Serum Pepsinogen Levels Research Articles

Cancer development based on chronic active gastritis and resulting gastric atrophy as assessed by serum levels of pepsinogen and Helicobacter pylori antibody titer

Our study investigated the relationship between gastric cancer development and activity of Helicobacter pylori-associated chronic gastritis or the resulting chronic atrophic gastritis (CAG). A cohort of 4,655 healthy asymptomatic subjects, in whom serum pepsinogen (PG) and H. pylori antibody titer had been measured to assess the activity and stage of H. pylori-associated chronic gastritis, was followed for up to 16 years, and cancer development was investigated. In subjects with a serologically diagnosed healthy stomach (H. pylori-negative/CAG-negative), cancer incidence rate was low, at 16/100,000 person-years. With the establishment of H. pylori infection and progression of chronic gastritis, significant stepwise cancer risk elevations were seen from CAG-free subjects (H. pylori-positive/CAG-negative) [hazard ratio (HR) = 8.9, 95% confidence interval (CI) = 2.7-54.7] to subjects with CAG (H. pylori-positive/CAG-positive) (HR = 17.7, 95% CI = 5.4-108.6) and finally to subjects with metaplastic gastritis (H. pylori-negative/CAG-positive) (HR = 69.7, 95% CI = 13.6-502.9). In H. pylori-infected CAG-free subjects, significantly elevated cancer risk was observed in the subgroup with active inflammation-based high PG II level or potent immune response-based high H. pylori antibody titer; the former was associated with a particularly high risk of diffuse-type cancer, and both subgroups showed high cancer incidence rates of around 250/100,000 person-years, comparable to that in subjects with CAG. No such risk elevation was observed in H. pylori-infected subjects with CAG. These results clearly indicate that gastric cancer develops mainly from the gastritis-atrophy-metaplasia-cancer sequence and partly from active inflammation-based direct carcinogenesis, and that serum levels of PG and H. pylori antibody titer provide indices of cancer development in H. pylori-infected subjects.

The Efficiency of Gastric Screening by the ABC Method Using the Combination Assay of Serum Anti-Helicobacter pylori IgG Antibody and the Serum Pepsinogen Levels

Purpose: The present investigation was made to assess the efficiency of gastric screening by the ABC method, which allows stratification of the risk for the development of gastric cancer into four groups based on the results of the two serological tests: anti-Helicobacter pylori IgG antibody titer and the pepsinogen (PG) I and II levels. Methods:Helicobacter pylori and PG levels were measured in the total number of 61,106 asymptomatic individuals (about 14,000 per year; majority participants checked every year) at a workplace in Tokyo as a primary screening between April 2007 and March 2011. Subjects were classified into one of four groups; Group A [Hp(-) PG(-)], Group B [Hp(+) PG(-)], Group C [Hp(+) PG(+)], and Group D [Hp(-) PG(+)], respectively. Group A were excluded from the secondary endoscopic examination, and Groups B, C, and D were recommended to undergo it every 3 years, 2 years, and every year, respectively. We examined how the ABC method contributed to the reduction in the number of individuals who were advised to undergo the secondary endoscopic examination. Results: In a total of 61,106 participating individuals, the ratio of Groups A, B, C, and D were 74.2%, 15.5%, 9.2%, and 1.2%, respectively. Based on the time of recent endoscopic examination, 8,199 were advised to undergo the secondary endoscopic examination, and it amounted to 13.4% of all the participating individuals. The ratio of Group A was increasing gradually (70.6% in 2007, 72.7% in 2008, 75.8% in 2009, and 77.9% in 2010), and the increasing ratio of Group A was estimated about 3% per year. Of the 4,658 individuals who underwent the secondary endoscopic examination, gastric cancer was detected in 24 patients, which corresponded to 0.04% of all participants and to 0.52% of those with endoscopic examination. Although five patients were diagnosed with the advanced gastric cancers, it was the first time for all of five advanced cancers to have this screening program for reasons such as mid-career hiring. Conclusion: The ABC method drastically reduced the number of the secondary endoscopic examination for gastric screening for employees at a workplace. The increasing ratio of Group A is expected to contribute to a further reduction of cost and manpower caused by endoscopic examination, and makes this screening program more efficient in the future.

