title: Are the serum biomarkers pepsinogen I and II good predictors for the detection of subjects with atrophic gastritis in areas that have different gastric cancer incidence?
abstract: BACKGROUND
  Northern Iran (Ardabil) is characterized by a high gastric cancer (GC) rate, whereas Southern Iran (Kerman and Yazd) has a low GC rate. The aim of this study is to verify the potential for pepsinogen I and II to detect atrophic gastritis (AG) in both high and low risk populations for GC.
  
  
  METHODS
  Sera of blood donors and patients with GC from Ardebil, Kerman and Yazd were used to measure levels of pepsinogen I, II and H. pylori IgG antibody. GC rates in these cities were determined according to the Cancer Registry and upper gastrointestinal (GI) endoscopy results.
  
  
  RESULTS
  There were 449 subjects with an average age of 45 ± 15 years. The GC rate in the endoscopy units of the hospital in Ardabil was four times higher than Kerman or Yazd. The mean serum pepsinogen I levels did not differ between Ardabil (102 ± 42.6 µg/mL), Kerman (103.3 ± 49.8 µg/mL), and Yazd (111.7 ± 39 µg/mL). Pepsinogen II levels were: 8.1 ± 4.7 µg/mL (Ardabil), 7.5 ± 5.3 µg/mL (Kerman), and 7.6 ± 4.4 µg/mL (Yazd), which were not different. The H. pylori infection rates were: Ardabil (61%), Kerman (55%), and Yazd (73%). A low ratio of pepsinogen I to II (≤3) was seen in Ardabil (1.3%), Kerman (1.9%), and Yazd (0.0%), which was not significant. A total of 51.9% of GC patients from Ardabil had normal pepsinogen I (≥70 µg/mL) levels and pepsinogen I/II ratios that were >5.
  
  
  CONCLUSIONS
  Serum biomarkers pepsinogen I and II and their ratios are probably not sensitive predictors of AG in areas that have either a high or low GC prevalence. This finding is likely related to the lack of an association between GC and advanced AG.
authors.affiliation: Digestive Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Mohamadkhani
authors.forename: Sodaif
authors.initials: S
authors.lastname: Darvish Moghaddam
authors.forename: Hassan
authors.initials: H
authors.lastname: Salmanroghani
authors.forename: Amin
authors.initials: A
authors.lastname: Allafsghari
authors.forename: Abbas
authors.initials: A
authors.lastname: Yazdanbod
authors.forename: Mahboobeh
authors.initials: M
authors.lastname: Mirzaei
authors.forename: Arghavan
authors.initials: A
authors.lastname: Haj-sheykholeslami
authors.forename: Jafar
authors.initials: J
authors.lastname: Bashiri
authors.forename: Alireza
authors.initials: A
authors.lastname: Sadjadi
authors.forename: Sadegh
authors.initials: S
authors.lastname: Massarrat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005757:Gastritis, Atrophic / Q000097:blood / Q000175:diagnosis*; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020116:Pepsinogen A / Q000097:blood*; D020115:Pepsinogen C / Q000097:blood*; D013274:Stomach Neoplasms / Q000453:epidemiology*
chemical_list: D015415:Biomarkers; D020115:Pepsinogen C; D020116:Pepsinogen A