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

Abstract

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.

Study on Clinical Factors Involved in <b><i>Helicobacter pylori</i></b>-Uninfected, Undifferentiated-Type Early Gastric Cancer

“…With regard to the accuracy of HPU assessment, other reports have assessed H. pylori status by anti- H. pylori antibody, histopathology, endoscopic finding, PG test, urea breath test, rapid urease test, and/or prior H. pylori eradication [10-12]. However, a certain proportion of patients with chronic atrophic gastritis has been identified as the subjects with serum anti- H. pylori negative and PG test negative [13-14]. In this study, we assessed H. pylori status with urea breath test negative, endoscopic finding, histopathology, PG test, and anti- H. pylori antibody, as well as the absence of prior H. pylori eradication.…”

Guidelines for endoscopic diagnosis of early gastric cancer

“…There are also other issues such as the following: group A includes cases with prior or current H. pylori infection, 5 while a systematic review has shown that dividing subjects into three groups, i.e., groups A, B, and C+D, rather than four, would be more appropriate 6 . In this context, the cut‐off value and measuring method of H. pylori antibody titers, interpretation of the PG level, and cut‐off value of the PG I/PG II ratio have been investigated 7–9 …”

Comparison of Three Prediction Rules for Assessing the Risk of Gastric Cancer in Chinese Health Examination Populations

“…However, it is worth noting that a number of studies mentioned that gastric cancer and precancerous lesions were detected in the low risk groups of several prediction rules. [16,[20][21]. In our study, the Scoring System from JPHC identi ed the most patients as low risk (1096, 76.32%), followed by the ABC method (811, 56.48%), and Li's Scoring System (37, 37.95%).…”