Korean J Lab Med.  2008 Jun;28(3):201-206. 10.3343/kjlm.2008.28.3.201.

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

• Chae H
• Lee JH
• Lim J
• Kim M
• Kim Y
• Han K
• Kang CS
• Shim SI
• Kim JI
• Park SH

• KMID: 854867
• DOI: http://doi.org/10.3343/kjlm.2008.28.3.201

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), nonatrophic 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.

Keyword

Atrophic gastritis; Pepsinogen; Pepsinogen I/II ratio; Gastric cancer

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Female
Gastritis, Atrophic/*diagnosis
Helicobacter Infections/diagnosis
Helicobacter pylori
Humans
Male
Middle Aged
Nephelometry and Turbidimetry
Pepsinogen A/*blood
Pepsinogen C/*blood
ROC Curve
Reagent Kits, Diagnostic
Sensitivity and Specificity

Figure

• 

  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%).

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