Search

Background and Aims：Chronic atrophic gastritis (CAG) is an important precursor of gastric cancer(GC), and there is currently a lack of reliable non-invasive diagnostic markers. This study aims to find a biomarker for non-invasive screening of CAG in the community. Methods: A total of 540 individuals were enrolled (test set = 385, validation set = 155). ROC curve analysis was used to evaluate the diagnostic significance of Trefoil Factor 3(TFF3) alone or in combination with pepsinogen (PG) for CAG in test and validation set. Furthermore, the diagnostic value of TFF3 and PG in different H. pylori infection states was studied. Results：When compared with the chronic superficial gastritis (CSG), the expression level of TFF3 in the CAG was higher (27ng/ml VS 19.61, P < 0.001). ROC curve analysis found that the sensitivity, specificity, and area under the curve (AUC) of CAG diagnosis using serum TFF3 alone at the optimal cut-off value of 26.55ng/ml were 0.529, 0.87, and 0.739, respectively. When TFF3 was combined with The Ratio of PGI to PGII (PGR), the AUC and specificity reached to 0.755 and 0.825 respectively. TFF3 individual or combined with PGR had good predictive value especially in the H. Pylori negative patients. Conclusion: TFF3 combined with PGR can effectively predict CAG especially in the patients with H. pylori negative. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Serum pepsinogen (PG) is a good indicator of atrophic changes in the gastric mucosa. Gastric mucosal atrophy is a high-risk factor for gastric cancer. Serological testing for PG combined with endoscopy can help to improve gastric cancer screening. In this study, we established the reference ranges of serum PG-I, PG-II, and the PG-I/II ratio (PGR) in the Chinese population by chemiluminescence immunoassay (CLIA) and enzyme-linked immunosorbent assay (ELISA). Besides, in the real world, doctors are often confused by the results of different testing platforms. Thus, a comparison of methods CLIA and ELISA was performed. Methods: 2904 individuals were enrolled from six regions in China as part of the Chinese Adult Digestive Diseases Surveillance (2016) program. The individuals completed questionnaires and volunteered to undergo examinations, including gastroscopy, urea breath test, abdominal ultrasound examination and routine serologic tests. Serum was collected to measure PGs (including PG-I, PG-II and PGR) by CLIA and ELISA. Participants who were found obvious abnormalities or absent from the examinations were excluded. Ultimately, 747 healthy individuals were enrolled in this study. The Kolmogorov–Smirnov test was used to assess the distribution of variables. The Kruskal–Wallis H or Mann–Whitney U-tests were used to compare different sex, age, and geographical groups. The 95% reference ranges of PGs obtained by the two methods were established according to document CLSI-EP28-A3, with covariates of sex, age, and region. Spearman correlation analysis, linear regression analysis and allowable total error (ATE) zone analysis were utilized for comparing the two methods. Results: On overall, the 95% reference ranges of PG-I, PG-II, and PGR measured by CLIA were 23.00– 110.64 ng/mL, 2.50– 19.13 ng/mL, and 3.87– 13.30, respectively. Meanwhile, the reference ranges of PG-I, PG-II, and PGR measured by ELISA were 36.93– 205.06 ng/mL, 1.65– 17.96 ng/mL, and 7.50– 33.60, respectively. Both PG-I and PG-II levels measured by the two platforms were found to be influenced by sex and age. PGR measured by CLIA was influenced by age but not by sex, while PGR measured by ELISA was not affected by either age or sex. Regional factors did not significantly impact the PG results, except for PG-I detected by ELISA. Ultimately, reference ranges for PGs were established based on age and sex stratification. Additionally, the Spearman correlation analysis revealed that the correlation coefficients for PG-I, PG-II, and PGR detected by the two methods were 0.899, 0.887, and 0.777, respectively, indicating a strong correlation between the two methods. The regression equation for the PG levels detected by two methods was obtained through linear regression analysis. The ATE analysis provided a visual depiction of the consistency between the two methods, clearly indicating the poor agreement between them. Conclusion: This study established the reference ranges of PGs by strict and intact enrollment standard. In addition, the results indicated a strong linear relationship between the two methods, yet with a clear bias, which was valuable for laboratory interpretation. [ABSTRACT FROM AUTHOR]

Simple Summary: Individuals with atrophic gastritis and gastric intestinal metaplasia, considered gastric precancerous conditions (GPC), are at increased risk of developing gastric adenocarcinoma. The identification and surveillance of these patients are important for the diagnosis of early gastric neoplasia. Non-invasive markers of GPC with good diagnostic performance could allow the implementation of a stepwise screening approach and, with successful personalized endoscopic surveillance, possibly decrease gastric cancer morbidity and mortality. Pepsinogen I and II and their ratio are the most broadly investigated biomarkers with moderate diagnostic performance. Their combination with other markers like Helicobacter pylori antibodies and gastrin-17 (called GastroPanel®) allows for more precise identification of GPC but without significant improvement in overall performance. Other new serum biomarkers could possibly enhance the performance of pepsinogens. Some of them may be considered stand-alone biomarkers; however, until now, no high-quality data support the use of any of them. Gastric cancer (GC) is still one of the most prevalent cancers worldwide, with a high mortality rate, despite improvements in diagnostic and therapeutic strategies. To diminish the GC burden, a modification of the current diagnostic paradigm, and especially endoscopic diagnosis of symptomatic individuals, is necessary. In this review article, we present a broad review and the current knowledge status on serum biomarkers, including pepsinogens, gastrin, Gastropanel®, autoantibodies, and novel biomarkers, allowing us to estimate the risk of gastric precancerous conditions (GPC)—atrophic gastritis and gastric intestinal metaplasia. The aim of the article is to emphasize the role of non-invasive testing in GC prevention. This comprehensive review describes the pathophysiological background of investigated biomarkers, their status and performance based on available data, as well as their clinical applicability. We point out future perspectives of non-invasive testing and possible new biomarkers opportunities. [ABSTRACT FROM AUTHOR]

