Pepsinogen and Serum IgG Detection Is a Valuable Diagnostic Method for Helicobacter pylori Infection in a Low-Prevalence Country: A Report from Sri Lanka

Abstract

The use of serum anti-Helicobacter pylori IgG and pepsinogen (PG) detection as a diagnostic method was evaluated in Sri Lanka. Gastric biopsies were performed (353 patients), and the prevalence of H. pylori infection was 1.7% (culture) and 2.0% (histology). IgG serology testing showed an area under the curve (AUC) of 0.922 (cut-off, 2.95 U/mL; specificity, 91.56%; sensitivity, 88.89%). Histological evaluation showed mild atrophy (34.3%), moderate atrophy (1.7%), metaplasia (1.7%), chronic gastritis (6.2%), and normal tissue (56%). The PGI/PGII ratio was significantly higher in H. pylori-negative patients (p < 0.01). PGII and PGI/PGII levels were lower in patients with metaplasia than in those with normal mucosa (p = 0.049 and p < 0.001, respectively). The PGI/PGII ratio best discriminated metaplasia and moderate atrophy (AUC 0.88 and 0.76, respectively). PGI and PGII alone showed poor discriminative ability, especially in mild atrophy (0.55 and 0.53, respectively) and chronic gastritis (0.55 and 0.53, respectively). The best cut-off to discriminate metaplasia was 3.25 U/mL (95.19% specificity, 83.33% sensitivity). Anti-H. pylori IgG and PG assessment (ABC method) was performed (group B, 2.0%; group A, 92.1%). The new cut-off more accurately identified patients with metaplasia requiring follow-up (group B, 5.4%). Assessment of anti-H. pylori IgG and PG is valuable in countries with a low prevalence of H. pylori infection.

Animal Models and Helicobacter pylori Infection

“…Bacteria mainly colonize the gastric mucosa, and if they remain untreated, the infection persists throughout life. Although geographical variations in the current infection rate range from 80 to 90% to as low as 2.5%, at least 50% of the world’s population is infected with this bacterium [ 1 , 2 ]. Epidemiological data suggest that infection transmission occurs via oral, fecal–oral, or iatrogenic routes.…”

Management of dyspepsia and Helicobacter pylori infection: the 2022 Indonesian Consensus Report

“…In areas with low prevalence of H. pylori (e.g., Java and Borneo/Kalimantan), the clinicians should be careful to interpret the result since patients with false-positive results may fall into group D, the highest risk group for stomach cancer [ 64 ]. In addition, special for PG, previous study in Indonesians found that this biomarker levels is useful to determine chronic gastritis in dyspepsia patients [ 64 , 65 ].…”

Potential Antigenic Candidates for the Development of Peptide-Based Vaccines to Induce Immunization against Helicobacter pylori Infection in BALB/c Mice

“…IgG and IgA are common antibodies in different body fluids, and they shield against multiple bacterial and viral infections. In serum, the IgG level is likely to increase with H. pylori infection, and it was suggested as a diagnostic tool for this infection [ 24 ]. Unlike IgG, IgA can be transferred into the gastric lumen, and is considered the initial defense line against H. pylori infection [ 25 ].…”