyspepsia compared to other prokinetics, including metoclopramide and domperidone. Thus, prescribing the prokinetic Ganaton® (itopride hydrochloride) as empirical therapy for dyspepsia of undetermined etiology, including patients with a preliminary diagnosis of gastritis, is a pathogenetically justified approach aimed at improving the patient’s condition in the short term before establishing a final clinical diagnosis.

Patients with chronic gastritis (CG) with the development of atrophy of the gastric mucosa are at an increased risk of developing gastric cancer (GC). In the management of such patients, the development of high-grade dysplasia and invasive gastric cancer should be defined as adverse outcomes that must be prevented. To this end, patients with a diagnosis of «Chronic atrophic fundic/multifocal gastritis» are subject to dynamic dispensary observation to assess the achievement of target indicators, take into account information about changes in the diagnosis and concomitant diseases, emerging complications, as well as to enter data on ongoing therapeutic and preventive measures. This article presents the main aspects of prevention and dispensary monitoring of patients with an increased risk of gastric cancer.

The purpose of this publication is to systematize available data on the risks of developing stomach cancer in patients with a chronic autoimmune gastritis with a demonstration of the clinical case of a patient with a chronic autoimmune gastritis and a neuroendocrine gastric tumor of the type 1. Discussion: the article discusses the risks of stomach cancer in patients with chronic autoimmune gastritis. A mechanism for the formation of a neuroendocrine gastric tumor of the type 1, associated with autoimmune gastritis, is given. A clinical example of a patient with a long history of dyspepsia, the presence of concomitant changes in the results of laboratory tests, describes an algorithm for diagnosis of autoimmune gastritis and associated neuroendocrine tumors. The risks of the development in patients with autoimmune gastritis of formidable complications as an adenocarcinoma of the stomach are considered. Conclusion: Chronic autoimmune gastritis is a precancerous diseases of the stomach, with the progressive atrophy of the gastric body mucosa, and associated with an increased risk of developing neuroendocrine gastric tumor of the type 1 and adenocarcinoma of the stomach. Patients with autoimmune gastritis need dynamic outpatient observation, with endoscopic control and assessment of the degree and stage of gastritis in OLGA system, with immunogistochemistry to evaluate the risks of stomach cancer and timely implementation of the necessary measures of carcinoprection.

Introduction The Cdx2 gene provides an intestinal differentiation of epithelial cells and plays an oncosupressive role. An indirect method of the Cdx2 gene expression assessment is the immunohistochemical study of its product, the CDX2 protein. Therefore, the common approach to the immunohistochemical study of the CDX2 protein hasn’t been developed yet. A semi-quantitative CDX2 index based on the percentage of CDX2-positive cells in the tissue specimen, the staining intensity and an expression pattern has been proposed. The purpose of the study was to assess the reproducibility of the semi-quantitative CDX2 index calculation in chronic atrophic gastritis stages I-IV. Materials and methods 20 chronic atrophic gastritis cases (5 cases for each stage of the gastritis according to the Operative link for gastritis assessment system) were taken according to the Maastricht V protocol and examined by the immunohistochemical method (CDX2, clone EPR2764Y, ready to use). The reproducibility of the CDX2 semi-quantitative index was assessed by five pathologists. An agreement between observed raters was measured by the kappa statistics. Results The Cohen’s κ value is 0,8 for unweighted κ and 0,97 for weighted κ (extremely high level of agreement) for the semi-quantitative CDX2 index calculation. Discussion The least reproducible parameter used for the semi-quantitative CDX2 index calculation the percentage of CDX2-positive cells because of the subjective assessment. The Cohen’s weighted κ value was higher compared to the unweighted κ because of the close yet not similar CDX2 semi-quantitative index values calculated by pathologists. Conclusion The semi-quantitative CDX2 index can be used to rank CDX2 expression and has a high level of reproducibility.