Aspiration is a known risk factor for adverse outcomes post-lung transplantation. Airway bile acids are the gold-standard biomarker of aspiration; however, they are released into the duodenum and likely reflect concurrent gastrointestinal dysmotility. Previous studies investigating total airway pepsin have found conflicting results on its relationship with adverse outcomes post-lung transplantation. These studies measured total pepsin and pepsinogen in the airways. Certain pepsinogens are constitutively expressed in the lungs, while others, such as pepsinogen A4 (PGA4), are not. We sought to evaluate the utility of measuring airway PGA4 as a biomarker of aspiration and predictor of adverse outcomes in lung transplant recipients (LTRs) early post-transplant. Expression of PGA4 was compared to other pepsinogens in lung tissue. Total pepsin and PGA4 were measured in large airway bronchial washings and compared to preexisting markers of aspiration. Two independent cohorts of LTRs were used to assess the relationship between airway PGA4 and chronic lung allograft dysfunction (CLAD). Changes to airway PGA4 after antireflux surgery were assessed in a third cohort of LTRs. PGA4 was expressed in healthy human stomach but not lung. Airway PGA4, but not total pepsin, was associated with aspiration. Airway PGA4 was associated with an increased risk of CLAD in two independent cohorts of LTRs. Antireflux surgery was associated with reduced airway PGA4. Airway PGA4 is a marker of aspiration that predicts CLAD in LTRs. Measuring PGA4 at surveillance bronchoscopies can help triage high-risk LTRs for anti-reflux surgery. [ABSTRACT FROM AUTHOR]

Introduction: Atrophic gastritis and intestinal metaplasia are precursor lesions of gastric cancer. The aim of this study was to determine the usefulness of the biomarkers pepsinogen I(PgI), pepsinogen II (PgII), gastrin-17, and H. pylori antibodies in the identification of precursor lesions. Methods: We studied 129 patients with gastric symptoms. The biomarker status was determined using GastroPanel by means of the ELISA-technique. Results: Biomarkers detected atrophy in 14% of the subjects, and 49.6% had positive antibodies for H. pylori. A PgI/PgII ratio < 3 was an important risk biomarker for precursor lesions in our population (OR = 9.171, 95% CI: 1.723-48.799, p = 0.009); however, biomarkers showed low accuracy with histopathological study. Conclusions: In the Western Mexican population, precursor lesions (AG, IM) are common in adults (45%) with dyspepsia but infrequent in children (8%). H. pylori infection was detected in 41.3% of adults and 16.0% of children. Of the studied biomarkers, a PgI/PgII ratio < 3 was an important risk factor for precursor lesions such as AG or IM in our population, with an OR of 9.171 (95% CI: 1.723-48.799, p = 0.009). [ABSTRACT FROM AUTHOR]

Biomarkers are specific molecular, histological, or physiological characteristics of normal or pathogenic biological processes and are promising in the diagnosis of gastrointestinal nematodes (GINs). Although some biomarkers have been validated for infection by Ostertagia sp. in cattle raised in temperate regions, there is a lack of information for tropical regions. The aim of this project was to assess potential biomarkers and validate the most promising. In the first study, 36 bovines (Nelore breed) naturally infected by GINs were distributed into two groups: infected (not treated with anthelmintic) and treated (treated with fenbendazole on days 0, 7, 14, 21, 28, 42, and 56). The variables of interest were live weight, fecal egg count, hemogram, serum biochemical markers, phosphorus, gastrin, and pepsinogen. In the second step, pepsinogen was assessed in cattle of the Nelore breed distributed among three groups: infected (not treated with anthelmintic), MOX (treated with moxidectin), and IVM + BZD (treated with ivermectin + albendazole). In the first study, no difference between groups was found for weight, albumin, hematocrit (corpuscular volume [CV]), erythrocytes, or hemoglobin. Negative correlations were found between pepsinogen and both CV and albumin, and albumin was negatively correlated with the percentage of Haemonchus sp. in the fecal culture. Among the biomarkers, only pepsinogen differentiated treated and infected (beginning with the 28th day of the study). In the second study, a reduction in pepsinogen was found after anthelmintic treatment. Therefore, pepsinogen is a promising biomarker of worms in cattle naturally infected by the genera Haemonchus and Cooperia in tropical areas. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of yueju baohe pills combined with acupoint thread embedding on gastric motility index, serum gastrointestinal hormones and pepsinogen in patients with functional dyspepsia (FD) of liver-stomach disharmony type. Methods: 123 FD patients who were admitted to Beijing Gulou Traditional Chinese Medicine Hospital from June 2020 to June 2023 were selected by random number table method, patients were divided into control group (61 cases) and study group (62 case). Control group was received routine treatment with acupoint thread embedding, and study group was treated with yueju baohe pill on the basis of control group. The efficacy, chinese medicine syndrome scores, gastric motility index, gastrointestinal hormones index and pepsinogen index were compared between two groups. Results: The total clinical effective rate in study group was higher than that in control group (P<0.05). The total scores of main symptoms, secondary symptoms and chinese medicine syndrome scores in study group were lower than those in control group after treatment (P<0.05). Motilin (MLT) in study group was higher than that in control group, and somatostatin (SS) and gastrin (GAS) were lower than those in control group after treatment (P<0.05). The postprandial gastric antrum contraction frequency (F), contraction amplitude (P) and exercise index (MI) in study group were higher than those in control group after treatment (P<0.05). Pepsinogen I (PGI) and pepsinogen II (PG II) in study group were higher than those in control group after treatment (P<0.05). Conclusion: Yueju baohe pills combined with acupoint thread embedding can effectively improve the serum gastrointestinal hormones and pepsinogen levels and promote gastric motility, further improve gastrointestinal function [ABSTRACT FROM AUTHOR]

