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Useful Serum Pepsinogen Levels for Detecting Ongoing Helicobacter pylori Infection in Asymptomatic Subjects: A Cross-Sectional Study Based on 13C-urea Breath Test Findings

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Abstract

Background /Aims

The serum pepsinogen (PG) assay is used to screen subjects at high risk for gastric cancer. Currently, there are few studies on the PG levels for the detection of Helicobacter pylori infection. This study aimed to determine the PG assay findings for detecting ongoing infection.

Methods

Asymptomatic subjects who underwent a 13C-urea breath test (13C-UBT) on the day of gastroscopy and serum assay for cancer screening were included. Subjects with a recent intake of acid suppressants or antibiotics, gastrectomy, or renal failure were excluded. H. pylori infection was defined as a positive 13C-UBT result.

Results

Among the 500 included subjects, 167 (33.4%) had current infection. The serum PG II levels of > 12.95 ng/mL (area under the curve [AUC] = 0.930, sensitivity 86.5%, specificity 90.7%) and PG I/II ratios of < 4.35 (AUC = 0.875, sensitivity 86.8%, specificity 79.6%) were related to infection. The PG I/II ratios were inversely correlated with age (r = -0.160, p = 0.039). The cutoff values of PG I/II ratios were lower in older subjects aged ≥ 50 years (< 4.05; AUC = 0.875, sensitivity 80.7%, specificity 88.2%) than in younger subjects aged < 50 years (< 4.35; AUC = 0.873, sensitivity 77.4%, specificity 88.9%).

Conclusions

Serum PG II levels > 12.95 ng/mL and PG I/II ratios < 4.35 suggest ongoing infection in asymptomatic subjects; therefore, H. pylori confirmation tests (i.e., 13C-UBT) should be considered under these conditions. Stricter criteria are required in older subjects aged ≥ 50 years (PG I/II ratio < 4.05) to detect ongoing infection than younger subjects.

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Acknowledgments

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (2016R1D1A1B02008937).

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Gastroenterology, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea

    Jong Hyeon Jeong, Sun-Young Lee, Jeong Hwan Kim, In-Kyung Sung & Hyung Seok Park

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  1. Jong Hyeon Jeong
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  2. Sun-Young Lee
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  4. In-Kyung Sung
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Contributions

Jong Hyeon Jeong and Sun-Young Lee carried out data curation, analysis, investigation, and writing. Sun-Young Lee was responsible for conceptualization, acquisition of funding, and project administration. All authors took part in methodology, resources, software, validation, and approval of final manuscript.

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Correspondence to Sun-Young Lee.

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No benefits have been received or will be received from a commercial party related to the content of this study.

Ethical approval

This study was approved by the Institutional Review Board of Konkuk University Medical Center (2021–02-021), and all subjects signed informed consent forms before the tests.

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Jeong, J.H., Lee, SY., Kim, J.H. et al. Useful Serum Pepsinogen Levels for Detecting Ongoing Helicobacter pylori Infection in Asymptomatic Subjects: A Cross-Sectional Study Based on 13C-urea Breath Test Findings. Dig Dis Sci 67, 5602–5609 (2022). https://doi.org/10.1007/s10620-022-07471-2

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