Identification of serum miRNAs as novel non-invasive biomarkers for detection of high risk for early gastric cancer

Background:Many micro-RNAs (miRNAs) are differentially expressed in Helicobacter pylori-infected gastric mucosa and in gastric cancer tissue and previous reports have suggested the possibility of serum miRNAs as complementary tumour markers. The aim of the study was to investigate serum miRNAs and pepsinogen levels in individuals at high risk for gastric cancer both before and after H. pylori eradication.Methods:Patients with recent history of endoscopic resection for early gastric cancer and the sex- and age-matched controls were enrolled. Serum was collected from subjects before or after eradication and total RNA was extracted to analyse serum levels of 24 miRNAs. Serum pepsinogen (PG) I and II levels were measured using enzyme-linked immunosorbent assay kits.Results:Using miR-16 as an endogenous control, the relative levels of miR-106 and let-7d before and after H. pylori eradication and miR-21 after eradication were significantly higher in the high-risk group than in the controls. H. pylori eradication significantly decreased miR-106b levels and increased let-7d only in the control group. After eradication, the combination MiR-106b with miR-21 was superior to serum pepsinogen and the most valuable biomarker for the differentiating high-risk group from controls.Conclusion:Serum miR-106b and miR-21 may provide a novel and stable marker of increased risk for early gastric cancer after H. pylori eradication.

Pepsinogen I and II expressions in situ and their correlations with serum pesignogen levels in gastric cancer and its precancerous disease

BackgroundSerum pepsinogen (PG) I/II ratio has been widely used as “serological biopsy” for the screening of gastric cancer (GC) and atrophic gastritis (GA). However, study concerning in situ expression of PGs is currently insufficient, particularly for their relationship with serum PGs levels. This study was designed to investigate in situ expression of PGI and PGII in subjects with normal mucosa (NOR), superficial gastritis (GS), GA and GC, and to evaluate the correlations between PGs expressions in situ and in serum.Methods185 subjects were enrolled for the study, including 30 NOR, 70 GS, 54 GA and 31 GC. PGI and PGII expressions in situ and in serum were detected by immunohistochemistry and enzyme-linked immunosorbent assay (ELISA) respectively. H. pylori immunoglobulin (Ig) G was also determined by ELISA.ResultsIn situ expressions of PGI, PGII and PGI/II ratio consistently decreased in sequence of NOR/GS- > GA- > GC. The expressions of PGI, PGII and PGI/II ratio in situ were statistically higher in youngers than in olders (P < 0.05). In the NOR subjects, PGI staining was statistically higher in males than that in females (p = 0.02). For the correlations between in situ and serum expressions of PGI, PGII and PGI/II ratio, a borderline correlation in the total study sample (r = 0.131, P = 0.076) and a statistical correlation in GA cases (r = 0.307, P = 0.027) were observed for the PGI/II ratio. The PGI expression correlated well with that of PGII in situ and in serum.ConclusionsThe in situ levels of PGI, PGII and PGI/II ratio sharply decreased in the GA and GC cases. The youngers exhibited higher levels of PGI, PGII and PGI/II ratios than the olders. The in situ PGI/II ratio rather than PGI and PGII alone showed certain correlation with that in serum, and the PGI expression correlated well with PGII expression. Further studies with large-scale samples are still required to validate our findings.

What is the relationship between level of infection and ‘sickness behaviour’ in cattle?

