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Link between Serum Pepsinogen Concentrations and Upper Gastrointestinal Endoscopic Findings

View Article: PubMed Central - PubMed

ABSTRACT

The serum pepsinogen (PG) assay findings are correlated with the status of Helicobacter pylori infection, but there are controversies on the link with upper gastrointestinal (UGI) endoscopic findings. The aim of this study was to determine the significance of a serum PG assay for correlating with endoscopic findings in H. pylori-seroprevalent adult population. Korean adults who visited for a health check-up were included consecutively. Subjects after gastrectomy or H. pylori eradication were excluded. After completing the serum PG assay and anti-H. pylori immunoglobulin G (IgG) titer on the same day of UGI endoscopy, subjects with equivocal serology test finding or gastric neoplasm were excluded. Of the 4,830 included subjects, 3,116 (64.5%) were seropositive for H. pylori. Seropositive finding was related to high serum PG I (P < 0.001) and PG II (P < 0.001) concentrations, low PG I/II ratio (P < 0.001), old age (P < 0.001), and male gender (P = 0.006). After adjusting age and gender, the serum PG I and II concentrations were positively correlated with the presence of nodular gastritis (NG) (all P = 0.003). The serum PG I was positively correlated with gastric ulcer (P = 0.003), and it was correlated with duodenal ulcer in seropositive subjects (P = 0.008). The PG I/II ratio was positively correlated with erosive esophagitis, while it was inversely related to chronic atrophic gastritis and metaplastic gastritis (all P < 0.001). Our findings suggest that the serum PG assay finding correlates well with the UGI endoscopic finding. A higher serum PG concentration in subjects with NG and peptic ulcer disease suggests that endoscopic findings reflect gastric secreting ability.

No MeSH data available.


Related in: MedlinePlus

Diagnostic criteria used for discriminating endoscopic findings of H. pylori-related gastritis on the background gastric mucosa. (A) CAG. Transparent vessels are visible from the lesser curvature side to the anterior wall of the antrum extending up to the low-body with a demarcation line, so-called atrophic border. (B) NG on the antrum. Multiple and tiny, colorless nodules are scattered. The shape and size of the nodules are regular. (C) NG on the body. The nodules may extend up to the body, since they are submucosal protrusions that consist of lymphoid follicles. (D) MG with whitish color change. Large-sized, whitish elevations are noticed on the antrum. The shape and size of the discolored lesions are irregular. (E) MG with hyperemic color changes. Multiple, hyperemic depressions are augmented by irregular, whitish surrounding mucosa which indicates intestinal metaplasia. (F) MG on the body. Intestinal metaplasia has variable appearances from irregular, whitish elevations to geographic, hyperemic depressions.CAG = chronic atrophic gastritis, MG = metaplastic gastritis, NG = nodular gastritis.
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Figure 1: Diagnostic criteria used for discriminating endoscopic findings of H. pylori-related gastritis on the background gastric mucosa. (A) CAG. Transparent vessels are visible from the lesser curvature side to the anterior wall of the antrum extending up to the low-body with a demarcation line, so-called atrophic border. (B) NG on the antrum. Multiple and tiny, colorless nodules are scattered. The shape and size of the nodules are regular. (C) NG on the body. The nodules may extend up to the body, since they are submucosal protrusions that consist of lymphoid follicles. (D) MG with whitish color change. Large-sized, whitish elevations are noticed on the antrum. The shape and size of the discolored lesions are irregular. (E) MG with hyperemic color changes. Multiple, hyperemic depressions are augmented by irregular, whitish surrounding mucosa which indicates intestinal metaplasia. (F) MG on the body. Intestinal metaplasia has variable appearances from irregular, whitish elevations to geographic, hyperemic depressions.CAG = chronic atrophic gastritis, MG = metaplastic gastritis, NG = nodular gastritis.

Mentions: UGI endoscopy was performed at our center by one of the board-certified attending gastroenterologists using either a GIF-H260 (Olympus, Tokyo, Japan) or an EG-2990i (Pentax, Tokyo, Japan) endoscope. Endoscopic findings were initially described based on the criteria of the Sydney classification, and additional findings were recorded. With regard to the background gastric mucosa, the presence of H. pylori-related endoscopic findings was recorded (Fig. 1). NG was defined as chicken-skin like mucosal changes on the antrum. CAG was diagnosed when there was permeability of blood vessels with an atrophic border. MG was defined as whitish patches with or without depressed hyperemic lesions. GU and DU were diagnosed as a deep mucosal defect suspicious for submucosal invasion. An old ulcer scar due to a past history was not included as GU or DU subject in this study. A diagnosis of EE was made only when there was an erosion (hyperemic streak) on the low esophagus.