Introduction Diagnosis of the gastric mucosa atrophy represents an important problem, the solution of which depends on the possibility of secondary prevention of gastric cancer. A possible way of solution is the use of immunohistochemical markers - proteins associated with cellular remodeling of gastric mucosa, PDCD4 and CDX2.The aim of the work is to evaluate the possibility of using immunohistochemical markers PDCD4 and CDX-2 to diagnose atrophy of the gastric mucosa in chronic gastritis and increase the informative value of biopsy examination.Materials and method The object of the study was 155 cases of biopsy examination of the gastric mucosa of patients with chronic gastritis (5 fragments per case − 775 biopsy specimens). A comparative semi-quantitative assessment of immunohistochemical expression of CDX2, PDCD4 at different stages of chronic gastritis was performed. Spearman correlation coefficient was used to assess correlation relationship.Results There were no statistically significant differences in the level of PDCD4 in studied samples depending on the stage of chronic gastritis, p=0.06. Statistically significant increase of CDX2sum index in progressing stage of chronic atrophic gastritis (p=0.005), demonstrated a pronounced positive correlation r=0.70 (p<0.01).Discussion According to the results obtained, it is shown that the decline in PDCD4 protein does not occur with the progression of atrophy severity. Complementary use of immunohistochemical marker CDX2 is able to give an idea of the presence and severity of both metaplastic and absolute atrophic changes in the gastric mucosa.Conclusion Equally high level of PDCD4 protein index in the gastric mucosa at different stages of chronic gastritis excludes the possibility of its use as an immunohistochemical marker of atrophy. Semi-quantitative immunohistochemical index of CDX2 protein can be used as an additional marker in decision support system for assessment of atrophic changes in gastric mucosa.

According to the prevalence, chronic biliary gastritis is among the most common etiological variants of chronic gastritis along with Helicobacter pylori associated gastritis and NSAID gastropathy. This review has been prepared to systematize data on the causes, pathogenetic mechanisms and methods of the diagnosis and therapy of chronic biliary gastritis. The widespread prevalance of biliary gastritis in clinical practice with insufficient understanding of the pathogenesis, the lack of diagnostic standards and unified treatment methods make the coverage of this problem very relevant. The review also systematizes known information about risk factors and pathogenetic mechanisms of biliary gastritis, discusses methods of the diagnosis and treatment of this disease, in particular, the use of ursodeoxycholic acid and cytoprotectors as pathogenetic therapy. The authors note that the treatment of biliary gastritis should be comprehensive and aimed not only at relieving dyspeptic symptoms and improving the life quality of patients, but also at preventing and inhibiting atrophic changes in the gastric mucosa. KEYWORDS: biliary gastritis, duodenogastric reflux, reactive gastritis, bile reflux gastropathy, reactive gastropathy, ursodeoxycholic acid, cytoprotectors. FOR CITATION: Livzan M.A., Gaus O.V., Mozgovoi S.I., Telyatnikova L.I. Biliary gastritis: modern methods of diagnosis and therapy. Russian Medical Inquiry. 2022;6(5):244–251 (in Russ.). DOI: 10.32364/2587-6821-2022-6-5-244-251.

Stomach cancer occupies a leading position in oncological morbidity and mortality worldwide. Approximately 800,000 people die from stomach cancer every year. In two-thirds of patients gastric cancer is diagnosed at a late stage, when radical treatment becomes impossible. Helicobacter pylori (H. pylori) infection is considered as the main etiological factor for gastric cancer. To stratify the risk of developing gastric cancer an assessment of morphological changes in the gastric mucosa using the Operative Link for Gastritis Assessment of Atrophic Gastritis (OLGA) system is used. The stage of gastritis plays a key role in determining an individual’s risk of developing stomach cancer. H. pylori eradication therapy is an effective method for preventing gastric cancer. However not in all patients the elimination of the infection can prevent the development of gastric cancer in the future. It is extremely important to identify a group of people with ex-helicobacter gastritis, who have a high risk of developing stomach cancer, and to take timely preventive measures in them. The purpose of this publication is to summarize and systematize the currently available data on the risk of developing gastric cancer in patients with H. pylori-associated gastritis, including those after successful eradication.