We hypothesised that a range of parasite doses that cause subclinical disease would lead to similar behavioural changes in cattle. This was tested by infecting bull calves with one of four different doses of the gastrointestinal parasite Ostertagia ostertagi: 0 (control), 75,000 (L), 150,000 (M) or 300,000 (H) larvae, whilst measuring aspects of their behaviour, usually encompassed by the term ‘sickness behaviour’. For parasitised bulls faecal egg counts and serum pepsinogen levels were elevated from Day (D) 20, the latter being affected linearly by dose. The different doses had different effects on animal fitness: body weight gain (BWG) was reduced for treatments M and H from D23, with M animals showing a recovery after D30, whereas H bulls continued to have lower BWG. Behaviours were only affected for H animals. Average lying episode duration increased by 25% and lying and standing episode frequency decreased by 22% from around D29 when compared to uninfected controls. The number of steps taken by H animals decreased by 34% relative to the controls from D34–46. There was no significant effect on any parameters of feeding behaviour. The results suggest that, for a wide range of parasite doses, general posture, activity and feeding behaviour may be unaffected despite some effects on host fitness. However, higher doses which may lead to clinical disease result in effects that are possibly directly related to pathogen dose. The practical applications of detecting health challenges through behaviour may therefore depend on the level of infection and their pathophysiological consequences.

Sa1929 Helicobacter pylori Eradication: A Single-Center Quality Improvement Study

Background: Given the close relationship between Helicobacter pylori (Hp) infection and gastric cancer, accurate diagnosis of Hp infection is important in subjects with high gastric cancer risk. At present, Hp infection is often diagnosed based on serum levels of antiH. pylori IgG antibody. However, this test is known to show false negatives for some patients. We investigated the characteristics of Hp in falsely sero-negative patients in relation to serum pepsinogen as a serum marker of gastric atrophy. Methods: A total of 276 outpatients at the University Hospital of Hamamatsu University School of Medicine who underwent gastroscopy for screening of Hp infection were enrolled. For diagnosis of Hp infection, PCR using gastric juice samples and culture tests were performed. Serum levels of pepsinogen I (PGI), pepsinogen II (PGII), and anti-H. pylori IgG antibodies (anti-Hp IgG) were measured. The ratios of PGl to PGII (PGI/PGII ratios) were calculated as a serological marker of gastric atrophy. A PGI/PGII ratio , 3.0 indicated severe gastric atrophy and increased gastric cancer risk. Samples with an anti-Hp IgG titer , 10 U/ml were diagnosed as sero-negative for Hp. If the PCR or culture test was positive, the subject was diagnosed as infected with Hp. However, if a subjects was positive based on only the PCR test, had a titer value of , 10 U/ml, and had no atrophy endoscopically, they were deemed false-positive for PCR and excluded from the analysis. Results: Of the 276 subjects, 6 were diagnosed as false-positive for PCR. Of the remaining 270, 24 were not infected with Hp or negative for anti-Hp IgG (Hp-/IgG-), 219 were infected with Hp and positive for anti-Hp IgG (Hp+/IgG+), 16 were infected with Hp but negative for negative for anti-Hp IgG (Hp+/IgG-) and therefore considered falsely sero-negative for Hp infection, and 11 were not infected with Hp but positive for anti-Hp IgG (Hp-/IgG+) and therefore considered falsely sero-positive for Hp infection. Serum PGI/PGII ratios in the Hp-/IgG-, Hp+/IgG+, Hp+/IgG-, and Hp-/IgG+ groups were 5.46, 2.55, 2.59, and 5.28 respectively. The mean of serum PGI/PGII ratios in the falsely sero-negative group was lower than those of the Hp-/IgGor Hp-/IgG+ groups (P ,0.001 and 0.003), and its subjects were considered to be at risk for severe gastric atrophy that was the same as that of the Hp+/IgG+ group. Of the 16 subjects, 15 were positive for the PCR test alone. Conclusion: The results of the present study suggest that individuals who are falsely sero-negative for Hp infection have high risk of severe atrophic gastritis. Although the serological test for Hp is a simple and easy assay for use in screening of Hp infection, it carries risk of false negatives. In contrast, the PCR method can cause false positives but can diagnose Hp infection in sero-negative subjects who are at high risk for gastric cancer.