Link between Serum Pepsinogen Concentrations and Upper Gastrointestinal Endoscopic Findings
Diagnostic criteria used for discriminating endoscopic findings of H. pylori-related gastritis on the background gastric mucosa. (A) CAG. Transparent vessels are visible from the lesser curvature side to the anterior wall of the antrum extending up to the low-body with a demarcation line, so-called atrophic border. (B) NG on the antrum. Multiple and tiny, colorless nodules are scattered. The shape and size of the nodules are regular. (C) NG on the body. The nodules may extend up to the body, since they are submucosal protrusions that consist of lymphoid follicles. (D) MG with whitish color change. Large-sized, whitish elevations are noticed on the antrum. The shape and size of the discolored lesions are irregular. (E) MG with hyperemic color changes. Multiple, hyperemic depressions are augmented by irregular, whitish surrounding mucosa which indicates intestinal metaplasia. (F) MG on the body. Intestinal metaplasia has variable appearances from irregular, whitish elevations to geographic, hyperemic depressions.CAG = chronic atrophic gastritis, MG = metaplastic gastritis, NG = nodular gastritis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5383612&req=5

Figure 1: Diagnostic criteria used for discriminating endoscopic findings of H. pylori-related gastritis on the background gastric mucosa. (A) CAG. Transparent vessels are visible from the lesser curvature side to the anterior wall of the antrum extending up to the low-body with a demarcation line, so-called atrophic border. (B) NG on the antrum. Multiple and tiny, colorless nodules are scattered. The shape and size of the nodules are regular. (C) NG on the body. The nodules may extend up to the body, since they are submucosal protrusions that consist of lymphoid follicles. (D) MG with whitish color change. Large-sized, whitish elevations are noticed on the antrum. The shape and size of the discolored lesions are irregular. (E) MG with hyperemic color changes. Multiple, hyperemic depressions are augmented by irregular, whitish surrounding mucosa which indicates intestinal metaplasia. (F) MG on the body. Intestinal metaplasia has variable appearances from irregular, whitish elevations to geographic, hyperemic depressions.CAG = chronic atrophic gastritis, MG = metaplastic gastritis, NG = nodular gastritis.
Mentions: UGI endoscopy was performed at our center by one of the board-certified attending gastroenterologists using either a GIF-H260 (Olympus, Tokyo, Japan) or an EG-2990i (Pentax, Tokyo, Japan) endoscope. Endoscopic findings were initially described based on the criteria of the Sydney classification, and additional findings were recorded. With regard to the background gastric mucosa, the presence of H. pylori-related endoscopic findings was recorded (Fig. 1). NG was defined as chicken-skin like mucosal changes on the antrum. CAG was diagnosed when there was permeability of blood vessels with an atrophic border. MG was defined as whitish patches with or without depressed hyperemic lesions. GU and DU were diagnosed as a deep mucosal defect suspicious for submucosal invasion. An old ulcer scar due to a past history was not included as GU or DU subject in this study. A diagnosis of EE was made only when there was an erosion (hyperemic streak) on the low esophagus.

View Article: PubMed Central - PubMed

ABSTRACT

The serum pepsinogen (PG) assay findings are correlated with the status of Helicobacter pylori infection, but there are controversies on the link with upper gastrointestinal (UGI) endoscopic findings. The aim of this study was to determine the significance of a serum PG assay for correlating with endoscopic findings in H. pylori-seroprevalent adult population. Korean adults who visited for a health check-up were included consecutively. Subjects after gastrectomy or H. pylori eradication were excluded. After completing the serum PG assay and anti-H. pylori immunoglobulin G (IgG) titer on the same day of UGI endoscopy, subjects with equivocal serology test finding or gastric neoplasm were excluded. Of the 4,830 included subjects, 3,116 (64.5%) were seropositive for H. pylori. Seropositive finding was related to high serum PG I (P < 0.001) and PG II (P < 0.001) concentrations, low PG I/II ratio (P < 0.001), old age (P < 0.001), and male gender (P = 0.006). After adjusting age and gender, the serum PG I and II concentrations were positively correlated with the presence of nodular gastritis (NG) (all P = 0.003). The serum PG I was positively correlated with gastric ulcer (P = 0.003), and it was correlated with duodenal ulcer in seropositive subjects (P = 0.008). The PG I/II ratio was positively correlated with erosive esophagitis, while it was inversely related to chronic atrophic gastritis and metaplastic gastritis (all P < 0.001). Our findings suggest that the serum PG assay finding correlates well with the UGI endoscopic finding. A higher serum PG concentration in subjects with NG and peptic ulcer disease suggests that endoscopic findings reflect gastric secreting ability.

No MeSH data available.


Related in: MedlinePlus