Skip to main content

Serum Pepsinogens as a Predicator of the Topography of Intestinal Metaplasia in Patients with Atrophic Gastritis

Digestive Diseases and Sciences volume 49, pages 795–801 (2004)Cite this article

Abstract

The importance of atrophic gastritis with intestinal metaplasia is related to the fact that it increases the risk of gastric cancer development. The aim of this study is to evaluate the diagnostic potential of serum pepsinogens in predicting the topography of intestinal metaplasia. Both dye endoscopy and 13C-urea breath test were carried out in 878 subjects. Serum pepsinogen I, pepsinogen II, and IgG antibody to Helicobacter pylori were measured. The overall prevalence of intestinal metaplasia was higher in subjects with lower PG I/II ratios and lower PG I values. Based on ROC curves, a cutoff value for pepsinogen I/II ratio of less than 3.0 would have identified intestinal metaplasia with a sensitivity of 71.7% and a specificity of 66.7% in Helicobacter pylori-positive subjects. It is possible that serum pepsinogens could be used as a screening test for high-risk subjects with intestinal metaplasia.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

REFERENCES

  1. Mirvishi SS: The etiology of gastric cancer. J Natl Cancer Inst 71:629–647, 1983

    Google Scholar 

  2. Komoto K, Haruma K, Kamada T, Tanaka S, Yoshihara M, Sumii K, Kajiyama G, Talley NJ: Helicobacter pylori infection and gastric neoplasia: Correlations with histological gastritis and tumor histology. Am J Gastroenterol 93:1271–1276, 1998

    Google Scholar 

  3. Correa P: Helicobacter pylori and gastric carcinogenesis. AmJ Surg Pathol 19:S37–S43, 1995

    Google Scholar 

  4. Sipponen P, Kekki M, Haapakoski J, Ihamaki I, Siurala M: Gastric cancer risk in chronic atrophic gastritis: Statistical calculations of cross-sectional data. Int J Cancer 35:173–717, 1985

    Google Scholar 

  5. Ida K, Hashimoto Y, Kawai K: In vivo staining of gastric mucosa: Its applications to endoscopic diagnosis of intestinal metaplasia. Endoscopy 7:18–24, 1975

    Google Scholar 

  6. Suzuki SH, Suzuki H, Endo M, Takemoto T, Kondo T, Nakayama K: Endoscopic dyeing method for diagnosis of early cancer and intestinal metaplasia of the stomach. Endoscopy 5:124–129, 1973

    Google Scholar 

  7. Canto MI, Setrakian S, Petras RE, Blades E, Chak A, Sivak MV Jr: methylene blue selectively stains intestinal metaplasia in Barrett's esophagus. Gastrointest Endosc 44:1–7, 1996

    Google Scholar 

  8. Stathoupoulos G, Goldberg R, Blackstone M: Endoscopic diagnosis of intestinal metaplasia. Gastrointest Endos 36:544–545, 1975

    Google Scholar 

  9. Fennerty M, Sampliner R, McGee D, Hixson L, Garewal H: Intestinal metaplasia of the stomach: Identification by a selective mucosal staining technique. Gastrointest Endosc 38:696–698, 1992

    Google Scholar 

  10. Miki K, Ichinose M, Kawamura N, Matsushima M, Ahmad HB, Kimura M, Sano J, Tashiro T, Kakei N, Oka H, Furihata C, Takahashi K: The significance of low serum pepsinogen levels to detect stomach cancer associated with extensive chronic gastritis in Japanese subjects. Jpn J Cancer Res 80:111–114, 1989

    Google Scholar 

  11. Miki K, Ichinose M, Shimizu A, Huang SC, Oka H, Furihata C, Matsushima T, Takahashi K: Serum pepsinnogens as a screening test of extensive chronic gastritis. Gastroenterol Jpn 22:133–141, 1987

    Google Scholar 

  12. Oksanen A, Sipponen P, Miettinen A, Sarna S, Rautelin H: Evaluation of blood tests to predict normal gastric mucosa. Scand J Gastroenterol 35:791–795, 2000

    Google Scholar 

  13. Biemond I, Kreuning J, Jansen JB, Lamers CB: Serum pepsinogens in patients with gastric diseases or after gastric surgery. Scand J Gastroenterol 29:238–242, 1994

