Digestive Diseases and Sciences

, Volume 54, Issue 11, pp 2377–2384 | Cite as

The Validity of a Biomarker Method for Indirect Detection of Gastric Mucosal Atrophy Versus Standard Histopathology

  • Marcis LejaEmail author
  • Limas Kupcinskas
  • Konrads Funka
  • Agnese Sudraba
  • Laimas Jonaitis
  • Audrius Ivanauskas
  • Dainius Janciauskas
  • Gediminas Kiudelis
  • Han-Mo Chiu
  • Jaw-Town Lin
Original Article



Atrophy of the stomach mucosa is considered to be premalignant lesion for gastric cancer development; easy identification of this condition from a blood-sample would allow identifying the group of individuals at increased risk for cancer development.


The objective of the current study was to validate a biomarker method (pepsinogen I/II ratio and gastrin-17) for indirect detection of atrophy of the stomach mucosa versus standard histopathology in Caucasian and Asian populations.


Altogether, 241 patients aged 55 and above referred for upper endoscopy due to dyspeptic symptoms (125 from Latvia, 76 from Lithuania, and 40 from Taiwan) were enrolled.

Pepsinogen I, pepsinogen II, gastrin-17 (the latter after stimulation with protein-rich meal) and IgG/IgA antibodies to Helicobacter pylori infection were determined by ELISA method; standard histopathology according to the updated Sydney classification read by two independent expert pathologists was used for the comparison.


Pepsinogen I/II ratio below 3 was well related to atrophy (moderate to severe) in the corpus part of the stomach (P < 0.0001) with 83.3% sensitivity and 87.1% specificity. Gastrin-17 below 5 pmol/L was related to atrophy in the antral part (P = 0.007) with 36.8% sensitivity and 86.5% specificity.


Decreased pepsinogen I/II ratio is a reliable marker for atrophy in the corpus, and may be recommended for identification of individuals with this type of atrophy. The utility of gastrin-17 for the detection of atrophy in the antral part of the stomach still requires further evaluation due to the low sensitivity.


Atrophic gastritis H. pylori Pepsinogen Gastrin-17 Biomarkers 



The study was partially co-founded by Taiwan National Research council, Ministries of Education and Research in Latvia and Lithuania as well as State Research Program in Health in Latvia. The authors acknowledge Prof. Pentti Sipponen for his involvement in the pathology investigations as well as Biohit, Plc. for the support in performing the ELISA tests. We also acknowledge Abbott Pharmaceuticals, AstraZeneca Pharmaceuticals, Innothera Baltics, and KingMark Scientific Corp. for their support for the study by free supplying of eradication medication. We also acknowledge Prof. Uldis Teibe for the advisory assistance in the statistical analysis. We acknowledge the work performed by the other members of the Baltic-Taiwan atrophic gastritis study group, in particular: in Latvia: Viesturs Boka, Galina Cui, Ilva Daugule, Viesturs Krumins, Aija Line, Viesturs Putnins, Armands Sivins, Dans Stirna, Ivars Tolmanis, Aigars Vanags, Uldis Vikmanis; in Taiwan: Ming-Shiang Wu, Yi-Chia Lee.