Effect of Eradication on Functional Dyspepsia

Background/AimsThis study evaluated the effect of Helicobacter pylori eradication on functional dyspepsia (FD), and the relationship between the changes of histological gastritis and FD symptom responses.MethodsA total of 213 FD patients diagnosed by Rome III criteria were consecutively enrolled. H. pylori tests and gastritis grade by the Sydney system were performed before and 1 year after the proton pump based-eradication therapy for 7 days. Serum levels of pepsinogen, and genetic polymorphisms IL-6, IL-8 and IL-10 were investigated.ResultsTotal of 91 patients completed the 1 year follow-up. When the response rate of dyspepsia was compared at 1 year between the non-eradicated group (n = 24) and eradicated group (n = 67), each group showed complete response of 62.5% and 62.7%; satisfactory response (≥ 50%) of 0.0% and 19.4%; partial response (< 50%) of 12.5% and 11.9%; and refractory response of 25.0% and 6.0%, respectively (P = 0.015). In addition, the responder group (complete + satisfactory response) at 1 year showed improvement of activity and chronic inflammation in both the antrum and corpus (all P < 0.001). Multivariate analysis showed that H. pylori eradication (OR, 5.81; 95% CI, 1.07-31.59) and symptom improvement at 3 month (OR, 28.90; 95% CI, 5.29-157.82) were associated with the improvement of dyspepsia at 1 year. Among the successfully eradicated FD patients (n = 67), male (P = 0.013) and higher initial BMI (P = 0.016) were associated with the improvement of dyspepsia at 1 year.ConclusionsH. pylori eradication improved FD symptoms, as well as gastritis at 1 year, suggesting that inflammation mediates FD.

Weight gain-based targeted selective treatments (TST) of gastrointestinal nematodes in first-season grazing cattle

A three-year trial was performed in south-western Sweden to compare animal performance and levels of parasite control in three grazing groups, each with 18–24 first-season grazing (FSG) calves in similar set-stocked pasture enclosures. These groups were subjected to: (1) no parasite control (NT), (2) monthly repeated doramectin (Dectomax®) injections (SP), or (3) targeted selective weight gain-based anthelmintic treatments (TST) but only when individual calf performance was inferior to the average of the poorer 50% of those calves in group SP. In each year, weight and parasitological variables were measured at turn-out and then at predetermined intervals for 22–24 weeks during the grazing season. The dewormed calves in group SP had a higher average weight gain at housing (range 0.39–0.61kg/day) than those in TST (0.36–0.50kg/day), which in turn always exceeded the NT group (0.23–0.42kg/day). This indicates that the parasite challenge in the NT group was sufficiently high to result in production loss. However, the average cumulative faecal egg counts (FEC) at housing in NT were in the range 1271–1953 eggs per gram faeces (epg) and in TST 1221–1968epg. In contrast, parasite eggs were rarely recorded in group SP and then only during the first two years (on average 12 and 38epg). There were also no significant differences in FEC or serum pepsinogen levels between FSG in groups NT and TST. The animals in SP received 7 doses of doramectin each year, whereas those in TST received an average of 0.5 doses. Thus, the TST approach represented a 92% reduction in anthelmintic use. The average weight gain in animals subjected to TST was always significantly lower than in animals dewormed regularly. In addition, there were no signs of short-term selection for anthelmintic resistance in the group SP animals, despite the fairly intensive use of injectable doramectin.

Serum Pepsinogens and Helicobacter Pylori are not Associated with Esophageal Squamous Cell Carcinoma in a High-Risk Area in China

The role of serum pepsinogen level and Helicobacter pylori infection in esophageal carcinoma remains controversial. It may be a risk or protective factor, or without association with esophageal carcinoma. We prospectively examined associations between serum pepsinogen status, H pylori infection and the risk of esophageal squamous cell carcinoma in the Chinese population. In the present study, 1501 subjects from a community-based general population of Northern China were included. The incidence of esophageal carcinoma among the subjects was registered during a 15-year follow-up period by annual home visit, and the risks of low serum pepsinogen level and H pylori infection in the development of ESCC were evaluated using logistic regression. The total accumulated incidence of ESCC in the cohort was 666/100,000 during the 15-year follow-up. Notably, all the cases were verified to be ESCC. Logistic regression analysis showed that age ≥60 (OR = 9.67; 95% CI, 2.797-33.423) was the only risk factor for esophageal squamous cell carcinoma in the population. There was no significant association between sex, H pylori infection, pepsinogen level (PG I ≤70 ng/ml alone, PG I/II ratio ≤3 alone, or PG I ≤70 ng/ml and PG I/II ratio ≤3) and esophageal squamous cell carcinoma. In this prospective study, neither H pylori infection nor abnormal pepsinogen status had a predictive role for the development of esophageal squamous cell carcinoma in the rural population of China.

