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Pepsinogen Test for the Evaluation of Precancerous Changes in Gastric Mucosa: a Population-Based Study

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Olga Sjomina1,2, Jelizaveta Pavlova1,2, Ilva Daugule1,2, Pavel Janovic2, Ilze Kikuste1,3, Aigars Vanags3, Ivars Tolmanis3, Dace Rudzite1,2, Inese Polaka1,6, Ilona Kojalo1,2, Inta Liepniece-Karele1,2,5, Sergejs Isajevs1,2,5, Daiga Santare1,2, Valdis Pirags1,6, Jelena Pahomova6,7, Vilnis Dzerve6,7, Lilian Tzivian1, Andrejs Erglis1,6,7, Marcis Leja1-4

1) Institute of Clinical and Preventive Medicine, University of Latvia;
2) Faculty of Medicine, University of Latvia;
3) Department of Research, Riga East University Hospital;
4) Digestive Diseases Centre Gastro;
5) Academic Histology Laboratory;
6) Institute of Information Technology, Riga Technical University;
7) P. Stradins Clinical Hospital;
8) Institute of Cardiology and Regenerative Medicine, University of Latvia, Riga, Latvia

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.271.pep

Aims: The aim of the study was to evaluate the rationale of blood pepsinogen (PG) testing in population based screening settings.
Methods: Participants from a cross-sectional population-based study of cardiovascular risk factors in Latvia were invited to participate in the current study. Pepsinogen I and II were measured in blood samples taken during the initial study and at follow-up; upper gastrointestinal endoscopy was performed. There were three groups of patients: with moderately decreased (PG I< 70 ng/ml and PG I/PG II ratio < 3), with strongly decreased (PG I< 30 ng/ml and PG I/PG II ratio < 2), and with normal PG level. Biopsy with H. pylori detection was performed (updated Sydney system).
Results: Results from 259 patients were analyzed. Pepsinogens were decreased in 133 (51.4%), H. pylori was positive in 177 (66.0%) cases. Mean age was significantly lower in patients with normal compared to strongly decreased PG level group (52.8 vs. 64.1 years, p<0.001). Prevalence of severe corpus atrophy was higher in the strongly decreased compared to the normal PG test group: 7.0% vs. 0%; the same tendency was noted in the distribution of OLGA stages III-IV – 10.5% and 0.0%, OLGIM stages III-IV – 3.5% and 0%, and low-grade dysplasia – 15.8% and 2.4% (p<0.05). Two cases of gastric cancer were found; both presented decreased PG levels. A strong association between H. pylori eradication and PG ratio dynamics was found (p<0.05).
Conclusions: All high-risk lesions were found in the decreased PG test groups; two cancer cases were revealed.
However, PG demonstrated low specificity and low value of repeated testing. The value of PG as a sole test for gastric cancer risk is limited.
Key words: pepsinogens − screening − atrophy − gastric cancer − follow-up − H. pylori.
Abbreviations: EDTA: ethylenediaminetetraacetic acid; ELISA: enzyme-linked immunosorbent assay; GA: gastric atrophy; GC: gastric cancer; IM: intestinal metaplasia; OLGA: Operative Link on Gastritis Assessment; OLGIM: Operative link on intestinal metaplasia assessment; PG: pepsinogen.