  1. 1.
    Correa P. Is gastric cancer preventable? Gut. 2004;53(9):1217–1219.CrossRefPubMedGoogle Scholar
  2. 2.
    Sipponen P, Kekki M, Haapakoski J, Ihamaki T, Siurala M. Gastric cancer risk in chronic atrophic gastritis: statistical calculations of cross-sectional data. Int J Cancer. 1985;35(2):173–177.CrossRefPubMedGoogle Scholar
  3. 3.
    Uemura N, Okamoto S, Yamamoto S, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med. 2001;345(11):784–789.CrossRefPubMedGoogle Scholar
  4. 4.
    Imagawa S, Yoshihara M, Ito M, et al. Evaluation of gastric cancer risk using topography of histological gastritis: a large-scaled cross-sectional study. Dig Dis Sci. 2008;53(7):1818–1823.CrossRefPubMedGoogle Scholar
  5. 5.
    Correa P. Chronic gastritis: a clinico-pathological classification. Am J Gastroenterol. 1988;83(5):504–509.PubMedGoogle Scholar
  6. 6.
    Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002. Cancer incidence, mortality and prevalence worldwide. IARC CancerBase, no. 5, version 2.0. Lyon: IARCPress; 2004.Google Scholar
  7. 7.
    Chen CJ, You SL, Lin LH, Hsu WL, Yang YW. Cancer epidemiology and control in Taiwan: a brief review. Jpn J Clin Oncol. 2002;32(Suppl):S66–S81.CrossRefPubMedGoogle Scholar
  8. 8.
    Department of Health (Taiwan). Main causes of death by cancer in Taiwan. Taipei: Department of Health, Executive Yuan; 2004.Google Scholar
  9. 9.
    Weck MN, Brenner H. Prevalence of chronic atrophic gastritis in different parts of the world. Cancer Epidemiol Biomarkers Prev. 2006;15(6):1083–1094.CrossRefPubMedGoogle Scholar
  10. 10.
    Sipponen P, Ranta P, Helske T, et al. Serum levels of amidated gastrin-17 and pepsinogen I in atrophic gastritis: an observational case-control study. Scand J Gastroenterol. 2002;37(7):785–791.CrossRefPubMedGoogle Scholar
  11. 11.
    Varis K, Isokoski M. Screening of type a gastritis. Ann Clin Res. 1981;13(3):133–138.PubMedGoogle Scholar
  12. 12.
    Borch K, Axelsson CK, Halgreen H, Damkjaer Nielsen MD, Ledin T, Szesci PB. The ratio of pepsinogen A to pepsinogen C: a sensitive test for atrophic gastritis. Scand J Gastroenterol. 1989;24(7):870–876.CrossRefPubMedGoogle Scholar
  13. 13.
    Miki K, Ichinose M, Shimizu A, et al. Serum pepsinogens as a screening test of extensive chronic gastritis. Gastroenterol Jpn. 1987;22(2):133–141.PubMedGoogle Scholar
  14. 14.
    Miki K. Gastric cancer screening using the serum pepsinogen test method. Gastric Cancer. 2006;9(4):245–253.CrossRefPubMedGoogle Scholar
  15. 15.
    Miki K, Fujishiro M, Kodashima S, Yahagi N. Long-term results of gastric cancer screening using the serum pepsinogen test method among an asymptomatic middle-aged Japanese population. Dig Endosc. 2009;21(2):78–81.CrossRefPubMedGoogle Scholar
  16. 16.
    Dockray GJ, Varro A, Dimaline R, Wang T. The gastrins: their production and biological activities. Annu Rev Physiol. 2001;63:119–139.CrossRefPubMedGoogle Scholar
  17. 17.
    Burkitt MD, Varro A, Pritchard DM. Importance of gastrin in the pathogenesis and treatment of gastric tumors. World J Gastroenterol. 2009;15(1):1–16.CrossRefPubMedGoogle Scholar
  18. 18.
    Vaananen H, Vauhkonen M, Helske T, et al. Non-endoscopic diagnosis of atrophic gastritis with a blood test. Correlation between gastric histology and serum levels of gastrin-17 and pepsinogen I: a multicentre study. Eur J Gastroenterol Hepatol. 2003;15(8):885–891.CrossRefPubMedGoogle Scholar
  19. 19.
    Weck MN, Stegmaier C, Rothenbacher D, Brenner H. Epidemiology of chronic atrophic gastritis: population-based study among 9444 older adults from Germany. Aliment Pharmacol Ther. 2007;26(6):879–887.PubMedCrossRefGoogle Scholar
