Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2017 Aug;22(4):10.1111/hel.12393.
doi: 10.1111/hel.12393. Epub 2017 May 29.

Detection of gastric atrophy by circulating pepsinogens: A comparison of three assays

Marcis Leja  1   2   3 , M Constanza Camargo  4 , Inese Polaka  1   5 , Sergejs Isajevs  1   2   6 , Inta Liepniece-Karele  1   2   6 , Dainius Janciauskas  7 , Dace Rudzite  1   2 , Ilze Kikuste  1   3 , Aigars Vanags  3 , Ilona Kojalo  1   2 , Valdis Folkmanis  1 , Arnis Kirsners  1   2   5 , Ivars Tolmanis  3 , Charles S Rabkin  4
Affiliations
Comparative Study

Detection of gastric atrophy by circulating pepsinogens: A comparison of three assays

Marcis Leja et al. Helicobacter. 2017 Aug.

Abstract

Background: Circulating levels of pepsinogens have been used in high gastric cancer-risk Asian and European populations to triage endoscopic evaluation for more severe pathology. There are different analytic methods with uncertain correlations. We therefore compared diagnostic performance of three commonly used pepsinogen assays to detect histologically confirmed gastric atrophy.

Methods: We tested plasma samples from adult patients with (n=50) and without (n=755) moderate or severe gastric corpus atrophy, as determined histologically by consensus of three expert pathologists. A single laboratory measured pepsinogens I (PgI) and II (PgII) using commercially available assays: two ELISA assays produced by Biohit (Finland) and Vector Best (Russia), and a latex agglutination assay from Eiken (Japan). Quantitative correlations were assessed by Spearman statistics. Receiver operating characteristic (ROC) curves vs histological diagnosis were calculated using both the manufacturers' and optimized cutoffs.

Results: Pepsinogen levels were highly correlated among the assays (pairwise Rhos: PgI≥0.84, PgII≥0.87; all P-values<.01). Based on manufacturers' cutoffs, sensitivities, specificities and areas under the ROC curve for detecting moderate to severe histological corpus atrophy by PgI/PgII were 44%/91%/0.70, 56%/84%/0.76, and 52%/90%/0.77 for Biohit, Vector Best and Eiken, respectively. Cutoffs optimized by ROC or data mining analyses did not substantially improve test performance.

Conclusions: Commercial assays for pepsinogen have good relative agreement but are imperfect tests for clinical diagnosis of gastric atrophy.

Impact: Pepsinogen testing alone does not provide sufficient information for gastric cancer risk stratification. Future investigations should focus on other potential markers, in combination with pepsinogens.

Keywords: atrophy; gastric cancer; pepsinogen; risk stratification; stomach.

PubMed Disclaimer

Conflict of interest statement

Disclosure of Potential Conflicts of Interest

The authors declare no potential conflicts of interest

Figures

Figure 1
Figure 1
Pair-wise correlations of pepsinogen measurements by the three manufacturers’ test-systems
Figure 2
Figure 2
Diagnostic agreement among three pepsinogen test-systems in 50 patients with histologic diagnosis of corpus atrophy. The following cutoff values were used: PgI≤70 ng/ml and PgI/PgII≤3 for Eiken, and PgI/PgII<3 for Biohit and Vector Best
Figure 3
Figure 3
Receiver operating characteristics of PgI/PgII to detect corpus atrophy
See this image and copyright information in PMC

References

    1. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide. Lyon, France: International Agency for Research on Cancer; 2013. (IARC CancerBase No. 11 [Internet]). Available from: http://globocan.iarc.fr, accessed on 03/12/2016.
    1. Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut. 2017;66:6–30. - PubMed
    1. Fock KM, Katelaris P, Sugano K, et al. Second Asia-Pacific Consensus Guidelines for Helicobacter pylori infection. Journal of gastroenterology and hepatology. 2009;24:1587–1600. - PubMed
    2. Dinis-Ribeiro M, Areia M, de Vries AC, et al. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED) Endoscopy. 2012;44:74–94. - PMC - PubMed
    1. Dinis-Ribeiro M, Yamaki G, Miki K, Costa-Pereira A, Matsukawa M, Kurihara M. Meta-analysis on the validity of pepsinogen test for gastric carcinoma, dysplasia or chronic atrophic gastritis screening. J Med Screen. 2004;11:141–147. - PubMed
    1. Samloff IM. Pepsinogens, pepsins, and pepsin inhibitors. Gastroenterology. 1971;60:586–604. - PubMed

LinkOut - more resources