Patient management in chronic atrophic gastritis (CAG) in real clinical practice is a difficult task for a clinician. It is mainly due to the lack of reliable clinical stigmas that allow suspecting the presence of gastric mucosal atrophy. The diagnosis of chronic atrophic gastritis is valid only after a morphological assessment of gastrobiopaths taken during an endoscopy. According to a contemporary view, regardless of the inflammatory process etiology, CAG can progress to stomach cancer. At the same time, the point of no-return (at which the risk of inflammatory changes progression in the gastric mucosa and carcinogenesis preserves) is the CAG formation with the presence of intestinal metaplasia, even after the etiological factor is eliminated. Patients of this group, depending on the severity of inflammatory changes and atrophy, require constant dynamic follow-up and timely implementation of necessary measures for cancer prevention. To inhibit the progression of gastric mucosal precancerous changes, it is necessary to include the regimen using gastroprotective drugs for patients with CAG. Patients with autoimmune gastritis (in addition to the gastroprotective drugs) need to conduct regimens of cyanocobalamin therapy to prevent hematological and neurological disease manifestations. KEYWORDS: chronic atrophic gastritis, intestinal metaplasia, gastric cancer, Helicobacter pylori, autoimmune gastritis, gastroprotection, carcinoprevention, eradication therapy, rebamipide. FOR CITATION: Livzan M.A., Gaus O.V., Mozgovoi S.I. Chronic atrophic gastritis: patient management. Russian Medical Inquiry. 2021;5(6):427–432 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-427-432.

The aim of the study was to evaluate the potential of miR-21 expression in the gastric mucosa as the marker of early stage gastric adenocarcinoma and cancer development. Material and methods . The study included the following materials: the first group consisted of surgical material of 60 stomachs (gastric cancer of intestinal type), in each case, 1 fragment of tumor tissue and 4 specimens of the gastric mucosa of the distant zone (2 – antrum mucosa and 2 – fundal mucosa) were taken; the second group consisted of biopsy material of 62 cases in patients with chronic gastritis (5 specimens according to the OLGA-system protocol). The level of miR-21 expression in tissues was determined by reverse transcription polymerase chain reaction. Results. miR-21 expression in samples with gastric cancer was significantly higher (median – 158, p=0.0006) compared with the group of endoscopic biopsies of the gastric mucosa (median – 42). The highest level of expression was observed in adenocarcinoma tissues (median – 270), while there were no significant differences when comparing it with the level of miR-21 expression in samples of the distant zone mucosa (p=0.2).тIncreased miR-21 expression may indicate the high risk group of developing gastric adenocarcinoma, probablyтbefore the appearance of histological signs of neoplasia. Conclusion. Regression analysis performed to confirm the predictive potential of miR-21 expression demonstrated 13-fold increased risk of adenocarcinoma development associated with an increase in miR-21 levels for every 50 units of relative expression normalized to small U6 RNA. The constructed statistical model, which includes morphological criteria for evaluating the gastric mucosa and miR-21 expression, may reflect the degree of violation of cellular epigenetic molecular pathways and allows increasing the prognostic value of a biopsy investigation and the accuracy of a stratified assessment of the gastric adenocarcinoma risk development

