Current progress toward eradicating Helicobacter pylori in East Asian countries: Differences in the 2013 revised guidelines between China, Japan, and South Korea

Figure 1 Changes in serum pepsinogen levels according to the progress of gastric carcinogenesis. The pepsinogen II level is increased in the acute stage of Helicobacter pylori (H. pylori) infection. A pepsinogen II level exceeding 30 ng/dL indicates that the subject has a high risk of diffuse-type gastric cancer. The pepsinogen I level then decreases as the infection progresses to the chronic stage. These features altogether results in the pepsinogen I/II ratio decreasing with the progress of gastric carcinogenesis. A pepsinogen I level below 70 ng/dL and a pepsinogen I/II ratio below 3.0 indicate that the subject has a high risk of intestinal-type gastric cancer. Since the pepsinogen II level is decreased after H. pylori eradication to a variable degree, a combination test for serum H. pylori antibody and the pepsinogen I/II ratio is not recommended for gastric cancer screening after eradication.