Abstract
BackgroundPractical criteria for the use of serum pepsinogen (PG) values in diagnosing Helicobacter pylori infection have not yet been determined.MethodsThe results of gastric endoscopies, H. pylori infection tests, and PG values were retrospectively reviewed. Subjects were assigned to groups, including never-infected (with neither infection nor gastric mucosal atrophy), infected (with atrophy or findings indicating infection in endoscopy and positive infection tests except for antibody tests), and ex-infected (with gastric mucosal atrophy and negative infection tests, except for antibody tests). The optimal criteria with combined use of the PG II concentrations and the PG I/PG II ratio were investigated separately for PG measurements obtained with the chemiluminescent magnetic particle immunoassay (CLIA) and latex agglutination (LA) methods, such that the specificity was greater than 70% and the sensitivity was no less than 95% among the never-infected and infected subjects. Similar analyses were performed by combining the data from ex-infected and infected subjects.ResultsFor the CLIA (LA) method, the optimal criterion among 349 (397) never-infected and 748 (863) infected subjects was a PG II value of at least 10 (12) ng/mL or a PG I/PG II ratio no more than 5.0 (4.0), which produced 96.3% (95.1%) sensitivity and 82.8% (72.8%) specificity. When 172 (236) ex-infected subjects were included, the optimal criterion was the same, and the sensitivity was 89.1% (86.9%).ConclusionsThe above criteria may be practical for clinical use, and PG tests using these criteria might prevent unnecessary endoscopic examinations for never-infected subjects.
Highlights
The risk of gastric cancer is substantially different depending on an individual’s Helicobacter pylori infection status
Because gastric cancer risk is positively correlated with the severity of gastric mucosal atrophy, PG came to be used as a marker of gastric cancer risk among individuals harboring H. pylori.[7]
We considered sensitivity to be superior and decided preferable diagnostic accuracy occurred at 95% sensitivity and 70% specificity among subjects because false-negative results provoke severe effects in the risk evaluation of gastric cancer, especially in exclusion of subjects with low risk
Summary
The risk of gastric cancer is substantially different depending on an individual’s Helicobacter pylori infection status. Infected subjects have a risk of gastric cancer that is at least 20 times as high as never-infected subjects.[1,2]. A search was conducted for a marker that reflects the risk of gastric cancer.[7,8] Because gastric cancer risk is positively correlated with the severity of gastric mucosal atrophy, PG came to be used as a marker of gastric cancer risk among individuals harboring H. pylori.[7] A practical criterion that diagnosed the severity of gastric mucosal atrophy and indicated a high risk of gastric cancer was established and has been used since it was developed.[9]. Practical criteria for the use of serum pepsinogen (PG) values in diagnosing Helicobacter pylori infection have not yet been determined
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