The role of serum pepsinogen and gastrin test for the detection of gastric cancer in Korea.
OBJECTIVE
This study was performed to determine whether serum pepsinogen (PG) and gastrin testing can be used to detect gastric cancer in Korea.


METHODS
Serum levels of PG I (sPGI) and sPGII, PG I/II ratios, and gastrin levels were measured in 1006 patients with gastroduodenal diseases including cancer. Follow-up tests were performed 1 year after Helicobacter pylori eradication.


RESULTS
sPGI and sPGII levels increased and PG I/II ratios decreased in line with the severity of activity, chronic inflammation, and the presence of H. pylori (p < .01). In contrast, sPGI levels and PG I/II ratios decreased in proportion with the severity of atrophic gastritis (AG)/intestinal metaplasia (p < .01). Gastrin levels were found to be correlated with chronic inflammation negatively in the antrum but positively in the corpus. H. pylori eradication reduced sPGI, sPGII, and gastrin levels, and increased PG I/II ratios to the levels of H. pylori-negative patients, and was found to be correlated with reductions in activity and chronic inflammation of gastritis. The sensitivity and specificity of a PG I/II ratio of < or = 3.0 for the detection of dysplasia or cancer were 55.8-62.3% and 61%, respectively. In addition, sPGI and sPGII levels of intestinal-type cancer were significantly lower than those of the diffuse type, respectively (p = .008 and p = .05, respectively). Gastric cancer risk was highest in the H. pylori-positive, low PGI/II ratio (< or = 3.0) group with an odds ratio of 5.52 (confidence interval: 2.83-10.77).


CONCLUSIONS
PG I/II ratio (< or = 3.0) was found to be a reliable marker for the detection of dysplasia or gastric cancer, especially of the intestinal type. This detection power of PG I/II ratio (< or = 3.0) significantly increased in the presence of H. pylori, and thus, provides a means of selecting those at high risk of developing gastric cancer in Korea.
Kang
Jung Mook
JM
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Kim
Nayoung
N
Yoo
Ji Youn
JY
Park
Young Soo
YS
Lee
Dong Ho
DH
Kim
Hyun Young
HY
Lee
Hye Seung
HS
Choe
Gheeyoung
G
Kim
Joo Sung
JS
Jung
Hyun Chae
HC
Song
In Sung
IS
D000942:Antigens, Bacterial; D015415:Biomarkers / Q000097:blood; D005755:Gastrins / Q000097:blood*; D016481:Helicobacter Infections / Q000097:blood* / Q000188:drug therapy; D016480:Helicobacter pylori; D006801:Humans; D007723:Korea; D010435:Pepsinogens / Q000097:blood* / Q000378:metabolism; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000201:enzymology / Q000382:microbiology
D000942:Antigens, Bacterial; D015415:Biomarkers; D005755:Gastrins; D010435:Pepsinogens