The aim of the study is to develop an approach to assess the severity of the gastric mucosa (GM) atrophy based on the immunohistochemical (IHC) technique to improve diagnostic quality of the stage of chronic gastritis (CG) and to implement predictive assessment of risk factors of gastric cancer development.Material and methods. The study included 155 cases of CG selected in accordance with Operational Link for Gastritis Assessment (OLGA)-system (2 samples of antral gastric mucosa (GM), 1 sample of angular GM and 2 samples of corpus GM). All biopsy samples were examined using histological and IHC (CDX2) techniques. An expression semi-quantitative index was developed to characterize CDX2. The results obtained were statistically processed using the Mann-Whitney and Kruskal-Wallis tests, the Spearman correlation coefficient, and the construction of logistic regression models.Results. It was found that the value of the CDX2 index assessed within the GM biopsy samples positively correlates with the gradation of atrophy (r=0.665 (p<0.001)). A positive correlation remains between the CDX2sum index, calculated by summing the CDX2 index values at each of the GM points, and the stage of chronic gastritis according to the OLGA classification (r=0.70 (p<0.01)). When assessing the contribution of changes at each point of biopsy sampling and retrospective correlation of the CDX2 index at two points of the GM and the stage of chronic gastritis, the greatest correlation was found for points 3 (stomach angle) and 5 (greater curvature of the gastric body), at three points – for points 1 (greater curvature antrum), 3 and 5 (r=0.592 (p<0.01)). Logistic regression models were built to predict the stage of chronic gastritis based on the CDX2 index in the specified combinations of points. The following model was chosen as the optimal one: to take biopsies at three points (1, 3, 5) and assess their CDX2 index, with sensitivity equal 80.4%, specificity equal 82.8% and diagnostic accuracy equal 83.9%.Conclusion. The CDX2 semi-quantitative index can be used to evaluate GM atrophy. The performed regression analysis demonstrates its predictive role. The constructed regression model based on the CDX2 semi-quantitative index calculation at two/three points of GM allows increasing predictive value of biopsy investigations and accuracy of stratified assessment of the gastric adenocarcinoma risk development in patients with CG.

The aim of the study was to evaluate the potential of miR-21 expression in the gastric mucosa as the marker of early stage gastric adenocarcinoma and cancer development. Material and methods . The study included the following materials: the first group consisted of surgical material of 60 stomachs (gastric cancer of intestinal type), in each case, 1 fragment of tumor tissue and 4 specimens of the gastric mucosa of the distant zone (2 – antrum mucosa and 2 – fundal mucosa) were taken; the second group consisted of biopsy material of 62 cases in patients with chronic gastritis (5 specimens according to the OLGA-system protocol). The level of miR-21 expression in tissues was determined by reverse transcription polymerase chain reaction. Results. miR-21 expression in samples with gastric cancer was significantly higher (median – 158, p=0.0006) compared with the group of endoscopic biopsies of the gastric mucosa (median – 42). The highest level of expression was observed in adenocarcinoma tissues (median – 270), while there were no significant differences when comparing it with the level of miR-21 expression in samples of the distant zone mucosa (p=0.2).тIncreased miR-21 expression may indicate the high risk group of developing gastric adenocarcinoma, probablyтbefore the appearance of histological signs of neoplasia. Conclusion. Regression analysis performed to confirm the predictive potential of miR-21 expression demonstrated 13-fold increased risk of adenocarcinoma development associated with an increase in miR-21 levels for every 50 units of relative expression normalized to small U6 RNA. The constructed statistical model, which includes morphological criteria for evaluating the gastric mucosa and miR-21 expression, may reflect the degree of violation of cellular epigenetic molecular pathways and allows increasing the prognostic value of a biopsy investigation and the accuracy of a stratified assessment of the gastric adenocarcinoma risk development

Aim. To describe modern approaches to the diagnosis and treatment of neuroendocrine gastric tumours associated with chronic autoimmune gastritis on the example of a clinical case.General provisions. Patient H., born in 1948, suffered from a dyspepsia syndrome, the presence of chronic exhelicobacter gastritis and neuroendocrine tumour of unclear histogenesis in the upper third of the stomach body. The patient also suffered from systemic lupus erythematosus with skin lesions (discoid rash, palmar and plantar capillaries) and joint lesions (migrating polyarthritis). A general clinical examination revealed mild chronic iron deficiency anemia and increased neuron-specific enolase (NSE). An EGDS examination using expert-class equipment with the NBI function of close focus identified subepithelial formations of the stomach body. The histological results showed a morphological pattern consistent with a highly differentiated neuroendocrine tumour (G1), type 1, associated with chronic autoimmune gastritis.Conclusion. The autoimmune genesis of the chronic inflammation of the gastric mucosa may serve as a background for the development of neuroendocrine tumours of the stomach, which determines the management tactics in such conditions.

