A Significant Increase of Pepsinogen I/II Ratio is a Reliable Biomarker for the Successful Helicobacter pylori Eradication in Patients without Peptic Ulcer or Gastric Cancer

Abstract

Purpose: Serum pepsinogen I (PG I) and pepsinogen II (PG II) levels reflect the inflammation and atrophy of gastric mucosa. They were shown to reflect the severity of atrophic gastritis and thus to be useful for detecting an individual who has a tendency to develop gastric cancer. (Miki K, et al. Am J Gastroenterol 2003, 98:735-739). PG I and PG II change after Helicobacter pylori (H. pylori) eradication as the result of the improvement of gastric mucosal inflammation, and the PG I/PG II ratio (PGR) has been shown to be a reliable indicator for the success of H. pylori eradication in peptic ulcer patients.(Furuta T, et al. Am J Gastroenterol, 1997, 92:84-87). An aim of this study was to investigate the usefulness of PGR as an indicator of successful H. pylori eradication in patients without peptic ulcers or gastric cancer. Methods: We enrolled in this study, between June 2008 and May 2009, 44 patients (16 males and 28 females, average age: 61.5 years, range: 34-73 years). None of them had peptic ulcer or gastric cancer endoscopically. They were confirmed to have H. pylori infection by 13C-urea breath test (UBT). All of them had fasting serum PGR ≤3. They were given with lansoprazole 30 mg, clarithromycin 400 mg, and amoxicillin 750 mg b.i.d. for one week in order to eradicate H. pylori at first therapy. For the judgment of the success of H. pylori eradication, serum PG I and PG II were analyzed and UBT were performed 3 months after eradication. UBT value less than 0.5% was regarded as the golden standard for the eradication success. H. pylori eradication was judged as successful when the fasting serum PGR increased more than 40% of the pre-eradication value. Statistical analysis of the results was calculated by means of paired t test. Results:H. pylori eradication was successful in 29 patients and failed in 15 patients. Serum PG I, PG II, PGR (mean±SE) before and after H. pylori eradication was 46.9±4.4, 28.8±2.2, 1.64 ± 0.12 and 24.6±1.6, 7.13±0.34, 3.52 ± 0.21 (p <0.0001) in patients H. pylori eradication was successful. On the other hand, they were 52.5±7.4, 26.6±4.0, 1.97± 0.17 and 50.3±8.0, 25.0±3.1, 1.96 ± 0.19 (n.s.) in patients H. pylori eradication was unsuccessful. Conclusion: A significant (>40%) increase of fasting serum PGR after H. pylori eradication is a reliable biomarker for the successful H. pylori eradication (PGR change method) in patients without peptic ulcer or gastric cancer. Serum PGR has the comparable efficacy to UBT in determining the success of H. pylori eradication.Figure: Symptoms across 4 days - GCSI.