Gastritis is an inflammatory process in the gastric mucosa and submucosa caused by Helicobacter pylori (H. pylori). The infection modulates immune components, such as interleukin (IL) 17, high sensitivity C-reactive protein (hsCRP) and pepsinogen. This study aimed to determine the relationship between IL-17, hsCRP and pepsinogen in H. pylori infected gastritis. This observational cross-sectional study was conducted at Prof. Dr. R. D. Kandou General Hospital Manado from May-July 2022. Measurement of blood sample levels of IL-17, hsCRP, pepsinogen I, pepsinogen II and pepsinogen I/II ratio. Spearman's statistical test was used to determine correlations between these variables. This study involved 48 patients aged 21–64, with a majority of females (67%). IL-7 had a positive correlation with pepsinogen I (r = 0.292; p = 0.044) and pepsinogen II (r = 0.288; p = 0.047) in H. pylori infected gastritis. Meanwhile, IL-17 with pepsinogen I/II ratio, hsCRP with pepsinogen I, pepsinogen II, pepsinogen I/II ratio and IL-17 with hsCRP did not show a significant correlation (p > 0.05). There was a correlation between IL 17 to pepsinogen I and pepsinogen II in gastritis infected with H. pylori, suggesting the importance of these early markers of inflammation in determining the severity of gastric mucosal inflammation in pylori-infected patients. [ABSTRACT FROM AUTHOR]

Objective To observe the effects of different virulence types of Helicobacter pylori on pepsin and inflammatory factors. Methods　110 patients admitted from December 2021 to March 2023 were collected and divided into HP positive group (n=79) and HP negative group (n=31) according to 13 carbon breath test results. The HP positive group was divided into type I group ( n=52), type II group ( n=11) and undetermined group ( n=16) according to the Helicobacter pylori antibody typing. The HP negative group was selected and divided into blank control group ( n=12). Gastric juice pH value, sodion (Na+), potassium (K+), chloridion (Cl-), IL-6, IL-8, gastrin 17 (G-17), pepsinogen Ⅰ (PG Ⅰ) and pepsinogen Ⅱ (PG Ⅱ) were detected in all patients. Results　There was no difference in pH, Na+, Cl-, K+ between Hp positive group and Hp negative group (P > 0.05). The content of Cl- in HP-positive group was lower than that in HP-negative group (P < 0.05). The levels of IL-6, IL-8, G-17, PG Ⅰ and PG Ⅱ in HP-positive group were significantly higher than those in HP-negative group (P < 0.05). There was no significant difference in pH, Na+ and K+ between type I group and type II group, undetermined group and blank control group (P > 0.05). The content of Clin type I group and undetermined group was lower than that in blank control group (P < 0.05). The levels of IL-6, IL-8 and PG Ⅰ in type I group were higher than those in type II group, undetermined group and blank control group (P < 0.05). There was a significant difference in PG Ⅱ between the blank control group and the other groups (P < 0.05). There was no difference in G-17 content between type I group and undetermined group (P > 0.05). The level of G-17 in type I group was higher than that in type II group and blank control group (P < 0.05). Conclusion　Type I Hp infection may cause gastric mucosal injury by increasing the expression of IL-6, IL-8 and G-17, and then lead to abnormal digestive function [ABSTRACT FROM AUTHOR]

Background: The causes of vitamin B12 (B12) deficiency are varied and mainly related to gastric disorders. Glossitis is a common oral manifestation of B12 deficiency and is often first seen by dentists. This study aimed to investigate the correlation between B12 deficiency‐related glossitis (B12‐def glossitis) and gastric serum biomarkers [gastrin‐17(G17), pepsinogen I (PGI), pepsinogen II (PGII), and anti‐Helicobacter pylori (H. pylori) antibodies], and preliminarily discuss the etiology of B12‐def glossitis. Methods: A cross‐sectional study was conducted in patients complaining of glossodynia, burning sensation, or severe recurrent oral ulcers, but patients with a history of gastrectomy were excluded. All subjects underwent a uniform oral examination and hematological tests. Results: Of 243 patients, 133 with B12‐def glossitis were in the case group, and 110 with other oral mucosal diseases (non‐glossitis) and normal B12 levels were in the control group. In the case group, 84.2% (112/133) showed high G17 and low PGI levels (G17hi PGIlow). Univariate logistic regression showed that G17hi PGIlow was a high‐risk factor for B12‐def glossitis (OR: 92.44; 95% CI: 35.91, 238.02). Subgroup analyses in the case group showed that the G17hi PGIlow group presented with lower B12 levels and a lower positive rate of anti‐H. pylori antibodies compared to the non‐G17hi PGIlow group. Conclusion: Gastric serum biomarkers in patients with B12‐def glossitis generally showed G17hi PGIlow, suggesting possible atrophy of gastric corpus and fundus mucosa. The G17hi PGIlow and non‐G17hi PGIlow groups may represent different etiologies of B12 deficiency. [ABSTRACT FROM AUTHOR]

