Serum pepsinogen and gastrin-17 as potential biomarkers for pre-malignant lesions in the gastric corpus

Abstract

Abstract. There is a lack of non-invasive screening modalities to diagnose chronic atrophic gastritis (CAG) and intestinal metaplasia (IM). Thus, the aim of the present study was to determine the sensitivity and specificity of serum pepsinogen I (PGI), PGI:II, the PGI:II ratio and gastrin-17 (G-17) in diagnosing CAG and IM, and the correlations between these serum biomarkers and pre-malignant gastric lesions. A cross-sectional study of 72 patients (82% of the calculated sample size) who underwent oesophageal-gastro-duodenoscopy for dyspepsia was performed in the present study. The mean age of the participants was 56.2±16.2 years. Serum PGI:I, PGI:II, G-17 and Helicobacter pylori antibody levels were measured by enzyme-linked immunosorbent assay. Median levels of PGI:I, PGI:II, the PGI:II ratio and G-17 for were 129.9 µg/l, 10.3 µg/l, 14.7 and 4.4 pmol/l, respectively. Subjects with corpus CAG/IM exhibited a significantly lower PGI:II ratio (7.2) compared with the control group (15.7; P<0.001). Histological CAG and IM correlated well with the serum PGI:II ratio (r=-0.417; P<0.001). The cut-off value of the PGI:II ratio of ≤10.0 demonstrated high sensitivity (83.3%), specificity (77.9%) and area under the receiver operating characteristic curve of 0.902 in detecting the two conditions. However, the sensitivity was particularly low at a ratio of ≤3.0. The serum PGI:II ratio is a sensitive and specific marker to diagnose corpus CAG/IM, but at a high cut-off value. This ratio may potentially be used as an outpatient, non-invasive biomarker for detecting corpus CAG/IM.

Prevalence of atrophic gastritis in southwest China and predictive strength of serum gastrin-17: A cross-sectional study (SIGES)

“…Among the family of gastrin, G-17 particularly plays a critical role in the regulation of gastric acid secretion 43 . Some other researches similarly found high level of serum gastrin was associated with precancerous lesions and gastric cancer in Asians [44][45][46][47] . The results of the present study demonstrated that the prevalence of atrophic gastritis tended to increase from benign to malignant lesion.…”

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

“…Among these studies, 115 articles were excluded from the final analysis due to the following reasons: narrative review article ( n = 13), letter, comment, editorial or reply to questions ( n = 1), study protocol ( n = 1), incomplete data ( n = 92), and systematic review/meta-analysis or consensus report ( n = 8). The remaining 14 studies [20,21,22,23,24,25,26,27,28,29,30,31,32,33] were included in the quantitative synthesis. Eight studies [20,23,24,27,29,30,31,32] adopted the cut-off standard of PG I ≤70 ng/mL and PG I/PG II ratio ≤3, eight studies [21,22,25,26,27,28,30,33] adopted the cut-off standard of PG I/PG II ratio ≤3, and only two studies [27,33] adopted the cut-off standard of PG I ≤70 ng/mL.…”

“…From the 14 studies [20,21,22,23,24,25,26,27,28,29,30,31,32,33] for the diagnosis of CAG, we identified a total of 5541 patients (2220 patients with CAG vs. 3321 patients without CAG). Among them, 11 [20,22,23,24,25,26,27,28,30,31,32] were case-control studies, whereas two [21,33] were cross-sectional studies and only one [29] was cohort study. Seven studies [20,24,28,29,30,31,33] were conducted in Asia, whereas the remaining studies were conducted in Europe [21,22,26,27,32] and South America [23].…”

“…Among them, 11 [20,22,23,24,25,26,27,28,30,31,32] were case-control studies, whereas two [21,33] were cross-sectional studies and only one [29] was cohort study. Seven studies [20,24,28,29,30,31,33] were conducted in Asia, whereas the remaining studies were conducted in Europe [21,22,26,27,32] and South America [23]. In 2009, Leja M et al [25] reported enrollment of the population in Latvia, Lithuania, and Taiwan as an international study setting.…”

“…One study [21] included only high-risk patients, such as patients with severe CAG, IM, and dysplasia, excluding the healthy population. Another study [33] also included high-risk patients as a population for reference standard. These five studies for the diagnosis of CAG were rated as “high-risk” in at least one of the seven domains (Figure 2).…”