&lt;i&gt;Helicobacter pylori&lt;/i&gt; Infection Is Associated with a Decreased Risk of Tooth Loss in Healthy Japanese Men

The association between Helicobacter pylori infection and tooth loss has been studied in Western countries; however, this relationship remains controversial. Although the prevalence of H. pylori infection is higher and atrophic gastritis is usually observed in patients with H. pylori infection in Japan unlike that in Western population, no study has examined the association between H. pylori infection and tooth loss. We examined 959 healthy adults who participated in a mass survey. We counted the number of residual teeth and measured both H. pylori stool antigen and serum anti-H. pylori antibodies. Serum pepsinogen levels were measured to determine the presence of atrophic gastritis. Multiple logistic regression analysis was performed after adjustments for age, body mass index (BMI), smoking and alcohol habits, and educational background. In men, H. pylori infection was a significantly reduced risk factor for loss of all the teeth even after adjustments for other factors (OR, 0.32; 95% CI, 0.12-0.81; P < 0.05). However, such an association was not found in women (0.91; 0.49-1.69). The calculated OR for the presence of atrophic gastritis among individuals with tooth loss was not significant in both men and women. H. pylori infection was associated with a decreased risk of tooth loss in healthy Japanese men.

The association between precancerous gastric lesions and serum pepsinogens, serum gastrin, vascular endothelial growth factor, serum interleukin-1 Beta, serum toll-like receptor-4 levels and Helicobacter pylori Cag A status

The aim of this study was to investigate the association between serum pepsinogens, serum gastrin, serum vascular endothelial growth factor, serum interleukin-1 Beta, serum toll-like receptor-4 levels and Helicobacter pylori Cag A status in patients with various gastric precancerous lesions. One hundred and sixty two consecutive patients with various gastric lesions [38 (23.5%) H. pylori positive chronic non-atrophic gastritis, 45 (27.8%) autoimmune gastritis, 42 intestinal metaplasia and 37 dysplasia] were enrolled into the study. Serum pepsinogen I and II, gastrin 17, vascular endothelial growth factor, interleukin-1 Beta, toll-like receptor-4 levels, H. pylori Cag A status were evaluated. H. pylori was positive in 98 (60.5%) patients and 38 of these patients were Cag A positive. Serum pepsinogen level was significantly lower in patients with autoimmune atrophic gastritis compared to the patients with non-atrophic chronic gastritis (p<0.001), intestinal metaplasia (P<0.001) and dysplasia (P=0.002). Mean serum gastrin was 1209.6±268.48 pg/mL in patients with autoimmune atrophic gastritis and 234.95±184.018 pg/mL in patients with chronic non-atrophic gastritis. Mean toll-like receptor-4 level was 0.56±0.098 ng/mL in patient with dysplasia, and this value was higher compared to patients with chronic non-atrophic gastritis (P=0.007), autoimmune atrophic gastritis (P=0.003) and intestinal metaplasia (P=0.006). Interleukin-1 Beta level was significantly lower in patients with dysplasia compared to patients with chronic non-atrophic gastritis (P=0.034). Serum pepsinogens, serum gastrin and H. pylori Cag A status are important tests in detecting gastric precancerous lesions. However, toll-like receptor-4 may be a sensitive test to differentiate the patients with dysplasia from the other precancerous gastric lesions. Non-invasive tests are sensitive in the diagnosis of gastric precancerous lesions.

Examination of serum pepsinogen in functional dyspepsia.