Background and Aims: This study aimed to validate Helicobacter pylori serological and pepsinogen (PG) assays for detecting infection and gastric neoplasm. Methods: Individuals who underwent serum Chorus H. pylori and HBI PG assays were included from May to September 2023. The GastroPanel test was performed using the same blood sample. HBI assay findings were interpreted with the ABC method using the criteria of corpus atrophy (PG I ≤ 70 ng/mL & I/II ≤3) and advanced corpus atrophy (PG I ≤ 30 ng/mL & I/II ≤2). Results: A total of 144 H. pylori‐infected and 184 non‐infected Koreans were analyzed. The Chorus test (sensitivity 97.2%, specificity 89.1%) showed higher area under the curve (0.993 vs. 0.972, p = 0.003) than the GastroPanel test (sensitivity 95.8%, specificity 86.4%). Using the GastroSoft application, the incidence of gastric neoplasms was highest in the corpus atrophy group (50%), followed by the low acid‐output (25.8%), H. pylori infection (11.6%), and antral atrophy (9.1%) groups. There were no gastric neoplasms in the normal and high acid output groups. Using the ABC method, the incidence of gastric neoplasms was highest in the corpus atrophy groups (23.8% in Groups C and D), followed by Group B (12.3%) and Group A (2.4%). Corpus atrophy interpreted with the GastroSoft showed poor agreement (k = 0.225) with corpus atrophy interpreted with the ABC method, whereas it showed excellent agreement (k = 0.854) with advanced corpus atrophy. Conclusions: Although the Chorus test was more accurate than the GastroPanel test, both assays discriminated high‐risk individuals by detecting atrophy or infection. There were no gastric neoplasms in the normal or high acid‐output groups (GastroSoft application), and gastric neoplasm incidence was lowest in Group A (ABC method). Corpus atrophy determined by GastroSoft application is more consistent with advanced corpus atrophy determined by the ABC method than is corpus atrophy. [ABSTRACT FROM AUTHOR]

Background: Autoimmune gastritis (AIG), characterized with the presence of anti-parietal-cell antibodies (APCA), is a risk factor for gastric cancer. However, AIG may go underdiagnosed, especially in the case of H. pylori infection and the presence of gastric precancerous lesions (GPL), due to the ambiguous pathology and delayed symptom onset. Aim: Investigate the prevalence and characteristics of AIG in GPL patients. Methods: Prevalence of AIG was determined with the presence of APCA in patients with GPL (n = 256) and the control group (n = 70). Pathological characteristics and levels of gastrin 17 (G17), pepsinogen (PG) I and II and anti-Helicobacter pylori IgG were assessed in GPL cases, and the severity of intestinal metaplasia and gastric atrophy was scored by expert pathologists. Results: APCA positivity was observed in 18% of cases vs. 7% of controls (p = 0.033). Only 3/256 patients were previously diagnosed with AIG. The presence of APCA was associated with corpus-limited and extended GPL. A receiver operating curve analysis demonstrated that the G17 and PGI/II ratio could identify APCA-positive patients within GPL cases (AUC: 0.884). Conclusions: The prevalence of AIG is higher in patients with GPL but goes undiagnosed. Using G17 and PG I/II as diagnostic markers can help to identify patients with AIG and improve surveillance programs for patients with GPL. [ABSTRACT FROM AUTHOR]

Background: To analyze the difference of serum gastrin‐17 (G17) level in healthy people with different sex, age, and body mass index (BMI), to explore the correlation between G17 and pepsinogen, and to study the influences of Helicobacter pylori (H. pylori) infection and various inflammatory factors on G17 secretion level. Methods: A total of 531 subjects who received physical examination in our center from April 2019 to December 2019 were enrolled in the study. All subjects were tested for G17, pepsinogen I (PGI), pepsinogen II (PGII), PGI/PGII ratio (PGR), H. pylori, serum amyloid A (SAA), C‐reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The difference of G17 secretion in different subjects and its correlation with PG were analyzed to investigate H. pylori infection and expound the effects of inflammatory indicators on G17. Results: There was no significant difference in G17 secretion level in people with different sex, age and BMI (p >.05). G17 positively correlated with PGI and PGII, but negatively correlated with PGR. The G17 level of H. pylori‐positive subjects was 10.16 ± 12.84, and prominently higher than that of H. pylori‐negative subjects (3.27 ± 6.65). SAA and H. pylori infection were the greater risk factors for G17 abnormality among various indicators. CRP and ESR had no effect on G17 abnormality. Conclusions: G17 secretion is closely related to PG and H. pylori. Combined screening contributes to early screening of gastrointestinal diseases in normal people or groups at high risk for gastric cancer, but the influence of inflammatory indicators on G17 should be excluded to improve the reliability of the results. [ABSTRACT FROM AUTHOR]

