Pepsinogen Test for the Evaluation of Precancerous Changes in Gastric Mucosa: a Population-Based Study

Abstract

Aims: The aim of the study was to evaluate the rationale of blood pepsinogen (PG) testing in population based screening settings.Methods: Participants from a cross-sectional population-based study of cardiovascular risk factors in Latvia were invited to participate in the current study. Pepsinogen I and II were measured in blood samples taken during the initial study and at follow-up; upper gastrointestinal endoscopy was performed. There were three groups of patients: with moderately decreased (PG I< 70 ng/ml and PG I/PG II ratio < 3), with strongly decreased (PG I< 30 ng/ml and PG I/PG II ratio < 2), and with normal PG level. Biopsy with H. pylori detection was performed (updated Sydney system).Results: Results from 259 patients were analyzed. Pepsinogens were decreased in 133 (51.4%), H. pylori was positive in 177 (66.0%) cases. Mean age was significantly lower in patients with normal compared to strongly decreased PG level group (52.8 vs. 64.1 years, p<0.001). Prevalence of severe corpus atrophy was higher in the strongly decreased compared to the normal PG test group: 7.0% vs. 0%; the same tendency was noted in the distribution of OLGA stages III-IV – 10.5% and 0.0%, OLGIM stages III-IV – 3.5% and 0%, and low-grade dysplasia – 15.8% and 2.4% (p<0.05). Two cases of gastric cancer were found; both presented decreased PG levels. A strong association between H. pylori eradication and PG ratio dynamics was found (p<0.05).Conclusions: All high-risk lesions were found in the decreased PG test groups; two cancer cases were revealed.However, PG demonstrated low specificity and low value of repeated testing. The value of PG as a sole test for gastric cancer risk is limited.

Prediction of Chronic Atrophic Gastritis and Gastric Neoplasms by Serum Pepsinogen Assay: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy

“…Among the 38 studies for the diagnosis of GC, 28 studies [35,36,37,38,40,41,42,43,46,48,49,50,51,53,54,56,57,58,59,60,62,63,65,66,70,71,72,73] adopted the cut-off standard of PG I ≤70 ng/mL and PG I/PG II ratio ≤3, 11 studies [26,38,39,44,45,47,52,57,65,68,69] adopted the cut-off standard of PG I/PG II ratio ≤3, and only six studies [34,45,57,64,65,69] adopted the cut-off standard of PG I ≤70 ng/mL.…”

“…From the 43 studies [21,26,27,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73] for the diagnosis of gastric neoplasm, we identified a total of 114,448 patients (4689 patients with GC, 430 patients with neoplasm, 130 patients with dysplasia vs. 109,199 patients without gastric neoplasm). Among them, 20 [26,27,34,36,37,40,43,44,45,54,55,56,57,58,61,62,64,67,68,72] were case–control studies, whereas 18 [35,39,41,42,46,47,48,49,…”

“…Among them, 20 [26,27,34,36,37,40,43,44,45,54,55,56,57,58,61,62,64,67,68,72] were case–control studies, whereas 18 [35,39,41,42,46,47,48,49,50,51,53,59,60,63,66,69,70,71] were cohort studies, and only five [21,38,52,65,73] were cross-sectional studies. Six studies [21,26,27,59,70,73] were conducted in Europe, whereas the remaining 37 studies were conducted in Asia. The mean age of the enrolled population ranged from 33.4 to 68.2 years.…”

Diagnosis of Helicobacter pylori infection

“…Sjomina et al in Latvia and Tepes et al in Slovenia also observed decreased PG 1/2 ratio in precancerous conditions of the stomach mucosa . Another study noted that the PG 1/2 ratio decreased with increasing age in a healthy Chinese population …”

“…35 Sjomina et al in Latvia and Tepes et al in Slovenia also observed decreased PG 1/2 ratio in precancerous conditions of the stomach mucosa. 36,37 Another study noted that the PG 1/2 ratio decreased with increasing age in a healthy Chinese population. 38 Normal PG levels in obese patients (without "red flag" symptoms) may help in avoiding upper endoscopy before bariatric surgery.…”