Although serum pepsinogen (PG) is considered as a marker of gastric atrophy, it also reflects gastric acid secretion, which closely influences dyspeptic symptoms. We investigated serum PG levels and PGI/PGII ratios in dyspeptic patients, in relation to various different subtypes of symptoms including Rome III classifications. Serum PGs were measured in 75 subjects with dyspeptic symptoms and 42 asymptomatic healthy subjects. PG II level was significantly higher (p=0.0001) and PG I/II ratio was significantly lower (p<0.0001) in subjects with H. pylori infection than those without, while no associations were found between PG levels and usage of H2 receptor antagonists or proton-pump inhibitors. In all subjects with pain in stomach, abdominal bloating and PDS-like symptoms according to Rome III criteria, presented significantly higher levels of PGI, compared to subjects without symptoms (p=0.043, 0.015 and 0.037, respectively). In addition, burning sensation and abdominal pain presented significantly higher PGI/II ratios (p=0.0005 and 0.003, respectively), and higher PGI/II ratio was also positively correlated with a number of symptoms (p=0.04). When subjects were divided according to H. pylori infection status, higher PGI/II ratio was significantly associated with abdominal pain in H. pylori negative subjects (p=0.03), while higher PGI level was significantly associated with functional esophageal disorders (FEG) according to Rome III criteria, and higher number of dyspeptic symptoms in H. pylori positive subjects (p=0.016). Our data suggest that subjects with higher PGI level, and PG I/II ratio are more likely to develop several dyspeptic symptoms.

Application value of serum pepsinogen test in health check-up

Time resolved fluoroimmunoassay (TRFIA) was used to detect the serum level of pepsinogen (PG).And the 13C urea breath test (13C-UBT) was employed to detect the Helicobacter pylori (HP) infection rate for 1060 subjects of health check-up.Statistics showed that the serum PGⅠ level of males was significantly higher than that of females.And the ratio of females with PG Ⅰ ＜ 60 μg/L and PG Ⅰ ＜ 60 μg/L + PG Ⅰ/PG Ⅱ ＜ 6 was significantly higher than that of males.The PG Ⅱ level increased with age while PG Ⅰ/PG Ⅱ decreased.The PG Ⅰ level rose gradually until age of 60 and then maintained at a high level.For the HP-positive group,the serum levels PG Ⅰ and PG Ⅱ were significantly higher than those of the HP-negative group.And the PG Ⅰ/PG Ⅱ ratio was significantly lower than that of the HP-negative group. Key words: Pepsinogen; Healthy check-up

Influence of ESD Procedure on Serum Levels of Pepsinogens in Patients with Early Gastric Cancer

Influence of ESD Procedure on Serum Levels of Pepsinogens in Patients with Early Gastric Cancer

Serum Level of Pepsinogen Is Useful to Indicate Multiple Early Gastric Cancers in Patients who Undergo Endoscopic Submucosal Dissection

Serum Level of Pepsinogen Is Useful to Indicate Multiple Early Gastric Cancers in Patients who Undergo Endoscopic Submucosal Dissection

Administration of Gastric Acid Suppressive Agents Modulates the Level of Serum Pepsinogen in Patients with Early Gastric Cancer

Administration of Gastric Acid Suppressive Agents Modulates the Level of Serum Pepsinogen in Patients with Early Gastric Cancer

当科・人間ドック(一泊二日)における血清Helicobacterpylori(H.pylori)抗体(IgG抗体)陽性例の検討―とくに血清ペプシノゲンとの関連について―

当科・人間ドック(一泊二日)における血清Helicobacterpylori(H.pylori)抗体(IgG抗体)陽性例の検討―とくに血清ペプシノゲンとの関連について―

無症候の人間ドック受診者における血清ヘリコバクター抗体(IgG抗体)価及び血清ペプシノゲン値の年齢別推移

無症候の人間ドック受診者における血清ヘリコバクター抗体(IgG抗体)価及び血清ペプシノゲン値の年齢別推移

The efficacy of Helicobacter pylori eradication and folic acid intervention in treatment of atrophic gastritis