The clinical significance of serum pepsinogen (PG) for screening gastric cancer has been a controversial topic. Serum PG I levels have been demonstrated to be correlated with age, sex, and the Helicobacter pylori (HP) infection. However, the underlying factors that influence serum PG I variations remain to be fully elucidated. We aimed to evaluate the impacts of sex and body mass index (BMI) on PG I in Chinese population. The cross-sectional study recruited 4,299 apparently healthy participants in Fujian Province. Serum PG levels were automatically measured using ELISA method. Serum H. pylori-IgG antibody was detected by the colloidal gold immunoassay. Clinical characteristics were obtained by questionnaire. Totally, 2,263 participants who had tests of serum PG and anti-HP IgG antibody were enrolled. Increased BMI and serum uric acid were observed in males with low PG I value (<70 μg/L). Multiple logistic regression showed the presence of overweight was the independent risk factor for male participants with low PG I level (odds ratio [OR] 1.519; p=0.017). However, the association was not found in females. Sex-specific association of serum low PG I with overweight was observed in the southeast coastal areas of China. Thus, effects of sexual dimorphism should not be ignored during the clinical utilization of serum PG I. [ABSTRACT FROM AUTHOR]

Serum pepsinogen (PG) testing is recommended by the European guidelines for diagnosis of chronic atrophic gastritis (CAG). However, wide variations in diagnostic performances are observed, due to the differences in the extent of gastric atrophy, and possibly in its origin (Helicobacter pylori -, autoimmune (AIG)). Aim. To analyze the diagnostic performances of PGs testing according to these different parameters, using enzyme-linked-immunosorbent serologic assay (ELISA) and chemiluminescent immunoassay (CLEIA). Serum samples from patients having undergone gastroscopy with biopsies in five French centers were collected prospectively. Sensitivity (Se), specificity (Sp), and Area Under Curve were analyzed according to the extent and origin of CAG. Overall, 344 patients (156 males [45%]; mean age 58.8 [±14.2] years) were included, among whom 44 had AIG. Diagnostic performances of PG I for the detection of corpus CAG were excellent, with Se and Sp of 92.7% and 99.1% for ELISA and 90.5% and 98.2% for CLEIA, respectively. For AIG, corresponding values were 97.7% and 97.4% for ELISA, and 95.6% and 97.1% for CLEIA. In multivariate analysis, PG levels were associated with the auto-immune origin (p <0.001) but not with the extent of the atrophic gastritis. Pepsinogens are highly efficient for the diagnosis of corpus-limited CAG and allow to discriminate AIG from H. pylori -induced gastritis. [ABSTRACT FROM AUTHOR]

Gastric cancer (GC) is still one of the most prevalent cancers worldwide, with a high mortality rate, despite improvements in diagnostic and therapeutic strategies. To diminish the GC burden, a modification of the current diagnostic paradigm, and especially endoscopic diagnosis of symptomatic individuals, is necessary. In this review article, we present a broad review and the current knowledge status on serum biomarkers, including pepsinogens, gastrin, Gastropanel®, autoantibodies, and novel biomarkers, allowing us to estimate the risk of gastric precancerous conditions (GPC)—atrophic gastritis and gastric intestinal metaplasia. The aim of the article is to emphasize the role of non-invasive testing in GC prevention. This comprehensive review describes the pathophysiological background of investigated biomarkers, their status and performance based on available data, as well as their clinical applicability. We point out future perspectives of non-invasive testing and possible new biomarkers opportunities.

The gastric cancer risk varies based on the etiology and severity of gastritis, which depends on a history of Helicobacter pylori infection and the secretory capacity of the stomach. Type A gastritis is associated with reverse atrophy of the corpus and type B with progressive atrophy extending from the antrum to the corpus. Diffuse or spotty redness in the corpus together with high serum pepsinogen (PG) II levels and a low PG I/II ratio are observed in patients with H. pylori infection when secretory capacity of the stomach is intact. Diffuse-type gastric cancer may develop near the gastric folds, which is a rare site of atrophy. Low serum PG I levels are associated with progressive gastric corpus atrophy and intestinal metaplasia in patients with chronic and previous H. pylori infections. This clinical scenario predisposes patients to intestinal-type gastric cancer, which originates in the atrophic and metaplastic gastric mucosa. Conversely, a high PG I/II ratio is observed in patients without H. pylori infection. Serum PG I levels and the PG I/II ratio are high in patients with acute H. pylori-negative gastritis, including drug-induced gastritis but are significantly low in autoimmune gastritis. Gastric neuroendocrine tumors may develop in patients with autoimmune gastritis or in those with long-term acid suppressant use. Fasting serum gastrin levels and the risk of neuroendocrine tumors are high in both cases. In this review, types of gastritis are summarized along with evaluation performed to determine the secretory capacity of the background gastric mucosa.

