Clinical Usefulness of Serum Pepsinogen II in the Management of <i>Helicobacter pylori</i> Infection

Abstract

Background: Serum pepsinogen II (sPGII) levels are known to increase during Helicobacter pylori infection. Aim: To assess H. pylori infection and success of H. pylori therapy by means of sPGII levels. Methods: sPGII levels were determined in 156 H. pylori-positive and 157 H. pylori-negative consecutive patients with dyspeptic symptoms. Additionally, sPGII determination was performed in 70 H. pylori-positive patients 2 months after H. pylori eradication therapy. In 29 of these 70 patients, gastroscopy was performed to evaluate the effect of H. pylori therapy on gastric activity. Results:H. pylori-positive subjects demonstrated a significantly higher mean of sPGII levels than H. pylori-negative subjects (16.8 ± 7.4 vs. 8.6 ± 3.7 µg/l; p < 0.001). The best sPGII cut-off for predicting H. pylori infection was 9.93 µg/l (sensitivity 83%, specificity 73%). The best cut-off values to evaluate success of therapy were: sPGII of 9.47 µg/l, a sPGII variation level (difference between baseline and after therapy) of 4.54 µg/l, and a sPGII Δvalue (sPGII variation divided by sPGII before therapy) of 25% (sensitivity 93%, specificity 91%). Conclusions: sPGII levels may be used as a reliable marker of H. pylori infection in the initial diagnosis as well as to evaluate H. pylori eradication and subsequent changes in gastric inflammation.

Usefulness of a Serological Panel Test in the Assessment of Gastritis in Symptomatic Children

“…The difference between sPGI and sPGII could be explained by the gastric site of constitution; the first one is produced only in the corpus glands, while the latter in both the antrum and corpus, and consequently relating to gastric inflammation independently of its localization. In our previous study, indeed, performed in 70 H. pylori-positive dyspeptic adult patients [35] , sPGII increased significantly in comparison to H. pylori-negative ones and successful H. pylori eradication was followed by a significant reduction of both of these parameter levels and gastric mucosa neutrophilic infiltration.…”

“…Furthermore, the cross-combination of IgG-Hp ؒ sPGII product and IgG-Hp antibodies can reliably diagnose or exclude the presence of H. pylori chronic gastritis. These non-invasive serological tests are less stressful for children if compared to endoscopy or UBT, and could be proposed in the initial management of children with upper gastrointestinal symptoms as well as in monitoring H. pylori eradication, if the satisfactory result observed in adults [35] will be extended in children. These results need to be confirmed in a larger cohort, also stratifying children in different age classes in order to perform the appropriate cutoff parameters before recommending their widespread clinical application as non-invasive first-pass markers of gastric disease in a pediatric population.…”

“…Indeed, prior to the discovery of H. pylori, Samloff et al [29] reported that the inflammation of the gastric mucosa was associated with alterations in pepsinogens I and II secretion. It is well known that serum pepsinogen I (sPGI) and II (sPGII) increase in H. pylorirelated non-atrophic chronic gastritis in adults [30,31] as well in children [32,33] and their concentrations decrease after eradication therapy [34][35][36] . In particular, sPGII seems to better correlate with the severity of inflammation [33,34,37] .…”

Accuracy and Cut-Off Values of Pepsinogens I, II and Gastrin 17 for Diagnosis of Gastric Fundic Atrophy: Influence of Gastritis

“…Because pangastritis might play a role in gastric ulcer, gastric atrophy, and gastric cancer, we further suggested a cut-off value of 11.8 µg/l with 85.5% NPV. The clinical use of this marker is limited due to its low PPV but it might be helpful to be applied in combination with other markers in multistep screening programs, however it is suggested that PGII <9.47 µg/l [35] or one fourth decrease in PGII level [36] could be used as a marker for H. pylori eradication. Furthermore, using PGII cutoff value in addition to PGI could help to make a more homogenous group for epidemiologic studies of atrophy association with other gastrointestinal diseases.…”

Non-invasive assessment of gastric secretory function in centenarians

“…None of them took clopidogrel or warfarin, and underwent to upper GI endoscopy with biopsy: histopathology confirmed that all patients having serological values according to OGA had OGA (two having OLGA III and one having OLGA IV staging); iii) 10 patients had serological values according to antral gastritis, nine of them with atrophy, that do not influence gastric secretion. 6,10 Twenty-one out of 25 patients (84.0%) had serological values according to H. pylori infection (IgG against H. pylori >30 EIU). Due to the age of our population, no further investigation on current H. pyloristatus were performed.…”