Serum pepsinogens as a gastric cancer and gastritis biomarker in South and Southeast Asian populations

Serum pepsinogens have been widely acknowledged as gastric mucosal biomarkers; how-
ever, a multicountry report on the benefits of pepsinogens as biomarkers has not yet been
published. We analyzed 1,206 sera and gastric mucosal samples collected from Bangla-
desh, Bhutan, Indonesia, Myanmar, Nepal and Thailand then assessed the association
between gastric mucosal changes and Helicobacter pylori infection. The new cutoff values
for serum pepsinogen values were evaluated using a receiver operating characteristic anal-
ysis. The participants with H. pylori infection had significantly lower pepsinogen I and higher
pepsinogen II values, but a lower pepsinogen I/II ratio than participants without the infection
(all P < .001). The pepsinogen I and pepsinogen I/II values were significantly higher and
lower, respectively, in individuals with atrophic gastritis than in those without (both P < .001).
Among uninfected individuals, only the pepsinogen I/II ratio was significantly lower in atro-
phic individuals. Pepsinogen I/II ratio also were significantly different between disease
among H. pylori-positive and H. pylori-negative individuals, suggesting the pepsinogen I/II
ratio is a robust biomarker for determining both chronic and atrophic gastritis. The cutoffs for
detecting chronic and atrophic gastritis for the pepsinogen I/II ratio were 4.65 and 4.95,
respectively. In conclusion, pepsinogen levels are useful biomarker for both chronic gastritis
and atrophic gastritis, but they should be used with caution. Population-based validation is necessary to determine the best cutoff values. Among all pepsinogen values, the pepsino-
gen I/II ratio was the most reliable gastric mucosal-change biomarker.