Clinical significance of pepsinogen a isozymogens, serum pepsinogen A and C levels, and serum gastrin levels

Abstract

Gastric mucosal pepsinogen A phenotype, serum pepsinogen A level, serum pepsinogen C level, serum pepsinogen A/pepsinogen C ratio, and serum gastrin level were evaluated as potential markers for gastric cancer or its precursors in 19 healthy volunteers and 341 patients from the gastroscopy program. Gastric cancer, atrophic gastritis, and intestinal metaplasia of the stomach were associated with pepsinogen A phenotypes, characterized by an intense fraction 5, and with a low serum pepsinogen A level (less than 25 micrograms/l), a low serum pepsinogen A/pepsinogen C ratio (less than 1.5), and a high serum gastrin level (greater than 79 ng/l). The specificity of pepsinogen A phenotypes with an intense fraction 5 for gastric cancer or its precursors was 95.1% with a sensitivity of 20.4%. The sensitivity and specificity of the noninvasive tests were evaluated with the receiver operating characteristic. For clinical purposes, a serum pepsinogen A/pepsinogen C ratio less than 1.8 is the most suitable test, with a sensitivity of 74% and a specificity of 76% for gastric cancer or its precursors, with a reference population of patients with benign gastric disorders. However, the sensitivity and specificity of the single or combined tests are too low for population screening purposes.

Usefulness of Serum Pepsinogen Levels as a Screening Test For Atrophic Gastritis and Gastric Cancer

“…In the previous studies, no cut-off values were demonstrated to be related to serum PG I level and PG I / PG II ratios. In similar studies on this subject, different cut-off values were used, and the sensitivity and specificity were reported to range from 74.3-93% and 68.4-100%, respectively [8,[19][20][21][22]. The current study shows that cut-off values for the serum PG I level <25 ng/ml and the serum PG I / PG II ratio <3.0 would be convenient and meaningful for stomach cancer and atrophic gastritis screening.…”

“…Both of these types are produced in the essential cells in the stomach corpus and fundus and in mucous cervical cells. Unlike PG A, PG C is also produced in the Brunner glands in the proximal duodenum and in the pyloric glands in the antrum [8]. Serum pepsinogen levels reflect the morphological and functional status of the stomach mucosa, so they serve as markers of chronic atrophic gastritis [9].…”

“…Serum pepsinogen levels reflect the morphological and functional status of the stomach mucosa, so they serve as markers of chronic atrophic gastritis [9]. Low levels of serum PG A and PG A / PG C are observed in patients with atrophic gastritis, pernicious anemia, intestinal metaplasia, dysplasia, gastric polyps, and gastric cancer [8].…”

Assessing GastroPanel serum markers as a non-invasive method for the diagnosis of atrophic gastritis and &lt;i&gt;Helicobacter pylori&lt;/i&gt; infection

“…The use of serum pepsinogen I levels as an assessment of gastric acid secretion was adopted as early as in 1985 [13,14]. The clinical significance of pepsinogen A and pepsinogen C and serum gastrin levels [15] and the role of serum pepsinogen I and serum gastrin in the screening of severe atrophic corpus gastritis had been studied [16] and in screening of atrophic pan gastritis with high risk of cancer [17]. PGI reflects the status of the mucosa of the corpus and fundus of the stomach and is a wellknown indicator of the corpus mucosa.…”

Serum pepsinogen levels in gastric cancer patients and their relationship with Helicobacter pylori infection: a prospective study

“…The serum PG I/II ratio is also reduced in gastric carcinoma, as pepsinogen I decreases proportionally more than pepsinogen II. In contrast, the serum level of gastrin is increased in atrophic corpus gastritis [15]. In Japan, where studies have shown a high prevalence of chronic gastritis, serum pepsinogen has been studied as a mass screening tool for the detection of gastric cancer [7][8][9][10].…”