Published online Dec 16, 2021. doi: 10.12998/wjcc.v9.i35.10948
Peer-review started: April 25, 2021
First decision: June 3, 2021
Revised: June 18, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: December 16, 2021
Processing time: 229 Days and 0.9 Hours
Serum gastrin-17 (G-17), pepsinogen I (PGI), and pepsinogen II (PGII) concentrations regulate gastric acid secretion, and hypersecretion of gastric acid increases the risks of peptic ulcer and upper gastrointestinal bleeding. These associations suggest that serum G-17, PGI, and (or) PGII may predict gastrointestinal bleeding risk among peptic ulcer patients.
To evaluate the efficacies of serum G-17, PGI, PGII, and PGI/PGII ratio (PGR) for predicting upper gastrointestinal bleeding among peptic ulcer patients.
A total of 199 patients diagnosed with peptic ulcer confirmed by gastroscopy and positivity for Helicobacter pylori by the 14C-urea breath test were recruited, including 107 patients with simple peptic ulcer and 92 cases complicated by upper gastrointestinal bleeding. Serum PGI, PGII, G-17, and PGR were measured by immune methods and compared between bleeding and non-bleeding groups by univariate analysis. The specificity and sensitivity of PGs and G-17 for evaluating upper gastrointestinal bleeding risk were then assessed by constructing receiver operating characteristic (ROC) curves.
Serum G-17 was significantly higher among peptic ulcer patients with upper gastrointestinal bleeding compared to simple peptic ulcer patients (25.34 ± 14.29 vs 8.84 ± 8.03 pmol/L, t = 9.822, P < 0.01), whereas serum PGI, PGII, and PGR did not differ significantly between bleeding and non-bleeding groups (all P > 0.05). The risk of bleeding was significantly higher among peptic ulcer patients with elevated serum G-17 (> 15 pmol/L) compared to patients with normal or low serum G-17 (73.2% vs 27.4%, χ2 = 40.72, P < 0.01). The area under the ROC curve for serum G-17 was 0.866 ± 0.024, and a cut-off of 9.86 pmol/L yielded 90.2% sensitivity and 68.2% specificity for distinguishing peptic ulcer with and without upper gastrointestinal bleeding.
Serum G-17 is significantly upregulated in peptic ulcer patients and higher levels are predictive of upper gastrointestinal bleeding. Conversely, serum PGI, PGII, and PGR have no predictive value. Further prospective studies are warranted to examine if high G-17 can be used to assess risk of bleeding prior to onset.
Core Tip: Upper gastrointestinal tract bleeding is a severe complication of peptic ulcer that markedly increases mortality. Bleeding risk is elevated by hypersecretion of gastric acid, and secretion rate is associated with serum concentrations of gastrin 17 (G-17), pepsinogen I, and pepsinogen II. Thus, these values may predict bleeding risk among peptic ulcer patients. Indeed, bleeding risk was elevated in patients with G-17 above the normal range (> 15 pmol/L), and serum G-17 > 9.86 pmol/L distinguished bleeding from non-bleeding patients with 90.2% sensitivity and 68.2% specificity. Elevated G-17 may be an effective early predictor of bleeding from peptic ulcer.