The reproducibility of the Modified Vienna classification of gastrointestinal neoplasia on the gastric mucosal biopsies was evaluated by using the kappa statistic. The work of a group of pathologists-experts was organized in the remote access mode with a demonstration of 26 cases (98 microphotographs) and an evaluation of the diagnostic category of gastric intraepithelial neoplasia/dysplasia. Different levels of agreement between the opinions of the participating experts have been established in depending on the diagnostic difficulty level. The kappa level ranged from 0.2 (poor agreement) to 0.66 (good agreement) and was depending from the chosen method of correction of the result. , This circumstance contributed to the formation of opinion that the diagnoses indefinite neoplasia/dysplasia-low and high grade neoplasia/dysplasia were the most difficult decisions. Possible reasons which reduce the level of consistency of pathologists are discussed.

Aim of investigation. To identify cellular «target» of bismuth tripotassium dicitrate (De-nol) therapy – DNA protection of generative zone cells of stomach mucosa (SM) from damages by oxidative burst products in neutrophilic leukocytes at continued intake of the drug for 4 wks after the ending of eradication therapy.Material and methods. Overall 53 patients after successful eradication therapy for chronic H. pyloriassociated gastritis were investigated: in 28 of them De-nol treatment was continued, 25 were included to the group of comparison. At control upper GI endoscopy biopsy samples were taken from 5 SM points according to OLGA-system protocol. In biopsy specimens presence of neutrophilic infiltration was estimated in mucosal generative zones exclusively. Borders of a generative zone were determined by the presence of myofibroblasts surrounding glandular epithelium which were identified immunohistochemically, using smooth-muscle actin as a marker. Cells with damaged DNA were revealed by immunehistochemical detection of Р53 protein.Results. No correlation between neutrophilic infiltration of SM and р53-positive cells quantity in generative zone (–0,14≤r≤0,08) was revealed in both groups. Comparison of cumulative scores of P53 label in generative zones epithelium after treatment demonstrated no significant difference between groups. Only at comparison of P53 expression level in each sampling point statistically significant differences before and after treatment (Wilcoxon W-matched-pairs ranks criterion) have been found only in group of patients who continued treatment.Conclusions. Detection of the damaged DNA in SM generative zone cells by immunehistochemical assay of P53-positive cells allows to establish significant decrease of their number in biopsies of the patients, who received the drug after cessation of eradication therapy that can be considered as a marker of protective effect for generative zone cells — cytoprotective «target» of bismuth drug.

OBJECTIVE:To estimate the validity of the signs of metaplastic atrophic gastritis to elaborate a marker principle of its detection.SUBJECTS AND METHODS:Two hundred diagnostic cases morphologically diagnosed with chronic gastritis were selected for examination. The validity of the histological and immunohistochemical signs/markers reflecting a gland abnormality (hyperplasia of smooth muscle cells and argyrophilic and elastic fibers) and a cell phenotype change (intestinal and pyloric metaplasia): CDX-2, Shh, villin, CD10, MUC2, and MUC5AC was estimated in gastric biopsy specimens with atrophic gastritis forms verified in accordance with international classifications. The validity of the signs/markers was assessed, by calculating the sensitivity, specificity, prognostic value of positive and negative results, and positive and negative likelihood ratios.RESULTS:There were 3 molecules: CDX-2 is a nuclear transcription factor associated with intestinal differentiation; CCD10 is a brush border membrane-bound mycin and MUC2 is an intestinal-type mycin, which showed a high validity like the markers of metaplastic atrophic gastritis. An algorithm that could probably evaluate atrophic gastritis was elaborated for the successive immunohistochemical identification of the above-mentioned marker.CONCLUSION:The proposed technical decision to verify atrophic gastritis by the biomarker method may be not an alternative, but complementary technique of identifying the form of atrophic gastritis.