    Google Scholar 

  14. 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 24:870–876, 1989

    Google Scholar 

  15. Kekki M, Samloff IM, Varis K, Ihamaki T: A serum pepsinogen I and serum gastrin in the screening of severe atrophic corpus gastritis. Scand J Gastroenterol 26:109–116, 1991

    Google Scholar 

  16. Kodori A, Yoshihra M, Sumii K, Haruma K, Kajiyama G: Serum pepsinogen in screening for gastric cancer. J Gastroenterol 30:452–460, 1995

    Google Scholar 

  17. Kitahara F, Kobayashi K, Sato T, Kojima Y, Araki T, Fujino AM: Accuracy of screening for gastric cancer using serum pepsinogen concentrations. Gut 44:693–697, 1999

    Google Scholar 

  18. Nishizawa Y: Investigation of mass survey for gastric cancer. J Gastroenterol Mass Surv 98:74–79, 1993 (in Japanese)

    Google Scholar 

  19. Ohara S, Kato M, Asaka M, Toyota T: Studies of 13C-urea breath test for diagnosis of Helicobacter pylori infection in Japan. J Gastroenterol 33:6–13, 1998

    Google Scholar 

  20. Ichinose M, Miki K, Furihata C, Kageyama T, Hayashi R, Niwa H, Oka H, Matsushima T, Takahashi K: Radioimmunoassay of serum group I and group II pepsinogens in normal controls and patients with various disorders. Clin Chim Acta 126:183–191, 1982

    Google Scholar 

  21. Evans DJ Jr, Evans DG, Graham DY, Klein PD: A sensitive and specific serologic test for detection of Campylobacter pylori infection. Gastroenterology 96:1004–1008, 1989

    Google Scholar 

  22. Xia HHX, Kalantar JS, Talley NJ, Wyatt JM, Adams S, Cheung K, Mitchell HM: Antral-type mucosa in the gastric incisura, body, and fundus (antralization): A link between Helicobacter pylori infection and intestinal metaplasia? Am J Gastroenterol 95:114–121, 2000

    Google Scholar 

  23. Al-Knawy B, Morad N, Jamal A, Mirdad S, Fotouh MA, Ahmed ME, Saydain G, Seidi O, Shatoor A: Helicobacter pylori and intestinal metaplasia with its subtypes in the gastric antrum in a Saudi population. Scand J Gastroenterol 34:562–565, 1999

    Google Scholar 

  24. Shousha S, El-Sherif A, El-Guneid A, Arnaounst AH, Murray-Lyon IM: Helicobacter pylori and intestinal metaplasia: Comparison between British and Yemeni patients. Am J Gastroenterol 88:1373–136, 1993

    Google Scholar 

  25. Masci E, Viale E, Freschi M, Porcellati M, Tittobello A: Precancerous gastric lesions and Helicobacter pylori. Hepatogastroenterology 43:854–858, 1996

    Google Scholar 

  26. Judd PA: The ECP-EURONUT intestinal metaplasia study: Lifestyle and dietary data. Eur J Cancer Prev 3:81–87, 1994

    Google Scholar 

  27. Hala MT, El-Zimaity HM, Graham DY: Evaluation of gastric mucosal biopsy site and number for identification of H. pylori or intestinal metaplasia. Role of the Sydney system. Hum Pathol 30:72–77, 1999

    Google Scholar 

  28. The EUROGAST Study Group: Epidemiology of, and risk factors or Helicobacter pylori infection among 3194 asymptomatic subjects in 17 populations. Gut 34:1672–1676, 1993

    Google Scholar 

  29. Kokkola A, Rautelin H, Puolakkainen P, Sipponen P, Farkkila M, Haapiainen R, Kosunen TU: Diagnosis of Helicobacter pylori infection in patients with atrophic gastritis: Comparison with histology, 13C-urea breath test, and serology. Scand J Gastroenterol 35:138–141, 2000

    Google Scholar 

  30. Kosunen TU, Seppala K, Sarna S, Sipponen P: Diagnostic value of decreasing IgG and IgM antibody titers after eradication of Helicobacter pylori. Lancet 339:893–895, 1992

    Google Scholar 

  31. MacOni G, Vago L, Galletta G, Imbesi V, Sangaletti O, Parente F, Cucino C, Bonetto S, Porro GB: Is routine histological evaluation an accurate test for Helicobacter pylori infection? Aliment Pharmacol Ther 13:327–331, 1999

