Prevalence of Chromogranin A in Chronic Dyspepsia, IBS andChronic Diarrhea at Maharat Nakhon Ratchasima Hospital

Abstract

Many different clinical presentations of Neuroendocrine tumors (NETS) are occasional loose stools, episodicflushing or intermittent abdominal pain which is often misdiagnosed as gastroenteritis, menopause, peptic ulcer diseaseor irritable bowel disease. Aim: To study the prevalence of chromogranin A (CgA) in chronic dyspepsia, IBS andchronic diarrhea at MaharatNakhonRatchasima Hospital. Patients & Method: All patients (age>15 years) whopresented with chronic dyspepsia, IBS and chronic diarrhea at Medical Department of MaharatNakhonRatchasimaHospital during February-April 2010 were enrolled. The exclusion criteria were chronic renal failure, previous PPI usewithin 1 week, chronic heart failure. The blood samples were obtained and plasma CgA level was measured withradioimmunoassay commercially kits in central laboratory of Ramathibodi Hospital, Bangkok, Thailand. Results:Seventy-five patients were enrolled. Most of them were female (72%), living in NakhonRatchasima Province (94.7%)and had no co-morbid diseases (78.7%). Their mean age was 49.5±12.1 years. Majority of samples (86.7%) presentedwith chronic dyspepsia and median duration of their symptoms was 1 year. The mean of plasma CgA level was246±10.9 ng/ml (except 3 cases which had CgA level more than 870 ng/ml). Of them, 39 patients (52%) had plasmaCgA level more than the cut off level. In high plasma CgA level (positive) group, plasma CgA test was repeated among11 cases and 3 of them had persistently high levels (27.3%); >870, 222.3 and 109.9 ng/ml. The esophagogastroduodenoscopyand colonoscopy were done in 19 and 8 patients and no significant endoscopic finding wasfound. The clinical follow up of all positive group was performed without evidence of NETs even in 3 cases withpersistently positive test. Conclusion: The prevalence of positive CgA testing in dyspepsia, IBS and chronic diarrheaat MaharatNakhonRatchasima Hospital was high but there was no clinical implementation for early warning of NETsdetection.