  20. 20.
    Dinis-Ribeiro M, Yamaki G, Miki K, Costa-Pereira A, Matsukawa M, Kurihara M. Meta-analysis on the validity of pepsinogen test for gastric carcinoma, dysplasia or chronic atrophic gastritis screening. J Med Screen. 2004;11(3):141–147.CrossRefPubMedGoogle Scholar
  21. 21.
    Germana B, Di Mario F, Cavallaro LG, et al. Clinical usefulness of serum pepsinogens I and II, gastrin-17 and anti-Helicobacter pylori antibodies in the management of dyspeptic patients in primary care. Dig Liver Dis. 2005;37(7):501–508.CrossRefPubMedGoogle Scholar
  22. 22.
    Miki K, Ichinose M, Ishikawa KB, et al. Clinical application of serum pepsinogen I and II levels for mass screening to detect gastric cancer. Jpn J Cancer Res. 1993;84(10):1086–1090.PubMedGoogle Scholar
  23. 23.
    Hattori Y, Tashiro H, Kawamoto T, Kodama Y. Sensitivity and specificity of mass screening for gastric cancer using the measurement of serum pepsinogens. Jpn J Cancer Res. 1995;86(12):1210–1215.PubMedGoogle Scholar
  24. 24.
    Knight T, Wyatt J, Wilson A, et al. Helicobacter pylori gastritis and serum pepsinogen levels in a healthy population: development of a biomarker strategy for gastric atrophy in high risk groups. Br J Cancer. 1996;73(6):819–824.PubMedGoogle Scholar
  25. 25.
    Broutet N, Plebani M, Sakarovitch C, Sipponen P, Megraud F. Pepsinogen A, pepsinogen C, and gastrin as markers of atrophic chronic gastritis in European dyspeptics. Br J Cancer. 2003;88(8):1239–1247.CrossRefPubMedGoogle Scholar
  26. 26.
    Ricci C, Vakil N, Rugge M, et al. Serological markers for gastric atrophy in asymptomatic patients infected with Helicobacter pylori. Am J Gastroenterol. 2004;99(10):1910–1915.CrossRefPubMedGoogle Scholar
  27. 27.
    di Mario F, Cavallaro LG. Non-invasive tests in gastric diseases. Dig Liver Dis. 2008;40(7):523–530.CrossRefPubMedGoogle Scholar
  28. 28.
    Graham DY, Nurgalieva ZZ, El-Zimaity HM, et al. Noninvasive versus histologic detection of gastric atrophy in a Hispanic population in North America. Clin Gastroenterol Hepatol. 2006;4(3):306–314.CrossRefPubMedGoogle Scholar
  29. 29.
    Chen XY, van der Hulst RW, Bruno MJ, et al. Interobserver variation in the histopathological scoring of Helicobacter pylori related gastritis. J Clin Pathol. 1999;52(8):612–615.CrossRefPubMedGoogle Scholar
  30. 30.
    el-Zimaity HM, Graham DY, al-Assi MT, et al. Interobserver variation in the histopathological assessment of Helicobacter pylori gastritis. Hum Pathol. 1996;27(1):35–41.CrossRefPubMedGoogle Scholar
  31. 31.
    Haj-Sheykholeslami A, Rakhshani N, Amirzargar A, et al. Serum pepsinogen I, pepsinogen II, and gastrin 17 in relatives of gastric cancer patients: comparative study with type and severity of gastritis. Clin Gastroenterol Hepatol. 2008;6(2):174–179.CrossRefPubMedGoogle Scholar
  32. 32.
    Offerhaus GJ, Price AB, Haot J, et al. Observer agreement on the grading of gastric atrophy. Histopathology. 1999;34(4):320–325.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Marcis Leja
    • 1
    Email author
  • Limas Kupcinskas
    • 2
  • Konrads Funka
    • 3
  • Agnese Sudraba
    • 3
  • Laimas Jonaitis
    • 2
  • Audrius Ivanauskas
    • 2
  • Dainius Janciauskas
    • 2
  • Gediminas Kiudelis
    • 2
  • Han-Mo Chiu
    • 4
  • Jaw-Town Lin
    • 4
  1. 1.Digestive Diseases Centre GASTRO, Riga Eastern Clinical University HospitalUniversity of LatviaRigaLatvia
  2. 2.Faculty of MedicineKaunas University of MedicineKaunasLithuania
  3. 3.Faculty of MedicineUniversity of LatviaRigaLatvia
  4. 4.Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan, ROC

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