Abstract Background To analyze the difference of serum gastrin‐17 (G17) level in healthy people with different sex, age, and body mass index (BMI), to explore the correlation between G17 and pepsinogen, and to study the influences of Helicobacter pylori (H. pylori) infection and various inflammatory factors on G17 secretion level. Methods A total of 531 subjects who received physical examination in our center from April 2019 to December 2019 were enrolled in the study. All subjects were tested for G17, pepsinogen I (PGI), pepsinogen II (PGII), PGI/PGII ratio (PGR), H. pylori, serum amyloid A (SAA), C‐reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The difference of G17 secretion in different subjects and its correlation with PG were analyzed to investigate H. pylori infection and expound the effects of inflammatory indicators on G17. Results There was no significant difference in G17 secretion level in people with different sex, age and BMI (p > .05). G17 positively correlated with PGI and PGII, but negatively correlated with PGR. The G17 level of H. pylori‐positive subjects was 10.16 ± 12.84, and prominently higher than that of H. pylori‐negative subjects (3.27 ± 6.65). SAA and H. pylori infection were the greater risk factors for G17 abnormality among various indicators. CRP and ESR had no effect on G17 abnormality. Conclusions G17 secretion is closely related to PG and H. pylori. Combined screening contributes to early screening of gastrointestinal diseases in normal people or groups at high risk for gastric cancer, but the influence of inflammatory indicators on G17 should be excluded to improve the reliability of the results.

Objective To analyze the correlation between gastric mucosa serological biopsy ［serum pepsinogen Ⅰ（PGⅠ）, pepsinogen Ⅱ（PGⅡ）, ratio of PGⅠ/PGⅡ(PGR), gastrin-17 and helicobacter pyloriantibody（HP-IgG）］ and histological gastritis evaluation criteria （OLGA/OLGIM）, and to evaluate the efficacy of these indicators in the screening of gastric precancerous disease. Methods A total of 417 patients underwent gastroscopy for dyspepsia were selected in the 971st Hospital of the PLA Navy from January 2019 to December 2021 were selected. They were evaluated in groups according to the OLGA/OLGIM staging system, and the serum PGⅠ, PGⅡ, PGR, G-17 and HP-IgG were detected and analyzed. Results In OLGA/OLGIM group, PGⅠ and PGR decreased with the increase of group grade(P＜0.01), while the infection rates of G-17 and HP increased with the increase of group grade(P＜0.01). Kendall correlation analysis showed that there was a positive correlation between the combined scoring method and OLGA stage and OLGIM stage (r=0.44, 0.43,P

Background: Screening for chronic atrophic gastritis (CAG) is crucial for the prevention and early detection of gastric cancer. Endoscopy is the main method of CAG diagnosis, with high training requirements and limited accuracy, making it difficult to popularize. The study attempts to improve the positive rate and accuracy of CAG screening through non-invasive testing. Methods: A total of 2564 patients who underwent gastroscopy were included in this study. The results of gastroscopic evaluation, histological biopsy results (including H. pylori biopsy), urea breath test (UBT) results, serum pepsinogen, and testosterone were statistically analyzed. Results: We found significant differences in the diagnosis of CAG between endoscopy and histological biopsy. Pepsinogen II and pepsinogen I/II ratio were more useful for the diagnosis of CAG compared with pepsinogen I. The risk of CAG was increased when pepsinogen II exceeded 11.05 μg/L, and the pepsinogen I/II ratio was less than 3.75. CAG positivity was higher in patients with positive H. pylori infection on UBT screening. In addition, higher levels of testosterone, SHBG and HSD17B2, and lower level of GNRH1 were found in CAG mucosa. Patients with high serum testosterone had a higher risk of CAG. Conclusion: CAG screening should be combined with endoscopic evaluation, biopsy, and other non-invasive tests. Non-invasive tests include the combination of serum pepsinogen II protein and pepsinogen I/II ratio and high level of serum testosterone. UBT combined with serum pepsinogen testing may improve the positive rate of CAG and reduce gastric mucosal damage from multiple biopsies.

Background: Pepsinogen C (PGC) is expressed in chief cells, fundic mucous neck cells, and pyloric gland cells of gastric epithelium and also in breast, prostate, lung, and seminal vesicles. Methods: We explored the clinicopathological and prognostic significances of PGC mRNA using pathological and bioinformatics analyses. We generated PGC knockout and PGC-cre transgenic mice to observe the effects of PGC deletion and PTEN abrogation in PGC-positive cells on gastric carcinogenesis. Finally, we observed the effects of altered PGC expression on aggressive phenotypes by CCK8, Annexin V staining, wound healing and transwell assays and analyzed the partner proteins of PGC using co-IP (co-immunoprecipitation) and double fluorescence staining. Results: PGC mRNA level was inversely correlated with the T and G stage and a short survival of gastric cancer (p < 0.05). PGC protein expression was negatively linked to lymph node metastasis, dedifferentiation, and low Her-2 expression of gastric cancer (p < 0.05). No difference in body weight or length was evident between wild-type (WT) and PGC knockout (KO) mice (p > 0.05), but PGC KO mice had a shorter survival than WT mice (p < 0.05). No gastric lesions were observed in the mucosa of the granular stomach in PGC KO mice, which displayed lower frequency and severity of gastric lesion than in WT mice after treated with MNU. Transgenic PGC-cre mice showed high cre expression and activity in the lung, stomach, kidney, and breast. Gastric cancer and triple-negative lobular breast adenocarcinoma were found in PGC-cre/PTENf/f mice with two previous pregnancies and breast feeding, but breast cancer was not seen in transgenic mice exposed to either estrogen or progesterone, or those with two previous pregnancies and no breast feeding. PGC suppressed proliferation, migration, invasion, and induced apoptosis, and interacted with CCNT1, CNDP2 and CTSB. Conclusion: PGC downregulation was seen in gastric cancer, but PGC deletion resulted in resistance to chemically-induced gastric carcinogenesis. PGC expression suppressed the proliferation and invasion of gastric cancer cells possibly by interacting with CCNT1, CNDP2 and CTSB. Spontaneous triple-negative lobular adenocarcinoma and gastric cancer were seen in PGC-cre/PTENf/f mice, and the breast carcinogenesis was closely linked to pregnancy and breast feeding, but not to single exposure to estrogen or progesterone, or pregnancy. Limiting either pregnancy or breast feeding might help to prevent hereditary breast cancer. [ABSTRACT FROM AUTHOR]