Objective To investigate the effect of folic acid combined with Helicobacter pylori (Hp) eradication therapy on chronic atrophic gastritis.Methods From December 2009 to March 2011 at the First Affiliated Hospital of Nanjing Medical University,184 patients with endoscopic and pathological diagnosis of chronic atrophic gastritis (90 Hp positive and 94 Hp negative) were selected.Hp positive patients were divided into group A and group B.Forty-three patients in group A were treated with standard triple Hp eradication therapy and follow by folic acid therapy for three months.Forty-seven patients in group B and Hp negative patients received three months of folic acid therapy.The clinical symptoms of each group were scored before treatment,one month after folie acid therapy and three months after folic acid therapy and analyzed by t test. Patients of each group received gastroscopy before treatment and three months after medicine withdrawal. Endoscopic scores,pathological scores and t test were recorded.The serum levels of pepsinogen ( Ⅰ,Ⅱ ) and gastrin 17 in venous blood of 55 Hp negative patients were detected by enzyme-linked immunosorbent assay (ELISA) method before treatment and three months after medicine withdrawal.Results Compared with three months therapy (1.15 ± 0.03),after one month folic acid therapy (1.55 ± 0.04) was statistically significant in clinical symptoms score of all patients (t =8.18,P＜0.01).By the end of therapy,clinical symptom score of group A (1.06 ± 0.04) was lower than that of group B (1.56 ±0.08),and the difference was significant (t=6.00,P＜0.01).There was significant difference in endoscopic scores of all patients between before treatment (1.57±0.95) and after treatment (1.00±0.76,t=11.12,P＜0.01).The differences in each pathological score of all patients (inflammatory scoring,active scoring,atrophy scoring,intestinal metaplasia scoring,atypical hyperplasia degree scoring) were significant between before treatment and after treatment (t=5.51,6.90,7.53,6.34,2.90,respectively,all P＜0.01).The serum level of pepsinogen Ⅰ before treatment of 55 Hp negative patients [(1.03±0.19) nmol/L] was lower than that after treatment [(2.24±0.33) nmol/L],and the difference was statistically significant (t=3.19,P＜0.01).After treatment the level of gastrin 17 [(0.86±0.05) nmol/L] was higher than that before treatment [(0.47±0.05) nmol/L],and the difference was statistically significant ( t =5.33,P＜ 0.01 ).Conclusion Folic acid in combination with Hp eradication therapy can be favorable to atrophic gastritis,which may promote the secretion of pepsinogen and gastrin. Key words: Gastritis, atrophic; Pepsinogen A; Gastrins; Helicobacter pylori; Folic acid

Influence of endoscopic submucosal dissection on serum levels of pepsinogens in patients with early gastric cancer

The serum levels of pepsinogens (PG) have been considered to be a useful marker for assessing the risk of metachronous gastric cancer in patients who undergo endoscopic submucosal dissection. However, the influence of endoscopic submucosal dissection (ESD) on serum levels of PG has not yet been examined. The aim of this study was to examine whether the level of PG after ESD can be used to predict the risk of metachronous cancer. The study included of 100 consecutive patients who underwent ESD for gastric cancer at Hirosaki University Hospital from September 2009 to February 2011. Serum levels of PG I and II on the day before and after ESD were compared. Stool antigen test was also performed to examine the presence of Helicobacter pylori infection. The mean serum level of PG I before and after ESD was 34.3 ± 31.6 ng/mL and 70.5 ± 100.0 ng/mL (P < 0.001), respectively. PG I/II ratio before and after ESD was 2.40 ± 1.51 and 2.79 ± 1.70 (P < 0.001). The serum level of PG I and the PG I/II ratio were significantly changed after ESD, regardless of the use of proton pump inhibitor, Helicobacter pylori infection or the location of the tumor. ESD treatment modulates the serum level of PG I and significantly increases the PG I/II ratio. Serum levels of PG should be measured before the ESD procedure is performed to predict the risk of developing metachronous gastric cancer after ESD.