The epidemiology of low serum pepsinogen A levels and an international association with gastric cancer rates. EUROGAST Study Group.
OBJECTIVE
Low serum levels of pepsinogen A are indicative of chronic atrophy, a risk factor for gastric cancer. This study investigated the relationships between low pepsinogen A levels, Helicobacter pylori seropositivity, and gastric cancer rates in 17 populations worldwide.


METHODS
In each center, about 200 randomly selected subjects (50 male and 50 female, aged 25-34 and 55-64 years) provided serum samples for pepsinogen analysis and H. pylori serology.


RESULTS
Cumulative gastric cancer rates were associated with the prevalence of low pepsinogen A levels in men (coefficient, 0.15 [P = 0.06] for mortality; coefficient, 0.36 [P = 0.01] for incidence) but not women. The prevalence of low pepsinogen A levels was also correlated with H. pylori seropositivity in the older age group (r = 0.55; P = 0.02). Low pepsinogen A levels were significantly more common in the older group (7.5% vs. 2.1% in the younger group; P < 0.001), among women (5.5% vs. 4.1% in men; P = 0.04), and among nonsmokers (5.8% vs. 2.9% in current smokers; P = 0.001).


CONCLUSIONS
Low pepsinogen A levels are more common in areas with a high seroprevalence of H. pylori and in men in areas with high rates of gastric cancer. The prevalence of low pepsinogen A levels increases with age, but the excess in women and nonsmokers could reflect factors other than gastric pathology.
Webb
P M
PM
Hengels
K J
KJ
Møller
H
H
Newell
D G
DG
Palli
D
D
Elder
J B
JB
Coleman
M P
MP
De Backer
G
G
Forman
D
D
D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D000907:Antibodies, Bacterial / Q000032:analysis; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology / Q000276:immunology; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010435:Pepsinogens / Q000097:blood*; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000201:enzymology / Q000453:epidemiology* / Q000276:immunology
D000907:Antibodies, Bacterial; D010435:Pepsinogens