Journal List > Korean J Lab Med > v.28(3) > 1011467

Chae, Lee, Lim, Kim, Kim, Han, Kang, Shim, Kim, and Park: Clinical Utility of Serum Pepsinogen Levels as a Screening Test of Atrophic Gastritis



Atrophic gastritis is a well known risk factor for gastric adenocarcinoma. Its confirmatory diagnosis requires histology via endoscopy, which is an invasive method; therefore, periodic follow up evaluation as a screening method is difficult to perform. We evaluated the clinical utility of serum pepsinogens (PG) as a biomarker for screening of atrophic gastritis.


The study population consisted of 130 selected dyspeptic patients (M:F=52:78; age, 16-105 yrs; mean age, 50.8 yrs) who had undergone a diagnostic endoscopy. The serum pepsinogen test was performed by a latex turbidimetric immunoassay method (HBI, Korea) using Toshiba-200FR automatic analyzer. The PGI, II level and PGI:PGII ratio of non-atrophic gastritis group were compared with those of atrophic gastritis group, and a correlation with Helicobacter pylori infection was examined. Cut-off points for screening of atrophic gastritis were determined.


The mean serum concentration of PGI showed a decline from normal (60.7 ng/mL), non-atrophic gastritis (54.2 ng/mL), and atrophic gastritis (51.8 ng/mL) to gastric adenocarcinoma (32.6 ng/mL). The mean ratio of PGI:PGII was lower in atrophic gastritis (3.2) compared to non-atrophic gastritis (4.7) (P=0.021). In patients with H. pylori infection, the mean serum PGII level was higher and the PGI:PGII ratio was lower than those in patients without H. pylori infection, and the differences were statistically significant. For screening of atrophic gastritis, the best cut-off point of PGI:PGII ratio was 4, with a sensitivity of 82.6% and specificity of 91.7%.


The serum pepsinogen test is a useful biomarker for screening of atrophic gastritis, a well-known precancerous lesion of gastric adenocarcinoma. Measuring both pepsinogen I and II concentrations simultaneously to obtain pepsinogen I/II ratio provides a clinically useful information for the detection of atrophic gastritis.


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Fig. 1.
Receiver operating curve (ROC) for pepsinogen I/II ratio for screening of atrophic gastritis (cut-off value: pepsinogen I/II ratio <4, sensitivity: 82.6%, specificity: 91.7%).
Table 1.
Characteristics of the study population
  N Age mean±SD Age distribution, N (%) Male, N (%)
<49 50-59 60-69 >70
NM 16 39.8±17.7 11 (68.8) 3 (18.8) 1 (6.3) 1 (6.3) 4 (25.0)
AG 59 54.1±10.7 18 (30.5) 20 (33.9) 20 (33.9) 1 (1.7) 23 (39.0)
NAG 51 49.4±18.0 27 (52.9) 12 (23.5) 6 (11.8) 6 (11.8) 20 (39.2)
CA 4 64.5±9.3 0 (0.0) 2 (50.0) 0 (0.0) 2 (50.0) 4 (100)

Abbreviations: NM, normal gastric mucosa; AG, atrophic gastritis; NAG, non-atrophic gastritis; CA, gastric adenocarcinoma.

Table 2.
Serum concentrations of pepsinogen I, II and pepsinogen I/II ratios in subjects with normal gastric mucosa (NM), non-atrophic gastritis (NAG), atrophic gastritis (AG) and gastric adenocarcinoma (CA) (mean±SD)
  NM (n=16) NAG (n=51) AG (n=59) CA (n=4)
PGI (ng/mL) 60.7±41.3 54.2±33.2 51.8±33.2 32.6±40.0
PGII (ng/mL) 9.3±6.2 13.5±7.9 16.2±7.9 14.8±10.0
PGI:PGII 6.5±2.5 4.7±1.5 3.2±1.5 2.2±2.0

Abbreviations: PG, pepsinogen; See Table 1.

Table 3.
Mean serum concentrations of pepsinogen I, II and pepsinogen I/II ratios in subjects with non-atrophic gastritis (NAG) and atrophic gastritis (AG)
  NAG (n=51) AG (n=59) P-value
PGI (ng/mL) 54.2 51.8 0.578
PGII (ng/mL) 11.5 16.2 0.074
PGI:PGII 4.7 3.2 0.021

Abbreviations: See Table 2.

Table 4.
Mean serum concentrations of pepsinogen I, II and the pepsinogen I/II ratios in subjects with non-atrophic gastritis (NAG) and atrophic gastritis (AG) according to Helicobacter pylori infection status
  Total (n=33) NAG (n=12) AG (n=21)
HP+(n=21) HP-(n=12) P-value HP+(n=6) HP-(n=6) P-value HP+(n=13) HP-(n=13) P-value
PGI (ng/mL) 64.8 65.6 0.425 75.3 81.2 0.848 55.1 53.8 1.3
PGII (ng/mL) 19 14.2 0.029 17.8 14.7 0.604 19.7 11.3 0.008
PGI:PGII 3.8 5 0.028 4.6 5.3 0.257 3 5.3 0.037

Abbreviations: HP+, confirmed H. pylori positive cases by urea carbon breath test or Warthin-Starry silver stain in histology, HP-, H. pylori negative cases; See Table 2.

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