Clinical Utility of Serum Pepsinogen Levels as a Screening Test of Atrophic Gastritis

Hyojin Chae; Je-Hoon Lee; Jihyang Lim; Myungshin Kim; Yonggoo Kim; Kyungja Han; Chang-Suk Kang; Sang-In Shim; Jin-Il Kim; Soo-Heon Park

doi:10.3343/kjlm.2008.28.3.201

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

Original Article

Korean J Leg Med 2008;28(3):201-206.

Published online: 14 February 2008

DOI: https://doi.org/10.3343/kjlm.2008.28.3.201

Clinical Utility of Serum Pepsinogen Levels as a Screening Test of Atrophic Gastritis

Hyojin Chae, M.D.¹, Je-Hoon Lee, M.D.¹, Jihyang Lim, M.D.¹, Myungshin Kim, M.D.¹, Yonggoo Kim, M.D.¹, Kyungja Han, M.D.¹, Chang-Suk Kang, M.D.², Sang-In Shim, M.D.², Jin-Il Kim, M.D.³, Soo-Heon Park, M.D.³

¹Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

²Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea

³Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

Received 31 January 200822 April 2008 Accepted 7 May 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

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.

Methods

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.

Results

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%.

Conclusions

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.

Keywords: Atrophic gastritis, Pepsinogen, Pepsinogen I/II ratio, Gastric cancer

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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 (%)
	N	Age mean±SD	<49	50-59	60-69	>70	Male, N (%)
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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