Cutoff Serum Pepsinogen Values for Predicting Gastric Acid Secretion Status

Abstract

Measurement of the gastric acid secretion is useful for estimating the risk for various diseases in the upper gastro-intestinal tract; however, the procedure causes significant distress to the subjects. Pepsinogens I and II are secreted from the gastric fundic glands, and thus, the serum pepsinogen levels reflect the gastric functional statuses. The aim of this study is to establish appropriate serum pepsinogen cutoff points for predicting the gastric acid secretion status. In a total of 627 Japanese subjects, gastric acid secretion was measured with an endoscopic gastrin test, and the serum pepsinogen values and serum Helicobacter (H.) pylori-IgG antibody were also measured. After checking the correlation between gastric acid secretion and serum pepsinogen, the receiver operating characteristics analyses were employed for determining the most suitable cutoff points of serum pepsinogen for the gastric acid secretion status (i.e., hypochlorhydria, profound hypochlorhydria, and hyperchlorhydria). The pepsinogen I/II ratio and pepsinogen I showed the best correlation with gastric acid secretion in H. pylori-positive and H. pylori-negative subjects, respectively. The serum pepsinogen I/II ratio (or pepsinogen I in cases of H. pylori-negative subjects) was useful to determine the gastric acid secretion status with acceptable to outstanding diagnostic accuracy (the range of the area under the curve: 0.79-0.93). The diagnostic accuracy was further improved after stratifying the subjects by H. pylori-infection status. Estimating gastric acid secretion levels by simple measurement of serum pepsinogens will have significant clinical implications in estimating the risks for various diseases of the upper gastrointestinal tract.