Background: Although the ABC method for gastric cancer (GC) screening has been widely adopted in Japan, it may not be suitable for other countries due to population heterogeneity and different tumor histology. We aim to develop a modified ABC method to improve GC screening performance, especially among Helicobacter pylori (Hp) infected but serum pepsinogen (sPG) test‐negative individuals. Methods: A total of 4745 participants were recruited from Tianjin, China, and were classified into four groups by combined assay for Hp infection and sPG concentrations: Group A (Hp [−], PG [−]), Group B (Hp [+], PG [−]), Group C (Hp [+], PG [+]), and Group D (Hp [−], PG [+]). We used receiver‐operating characteristic (ROC) curves analysis and minimum p value method to determine the optimal cutoff point for PG II in Group B. We performed logistic regressions to examine the risk of GC across different subgroups. In addition to the derivation set, the performance of the modified ABC method was also evaluated in an external set involving 16,292 participants from Liaoning, China. Results: In the modified ABC method, we further classified Group B as low‐risk (Group B1) and high‐risk subgroups (Group B2) using optimal sPG II cutoff point (20.0 ng/mL) by ROC curves analysis and minimum p value method. Compared with Group B1, Group B2 had a significantly higher risk of GC (adjusted OR = 2.54, 95% CI = 1.94–3.33). The modified ABC method showed good discrimination for GC (AUC = 0.61, 95% CI = 0.59–0.63) and improved risk reclassification (NRI = 0.11, p <.01). Similar results were observed in the validation dataset. Conclusions: The modified ABC method can effectively identify high‐risk population for GC among Hp‐infected but sPG test‐negative participants in China. [ABSTRACT FROM AUTHOR]

Objective: To observe the efficacy of ouadruple therapy of rebamipide on helicobacter pylori (Hp) positive peptic ulcer and its influence on serum oxidative stress index and pepsinogen. Methods: Patients with Hp-positive peptic ulcer (n=100) who were admitted to Chest Hospital of Guangxi Zhuang Autonomous Region from July 2020 to December 2021 were selected, and they were divided into combination group (50 cases, ouadruple therapy of rebamipide) and control group (50 cases, standard ouadruple therapy) according to random number table method. Efficacy, scoring scale, serum oxidative stress index, pepsinogen (PG), incidence of adverse reactions, Hp eradication rate and recurrence rate were compared in the two groups. Results: The total clinical effective rate in the combination group was higher than that in the control group(P<0.05). The healing rate of peptic ulcer in the combination group was higher than that in the control group (P<0.05). After treatment, the scores of the Symptom Frequency Scale of Gastroesophageal reflux disease (FSSG) and clinical symptoms in the combination group were lower than those in the control group(P<0.05). After treatment, serum malondialdehyde (MDA) in the combination group was lower than that in the control group, and serum glutathione peroxidase (GSH-PX) and superoxide dismutase (SOD) in the combination group were higher than those in the control group(P<0.05). After treatment, pepsinogen (PG) Ⅰ and PG Ⅱ in the combination group were lower than those in the control group (P<0.05). There was no difference in the total incidence of adverse reactions in the two groups (P>0.05). The Hp eradication rate in the combination group was higher than that in the control group, and the recurrence rate was lower than that in the control group(P<0.05). Conclusion: In the treatment of patients with Hp-positive peptic ulcer, ouadruple therapy of rebamipide can effectively promote ulcer healing, relieve clinical symptoms, improve the stress state of the body and the level of pepsinogen, increase the Hp eradication rate, reduce adverse reactions and recurrence. [ABSTRACT FROM AUTHOR]

Pepsinogen A (PGA) plays an important role in the treatment of human gastrointestinal diseases. At present, PGA is mainly extracted from pig stomach, so its source is very limited and its price is very expensive. Production of PGA by microbial fermentation using an engineered strain with high PGA yield would be an ideal solution. This paper presents a new system for the high-level expression of PGA from Homo sapiens (hPGA) in Aspergillus niger. The hPGA5 gene codon was optimized according to the codon bias of A. niger and then connected to a strong promoter and signal peptide to construct an hPGA5 expression cassette. An ingenious multi-copy knock-in expression strategy mediated by the CRISPR/Cas9 tool was used to improve the production of hPGA in A. niger. By optimizing the copy number and integration sites of the hPGA5 gene, an engineering strain with a high yield of hPGA was constructed. After shake-flask fermentation for 7 d, the enzyme activity of recombinant hPGA reached 542.3 U/mL, which is the highest known activity. This lays a foundation for the production of hPGA by microbial fermentation. [ABSTRACT FROM AUTHOR]

