Su1980 Combining the Serum Pepsinogen Levels and Helicobacter pylori Antibody Test Is Not Useful for Detecting Gastric Neoplasms With Advanced Histology

Abstract

Background: Combining serum pepsinogen (PG) levels and Helicobacter pylori antibody test is useful for detecting high-risk population for gastric neoplasm. We tried to uncover whether this combinationmethod can predict the incidence and histology of gastric neoplasm. Methods: This study included 3946 asymptomatic Korean adults who underwent esophagogastroduodenoscopy with blood testing for PG levels and H. pylori antibody on the same day at our center. Subjects with extragastric malignancy, a history of H. pylori eradication or gastric neoplasm, or recent antacid medication were excluded. Gastric atrophy was defined as serum PG I of ≤ 70 ng/ml and PG I/II ratio of ≤ 3.0. The subjects were classified into four groups according to the presence (+) and absence (-) of gastric atrophy and H. pylori infection. Results: Of the 3328 included subjects, 17 were incidentally diagnosed as having either gastric adenoma or carcinoma. While the incidence of gastric neoplasm was highest in the gastric atrophy(+)/H. pylori(-) group (4.17%; odds ratio=25.8; p=0.009), this group exhibited the least advanced histology, such as gastric adenoma with low-grade dysplasia (LGD). The gastric atrophy(-)/H. pylori(-) group exhibited the lowest incidence of gastric neoplasm (0.17%) but the most-advanced histology, such as poorly cohesive carcinoma and adenoma with high-grade dysplasia. Conclusions: Combining serum PG levels and H. pylori antibody testing is useful for detecting gastric neoplasms progressing from gastric adenoma with LGD to differentiated, Lauren's intestinal-type gastric cancer based on the slow gastric carcinogenesis pathway. However, this method is not useful for detecting gastric neoplasms with advanced histology.