Alteration of correlation between serum pepsinogen concentrations and gastric acid secretion after H. pylori eradication

Iijima, Katsunori; Koike, Tomoyuki; Abe, Yasuhiko; Ara, Nobuyuki; Uno, Kaname; Imatani, Akira; Ohara, Shuichi; Shimosegawa, Tooru

doi:10.1007/s00535-009-0066-2

Cited by 16 publications

(17 citation statements)

References 46 publications

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“…pylori eradication. After H. pylori eradication, PGI acted as a superior predictor for gastric mucosal secretion than the PGI/PGII ratio[24], partly due to the increase in PGI/PGII ratio after H. pylori eradication [25] which is mirrored the PGII reduction after relatively healing of inflammation. This finding suggests that PGI and PGII are markers for two different stages of fundic atrophy development.…”

Section: Discussionmentioning

confidence: 98%

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

et al. 2011

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BackgroundTo establish optimal cutoff values for serologic diagnosis of fundic atrophy in a high-risk area for oesophageal squamous cell carcinoma and gastric cancer with high prevalence of Helicobacter pylori (H. pylori) in Northern Iran, we performed an endoscopy-room-based validation study.MethodsWe measured serum pepsinogens I (PGI) and II (PGII), gastrin 17 (G-17), and antibodies against whole H. pylori, or cytotoxin-associated gene A (CagA) antigen among 309 consecutive patients in two major endoscopy clinics in northeastern Iran. Updated Sydney System was used as histology gold standard. Areas under curves (AUCs), optimal cutoff and predictive values were calculated for serum biomarkers against the histology.Results309 persons were recruited (mean age: 63.5 years old, 59.5% female). 84.5% were H. pylori positive and 77.5% were CagA positive. 21 fundic atrophy and 101 nonatrophic pangastritis were diagnosed. The best cutoff values in fundic atrophy assessment were calculated at PGI<56 µg/l (sensitivity: 61.9%, specificity: 94.8%) and PGI/PGII ratio<5 (sensitivity: 75.0%, specificity: 91.0%). A serum G-17<2.6 pmol/l or G-17>40 pmol/l was 81% sensitive and 73.3% specific for diagnosing fundic atrophy. At cutoff concentration of 11.8 µg/l, PGII showed 84.2% sensitivity and 45.4% specificity to distinguish nonatrophic pangastritis. Exclusion of nonatrophic pangastritis enhanced diagnostic ability of PGI/PGII ratio (from AUC = 0.66 to 0.90) but did not affect AUC of PGI. After restricting study samples to those with PGII<11.8, the sensitivity of using PGI<56 to define fundic atrophy increased to 83.3% (95%CI 51.6–97.9) and its specificity decreased to 88.8% (95%CI 80.8–94.3).ConclusionsAmong endoscopy clinic patients, PGII is a sensitive marker for extension of nonatrophic gastritis toward the corpus. PGI is a stable biomarker in assessment of fundic atrophy and has similar accuracy to PGI/PGII ratio among populations with prevalent nonatrophic pangastritis.

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Section: Discussionmentioning

confidence: 98%

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

et al. 2011

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“…However, IgG antibody test showed high sensitivity and specificity over 90% for diagnosing H. pylori infection (Wilcox et al 1996;Sasazuki et al 2006) and it would be practical in clinical settings to measure both H. pylori antibody and pepsinogen concentrations using the same serum samples. Finally, the PG cutoff values calculated in the present analysis could not be applied to those with a history of H. pylori eradication because the correlation between gastric acid secretion and serum PGs is considerably altered after the therapy (Iijima et al 2009b). Since we have recently reported that gastric acid secretory capacity is inversely associated with the risk for gastric carcinoma emerging after successful eradication (Iijima et al 2012), the serum PG values after eradication might be useful for estimation of the cancer risk among eradicated patients.…”

Section: Discussionmentioning

confidence: 99%

Cutoff Serum Pepsinogen Values for Predicting Gastric Acid Secretion Status

Iijima

Koike

Abe

et al. 2014

Tohoku J. Exp. Med.