    Google Scholar 

  32. Plebani M, Basso D, Cassaro M, Brigato L, Scrigner M, Toma A, Mauro FD, Rugge M: Helicobacter pylori serology in patients with chronic gastritis. Am J Gastroenterol91:954–958, 1996

    Google Scholar 

  33. Malaty HM, Logan ND, GrahamDY, Ramchatesingh JE, Reddy SG: Helicobacter pylori infestion in asymptomatic children: Comparison of diagnostic test. Helicobacter 5:155–159, 2000

    Google Scholar 

  34. Al-Assi MT, Miki K, Walsh JH, Graham DP, Asaka M, Graham DY: Noninvasive evaluation of Helicobacter pylori therapy: Role of fasting or postprandial gastrin, pepsinogen I, pepsinogen II, or serum IgG antibodies. Am J Gastroenterol 94:2367–2372, 1999

    Google Scholar 

  35. Malaty HM, Graham DY, Wittingty WA, Srinivasan SR, Osato M, Berenson GS: Helicobacter pylori acquisition in childhood: A 12-year follow-up cohort study in a bi-racial community. Clin Infect Dis 28:279–282, 1999

    Google Scholar 

  36. Yamaji Y, Mitsushima T, Ikuma H, Okamoto H, Yoshida H, Kawabe T, Shiratori Y, Saito K, Yokouchi K, Omata M: Weak response of Helicobacter pylori antibody is high risk for gastric cancer: A crosssectional study of 10234 endoscoped Japanese. Scand J Gastroenterol 37:148–153, 2002

    Google Scholar 

  37. International Agency for Research on Cancer: Infection with Helicobacter pylori. IARC Monogr Eval Carcinogen Risks Hum 61:177–240, 1994

    Google Scholar 

  38. Asaka M, Kimura T, Kudo M, Takeda H, Mitani S, Miyazaki T, Miki K, Graham DY: Relationship of Helicobacter pylori to serum pepsinogens in an asymptomatic Japanese population. Gastroenterology 102:760–766, 1992

    Google Scholar 

  39. Furuta T, Kaneko E, Baba S, Arai H, Futami H: Percentage changes in serum pepsinogens are useful as indices of eradication Helicobacter pylori. Am J Gastroenterol 92:84–88, 1997

    Google Scholar 

  40. Shirin H, Bruck R, Kenet G, Krepel Z, Wardi Y, Reif S, Zaidel L, Geva D, Avni Y, Halpern Z: Evaluation of a new immunochromatographic test for Helicobacter pylori IgG antibodies in elderly symptomatic patients. J Gastroenterol 34:7–10, 1999

    Google Scholar 

  41. Newell DG, Hawtin PR, Stacey AR, MacDougall MH, Ruddle AC. Estimation of prevalence of H. pylori infection in an asymptomatic elderly population comparing [14C]urea breath test and serology. J Clin Pathol 44:385–387, 1991

    Google Scholar 

  42. Parkin DM, Pisani P, Ferlay J: Estimates of the worldwide incidence of 25 major caners in 1990. Int J Cancer 80:827–841, 1999

    Google Scholar 

  43. Blaser MJ, Chyou PH, Nomura A: Age at establishment of Helicobacter pylori infection and gastric carcinoma, gastric ulcer, and duodenal ulcer risk. Cancer Res 55:562–565, 1995

    Google Scholar 

Download references

Author information

Affiliations

  1. The Department of Gastroenterology and Hepatology, Toho University School of Medicine, Tokyo, Japan

    Yoshihisa Urita, Kazuo Hike, Naotaka Torii, Yoshinori Kikuchi, Eiko Kanda, Masahiko Sasajima & Kazumasa Miki

Authors
  1. Yoshihisa Urita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuo Hike
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naotaka Torii
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshinori Kikuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eiko Kanda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masahiko Sasajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kazumasa Miki
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Urita, Y., Hike, K., Torii, N. et al. Serum Pepsinogens as a Predicator of the Topography of Intestinal Metaplasia in Patients with Atrophic Gastritis. Dig Dis Sci 49, 795–801 (2004). https://doi.org/10.1023/B:DDAS.0000030091.92379.91

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:DDAS.0000030091.92379.91

  • intestinal metaplasia
  • serum pepsinogens
  • Helicobacter pylori
  • atrophic gastritis