J Korean Med Sci.  2017 May;32(5):796-802. 10.3346/jkms.2017.32.5.796.

Link between Serum Pepsinogen Concentrations and Upper Gastrointestinal Endoscopic Findings

• Lee SP
• Lee SY
• Kim JH
• Sung IK
• Park HS
• Shim CS

• KMID: 2375080
• DOI: http://doi.org/10.3346/jkms.2017.32.5.796

Abstract

The serum pepsinogen (PG) assay findings are correlated with the status of Helicobacter pylori infection, but there are controversies on the link with upper gastrointestinal (UGI) endoscopic findings. The aim of this study was to determine the significance of a serum PG assay for correlating with endoscopic findings in H. pylori-seroprevalent adult population. Korean adults who visited for a health check-up were included consecutively. Subjects after gastrectomy or H. pylori eradication were excluded. After completing the serum PG assay and anti-H. pylori immunoglobulin G (IgG) titer on the same day of UGI endoscopy, subjects with equivocal serology test finding or gastric neoplasm were excluded. Of the 4,830 included subjects, 3,116 (64.5%) were seropositive for H. pylori. Seropositive finding was related to high serum PG I (P < 0.001) and PG II (P < 0.001) concentrations, low PG I/II ratio (P < 0.001), old age (P < 0.001), and male gender (P = 0.006). After adjusting age and gender, the serum PG I and II concentrations were positively correlated with the presence of nodular gastritis (NG) (all P = 0.003). The serum PG I was positively correlated with gastric ulcer (P = 0.003), and it was correlated with duodenal ulcer in seropositive subjects (P = 0.008). The PG I/II ratio was positively correlated with erosive esophagitis, while it was inversely related to chronic atrophic gastritis and metaplastic gastritis (all P < 0.001). Our findings suggest that the serum PG assay finding correlates well with the UGI endoscopic finding. A higher serum PG concentration in subjects with NG and peptic ulcer disease suggests that endoscopic findings reflect gastric secreting ability.

Keyword

Endoscopy; Gastritis; Helicobacter pylori; Pepsinogen; Upper Gastrointestinal

MeSH Terms

Adult
Duodenal Ulcer
Endoscopy
Esophagitis
Gastrectomy
Gastritis
Gastritis, Atrophic
Helicobacter pylori
Humans
Immunoglobulin G
Male
Pepsinogen A*
Peptic Ulcer
Stomach Neoplasms
Stomach Ulcer
Immunoglobulin G
Pepsinogen A

Figure

• 

  Fig. 1 Diagnostic criteria used for discriminating endoscopic findings of H. pylori-related gastritis on the background gastric mucosa. (A) CAG. Transparent vessels are visible from the lesser curvature side to the anterior wall of the antrum extending up to the low-body with a demarcation line, so-called atrophic border. (B) NG on the antrum. Multiple and tiny, colorless nodules are scattered. The shape and size of the nodules are regular. (C) NG on the body. The nodules may extend up to the body, since they are submucosal protrusions that consist of lymphoid follicles. (D) MG with whitish color change. Large-sized, whitish elevations are noticed on the antrum. The shape and size of the discolored lesions are irregular. (E) MG with hyperemic color changes. Multiple, hyperemic depressions are augmented by irregular, whitish surrounding mucosa which indicates intestinal metaplasia. (F) MG on the body. Intestinal metaplasia has variable appearances from irregular, whitish elevations to geographic, hyperemic depressions.CAG = chronic atrophic gastritis, MG = metaplastic gastritis, NG = nodular gastritis.

• 

  Fig. 2 Flow of the study. Subjects with a history of successful H. pylori eradication were excluded from the beginning due to an altered serum PG assay finding after the eradication. After the evaluation, subjects with an equivocal H. pylori serology test finding and those who were confirmed as adenoma or adenocarcinoma were excluded.IgG = immunoglobulin G, PG = pepsinogen.

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