title: Diagnostic value of serum pepsinogen C in patients with raised serum concentrations of pepsinogen A.
abstract: Hypopepsinogenaemia A is often found in patients with gastric atrophy and gastric surgery. In these conditions serum pepsinogen C provides additional diagnostic information, especially when expressed as pepsinogen A:C ratio. Hyperpepsinogenaemia A has been shown in patients with duodenal ulcer disease, Zollinger-Ellison syndrome, hypertrophic gastropathy, chronic renal failure, and during omeprazole treatment. As patients with hyperpepsinogenaemia A often overlap in symptoms, endoscopical findings, and serum gastrin values, this study has evaluated whether measurement of serum pepsinogen C in subjects with hyperpepsinogenaemia A can help in differentiating clinical conditions. Serum concentrations of pepsinogen A and C were measured in serologically Helicobacter pylori negative blood transfusion donors (127) as reference population, and in patients with Zollinger-Ellison syndrome (24), duodenal ulcer (50), hypertrophic gastropathy (5), and chronic renal failure (50), and also in reflux oesophagitis patients on longterm omeprazole treatment (28). A low pepsinogen A:C ratio was found in all patients with hypertrophic gastropathy. A pepsinogen A:C ratio above the critical value of 4.7 was found in 14 (70.0%) of the Zollinger-Ellison patients, two (9.5%) of the duodenal ulcer patients, 11 (25.6%) of the patients with chronic renal failure, and in one (7.1%) of the patients receiving longterm omeprazole treatment. In fact, all but three hyperpepsinogenaemia A patients with a pepsinogen A:C ratio greater than 4.7 and normal renal function had the Zollinger-Ellison syndrome. In patients with hyperpepsinogenaemia A, a low pepsinogen A:C ratio may point to hypertrophic gastropathy, while a pepsinogen A:C ratio greater than 4.7 is suggestive for the Zollinger-Ellison syndrome.
authors.affiliation: Department of Gastroenterology, University Hospital, Leiden, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Biemond
authors.forename: J
authors.initials: J
authors.lastname: Kreuning
authors.forename: J B
authors.initials: JB
authors.lastname: Jansen
authors.forename: C B
authors.initials: CB
authors.lastname: Lamers
mesh_terms: D000328:Adult; D000368:Aged; D004796:Clinical Enzyme Tests; D004381:Duodenal Ulcer / Q000175:diagnosis; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005758:Gastritis, Hypertrophic / Q000175:diagnosis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D010435:Pepsinogens / Q000097:blood*; D015043:Zollinger-Ellison Syndrome / Q000175:diagnosis
chemical_list: D010435:Pepsinogens; D009853:Omeprazole