Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2021; 9(31): 9431-9439
Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9431
Association of serum pepsinogen with degree of gastric mucosal atrophy in an asymptomatic population
Hao-Lei Cai, Yu-Ling Tong
Hao-Lei Cai, Department of Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Yu-Ling Tong, International Healthcare Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Author contributions: Cai HL performed the research and wrote the paper; Tong YL designed the research, contributed to the analysis, and supervised the report.
Supported by National Natural Science Foundation of China, No. 71804161 and No. 72074188.
Institutional review board statement: This study was reviewed and approved by the Human Research Ethics Committee of the Second Hospital Affiliated to Zhejiang University School of Medicine (No. 2015-079).
Informed consent statement: All subjects provided written informed consent prior to enrollment in this study.
Conflict-of-interest statement: The authors declare that they have no related financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-ling Tong, MD, Doctor, International Healthcare Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. tongyl0313@zju.edu.cn
Received: March 26, 2021
Peer-review started: March 26, 2021
First decision: April 28, 2021
Revised: May 6, 2021
Accepted: September 27, 2021
Article in press: September 27, 2021
Published online: November 6, 2021
Processing time: 216 Days and 22.1 Hours
ARTICLE HIGHLIGHTS
Research background

Atrophic gastritis is a precancerous lesion of the stomach. Pepsinogen (PG) has been reported to reflect the morphology and function of the gastric mucosa.

Research motivation

PG can be used for non-invasive screening of atrophic gastritis and even gastric cancer (GC). Effective screening of subjects with gastric precancerous lesions and appropriate intervention can reduce the incidence of GC and increase the diagnostic rate of early GC.

Research objectives

The main objective of this research was to evaluate the diagnostic value of serum PG in the degree of gastric mucosal atrophy in an asymptomatic Chinese population undergoing standard physical examination.

Research methods

The study subjects underwent transnasal gastroscopy, and serum PG levels and the presence of Helicobacter pylori (H. pylori) infection were investigated to assess the diagnostic accuracy of PG for evaluating the degree of gastric mucosal atrophy. Pathology was evaluated using the Operative Link for Gastritis Assessment (OLGA) classification and Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) systems. ANOVA with post hoc Scheffe’s test was used for further assessment of the differences in age, PGI and PGII levels, and PGI/PGII ratio (PGR). Bonferroni’s correction and Pearson’s chi-square test were used to evaluate the differences between H. pylori-negative and H. pylori-positive patients. Receiver operating characteristic curve analysis was used to estimate the cutoff values for PGI, PGII, and PGR.

Research results

The association between PG and OLGA grade was higher compared with that between PG and the OLGIM grading system. Based on the OLGA grading system, the levels of PGI were slightly decreased, while those of PGII were slightly increased. PGR was reduced with increasing atrophy (P < 0.05). A slightly increasing trend was observed in the mean age of different OLGA groups. H. pylori-positive subjects exhibited significantly higher PGI and PGII serum levels and a significantly lower PGR compared with H. pylori-negative patients in the different OLGA groups (P < 0.05).

Research conclusions

Serum levels of PG are closely associated with OLGA stage and could be used as an effective non-invasive screening tool for evaluating the degree of gastric mucosal atrophy in asymptomatic subjects.

Research perspectives

Future studies could focus on the cutoff values of PG for the diagnosis of precancerous lesions or early gastric cancer in different regions of China.