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Measurement of the gastric acid secretion is useful for estimating the risk for various diseases in the upper gastro-intestinal tract; however, the procedure causes significant distress to the subjects. Pepsinogens I and II are secreted from the gastric fundic glands, and thus, the serum pepsinogen levels reflect the gastric functional statuses. The aim of this study is to establish appropriate serum pepsinogen cutoff points for predicting the gastric acid secretion status. In a total of 627 Japanese subjects, gastric acid secretion was measured with an endoscopic gastrin test, and the serum pepsinogen values and serum Helicobacter (H.) pylori-IgG antibody were also measured. After checking the correlation between gastric acid secretion and serum pepsinogen, the receiver operating characteristics analyses were employed for determining the most suitable cutoff points of serum pepsinogen for the gastric acid secretion status (i.e., hypochlorhydria, profound hypochlorhydria, and hyperchlorhydria). The pepsinogen I/II ratio and pepsinogen I showed the best correlation with gastric acid secretion in H. pylori-positive and H. pylori-negative subjects, respectively. The serum pepsinogen I/II ratio (or pepsinogen I in cases of H. pylori-negative subjects) was useful to determine the gastric acid secretion status with acceptable to outstanding diagnostic accuracy (the range of the area under the curve: 0.79-0.93). The diagnostic accuracy was further improved after stratifying the subjects by H. pylori-infection status. Estimating gastric acid secretion levels by simple measurement of serum pepsinogens will have significant clinical implications in estimating the risks for various diseases of the upper gastrointestinal tract.

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“…First, PGI level generally does not increase after eradication [17,18,34]. Second, low PGI level is associated with increased acid secretion after eradication, suggesting that PGI level would decrease synchronously with recovery from atrophy [35]. …”

Section: Discussionmentioning

confidence: 99%

Cutoff Pepsinogen Level for Predicting Unintendedly Eradicated Cases of <b><i>Helicobacter pylori</i></b> Infection in Subjects with Seemingly Normal Pepsinogen Levels

Kishikawa¹,

Kimura²,

Ito³

et al. 2017

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Backgrounds/Aims: In the ABC method, which is a method for risk stratification of gastric cancer using serum anti-Helicobacter pylori antibody and pepsinogen (PG) test, subjects with normal PG and seronegative for H. pylori are named as “Group A” and are regarded as having a low risk of gastric cancer. These “Group A” subjects include unintentionally eradicated cases at relatively high risk, and this study aimed to identify these subjects. Methods: Of the 109 subjects, 76 were classified as uninfected Group A subjects with negative histologic H. pylori infection and no histologic and endoscopic atrophy, and 33 subjects were classified serologically as Group A after successful eradication, which are serologically equal to the unintendedly eradicated cases in Group A. The usefulness of measuring PG levels to detect post-eradication cases was validated by using a receiver operating characteristic (ROC) curve analysis. Results: The area under the ROC curve for PGI level was 0.736 ± 0.06 (p < 0.01; cutoff value, 37.0 ng/mL; sensitivity, 77.6%; specificity, 72.7%), and that for the PGI/II ratio was 0.660 ± 0.06 (p < 0.01; cutoff value, 5.1; sensitivity, 84.2%; specificity, 43.4%). Conclusion: PGI levels of ≤37 ng/mL and PGI/II ratios of ≤5.1 effectively identified unintendedly eradicated cases in Group A.

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Alteration of correlation between serum pepsinogen concentrations and gastric acid secretion after H. pylori eradication

Cited by 16 publications

References 46 publications

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

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

Cutoff Serum Pepsinogen Values for Predicting Gastric Acid Secretion Status

Cutoff Pepsinogen Level for Predicting Unintendedly Eradicated Cases of <b><i>Helicobacter pylori</i></b> Infection in Subjects with Seemingly Normal Pepsinogen Levels

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