GASTROPANEL SAMPLE COLLECTION Person taking the blood sample shall fill the test request form which can be found at web site of Biohit Service Laboratory. GastroPanel examination Plasma sample for GastroPanel taken after fasting is intended to determine Helicobacter pylori antibodies and the levels of pepsinogen I, II and gastrin-17. Gastrin-17 can be determined after stimulation. GastroPanel-sample A minimum of 2 ml EDTA plasma from a fasting blood sample. The sample is sent to the Service Laboratory frozen. Use of Gastrin-17 stabilizer 50µl /1 ml plasma (Biohit Cat. No. 601 050 or 601 051) allows the sample transfer at room temperature (20-25 °C) and then the measurements should be performed within 4 days from the sample collection. See the detailed instructions below. Method Enzyme linked immunoassay. Patient Preparation The patient should not drink, eat or smoke for at least 4 hours (e.g. 10 hour overnight fasting is suitable also) before sample collection. The patient is allowed to take prescribed, regular medication, except the following medicine which have effects on the secretion of gastric fluids:   One week prior to sample collection: ranitidine (Esophex, Inside Brus, Ranicur, Ranil, Ranimex, Ranitidin, Ranitidine, Ranixal, Zantac), famotidine (Famotidin, Pepcid, Pepcidin, Pepcid Duo), nizsdine (Nizax), proton pump inhibitors lansoprazole, omeprazole, pantoprazole, esomeprazole, rabeprazole etc. (Lansoprazol, Lansoprazole, Lanzo, Zolt, Losec, Omeprazol, Nexium, Pariet, Somac, Gasterix, Pantoloc, Giasemin, Panzor). One day prior to sample collection: medication neutralizing gastric acid secretion : antasides (Balancid Novum, Gaviscon, Link, Magnesium milk, Novaluzid, Rennie) and mucosa protectin agents (Alsucral, Antepsin). The patient needs to consult her/his physician about the interruption of medication. In case the medication cannot be interrupted the patient should inform of the consumed medicines to the person who is taking the sample. Sample Collection The blood sample is taken after overnight fasting (approx. 10 hours) or at least 4 hour fasting into an EDTA tube (e.g. cat.no.454235 Vacuette 4ml tube containing K2EDTA) The blood sample needs to be centrifuged within 30 minutes, at 1500 - 2000 G for 10 minutes or as prescribes by other tube manufacturer or max. 4000 G for 2 minutes according to the centrifuge manufacturer. In case the plasma is not used for assaying it needs to be frozen immediately. Alternatively, the Gastrin-17 stabilizer, developed by Biohit, can be used (Gastrin-17 Stabilizer, Cat. No. 601 050, 601 051). The addition of the stabilizer into the plasma sample immediately after separation (100µl /2 ml plasma) enables the stability of the sample in room temperature (20-25°C) during transport. Preferable storage temperature of the sample for 4 days is in the refrigerator at 2-8°C. If sample cannot be measured within 4 days, it should be stored frozen The samples should be mixed thoroughly after thawing. Multiple freezing and thawing should be avoided. For temporarily storage the plasma samples can be stored frozen at -15- -20°C, but for storage of over 2 weeks, the temperature should be -70°C. Lipemic or cloudy specimens must not be used. In case a postprandial blood sample is needed, it should be taken into an EDTA tube after 20 minutes upon the intake of the protein drink. For further information please refer to the chapter on stimulation of Gastrin-17. Stimulation of Gastrin-17 If the GastroSoft report from the fasting sample suspects patient suffering of atrophic gastritis in antrum, it is recommended to repeat Gastrin-17 test with a postprandial blood sample. The secretion of gastrin-17 can be stimulated by the intake of a protein drink having average protein content 77% [Biohit Oyj, Cat. No. 601038 (50x20g), Cat. No. 601037 (5x20g)]. The stimulation should not be performed on patients who are very sensitive to lactose (lactose intolerance and hypolactasia). Preparation of the protein juice: 20 g of protein (one foil bag of protein powder) is mixed to 150 ml of water. The stimulated (postprandial) blood sample is taken 20 minutes after the intake of the protein juice. Reference ranges Reference ranges for normal test results can be found on the Interpretation of results web page. Delivery of the Plasma Sample The use of the Gastrin-17 stabilizer enables to deliver the plasma sample without coolers within 3 days. In case the Gastrin-17 stabilizer is not used the plasma sample needs to be delivered frozen. Ordering materials Biohit Gastrin-17 Stabilizer, Cat. No. 601 050, 601 051), sample collection instruction, possible shipping containers and protein stimulation powder cat.no 601038 (50x20g), 601037 (5x20g) can be ordered from tel: +358-9-773 86 345 or by email [email protected] or [email protected] Delivery address for Biohit Service Laboratory Biohit Palvelulaboratorio Laippatie 1 00880 Helsinki Finland