Background: No studies have evaluated the relationship between lifestyle and synchronous gastric cancers (SGCs) in patients with endoscopic submucosal dissection (ESD) for early gastric cancers (EGCs). Using data from the Tohoku gastrointestinal (GI) study, we aimed to identify factors associated with SGCs. Methods: Tohoku GI study is a multicenter prospective cohort study investigating the relationship between lifestyle and metachronous gastric cancers. Patients who had a schedule to undergo ESD for primary EGCs were enrolled. We used logistic regression analysis to examine the relationship of 15 candidate factors, including lifestyle, with the prevalence of SGCs in this study. Results: Of 850 patients between 2016 and 2019, 16.0% (136 patients) had SGCs. In multivariate analysis, smoking history (odds ratio [OR], 1.93; p = 0.048) and severe atrophic gastritis assessed by pepsinogen (OR, 1.92; p = 0.004) were risk factors for the prevalence of SGCs. Regarding smoking, current smoking (OR, 2.33; p = 0.021), but not former smoking (OR, 1.76; p = 0.098), was a significant risk factor for its prevalence. In the stratified analysis, severe atrophic gastritis assessed by pepsinogen was a risk factor in patients without Helicobacter pylori (H. pylori) eradication (OR, 2.10; p = 0.002), but not a risk factor in those with H. pylori eradication (OR, 0.75; p = 0.737). Conclusion: Smoking history was a risk factor for the prevalence of SGCs in patients with ESD for EGCs, and severe atrophic gastritis assessed by pepsinogen was also a risk factor when H. pylori was not eradicated. [ABSTRACT FROM AUTHOR]

Acidic digestion is an important digestive process of marine fish. In fish stomach, two enzymes are involved in the secretion of hydrochloric acid (HCl) and proteomic digestion: H+/K+-ATPase and pepsinogen. However, the starting of digestive function in fish is still unclear. To reveal the details of acidic digestion of turbot Scophthalmus maximus in early development, a 40 day of turbot larvae culture was conducted. The H+/K+-ATPase gene from the turbot S. maximus (smH+/K+-ATPase) was identified and characterized. Based on our previous discription on pepsinogen of turbot S. maximus, we combined pepsinogen and H+/K+-ATPase and analyzed the mechanism of acidic digestion in turbot. Results show that the spatial and temporal expression profiles of H+/K+-ATPase agreed with pepsinogen A and C in turbot, indicating a synergetic action between H+/K+-ATPase and pepsinogen during the acidic digestion process. In addition, the turbot juveniles showed a faster growth after the expressions of H+/K+-ATPase gene and pepsinogen gene, demonstrating that pepsin had a higher digestive efficiency, for which a compound diet should be provided to the fish from Day 22 onward. This study provided a reference for biology research and aquaculture of turbot and other marine fishes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of endoscopic mucosal resection in the treatment of gastric polyps and its effect on the levels of serum gastrin releasing peptide precursor (ProGRP) and pepsinogen I (PGI). Methods: 120 patients with gastric polyps admitted in our hospital from August 2019 to August 2022 were selected as the research objects, and were divided into groups according to different surgical methods. Among them, 60 patients who were treated with conventional endoscopic electrocoagulation were divided into the control group, and 60 patients who were treated with endoscopic mucosal resection were divided into the observation group. The occurrence of adverse effects and treatment costs between the two groups, serum ProGRP, PGI expression levels and inflammatory factors expression levels before and after surgery, and the overall resection rate and complications in the two groups were compared. Results: There was no difference in the total treatment costs between the two groups (P > 0.05) . The incidence of postoperative adverse effects in the observation group was lower than that in the control group (P < 0.05) ; There was no difference in serum ProGRP and PGI levels between the two groups before operation (P > 0.05) After treatment, the ProGRP and PGI levels of the two groups decreased, and the observation group was lower than the matched group (P < 0.05) ; There was no difference in PCT, CRP, IL-6 and IL-2 between the two groups before operation (P > 0.05) After operation, PCT, CRP, IL-6 and IL-2 of the two groups increased, and the observation group was lower than the matched group (P < 0.05) ; The gastric polyps were completely removed in both groups, and the overall resection rate was not different, and the incidence of perforation, delayed bleeding and infection was lower than that of the control group, but the difference was not significant (P > 0.05) Conclusion: Both endoscopic mucosal resection and conventional endoscopic electrocoagulation can completely remove gastric polyps in patients with gastric polyps, and the treatment cost is equivalent. The application of endoscopic mucosal resection can reduce the levels of ProGRP and PGI in patients, reduce the inflammatory reaction of the body, and have a low incidence of complications, which is worthy of clinical application and promotion [ABSTRACT FROM AUTHOR]

Objective　This study aims to analyze the level of G-17 and PG in ethnic minority gastric cancer patients in Lijiang, and to investigate their value in gastric cancer screening. Methods　Selected from July 2020 to August 2022, Lijiang people’ s hospital of gastroscopy patients with gastric cancer and gastritis, the biopsy confirmed gastric cancer in 52 cases of minority patients as an observation group, further gastric cancer group for early gastric cancer group and advanced gastric cancer group, while the same gastroscopy diagnosis of chronic gastritis (atrophic gastritis, atrophic gastritis) in 105 cases of ethnic minority patients as a control group. Serum G17, PGI, PGII, and PGR levels were collected for correlation analysis. Results　The serum G-17 level in gastric cancer group and atrophic gastritis group was significantly higher than that in non-atrophic gastritis group ( P < 0.05) . The serum PGⅡ level in gastric cancer group was significantly higher than that in atrophic gastritis group (P < 0.05) . The PGI level in early gastric cancer group was lower than that in advanced gastric cancer group, and the difference was statistically significant (P < 0.05) . The AUC values of serum G-17, PGI, PGII and PGR combined tests were higher than those of single test (P < 0.000 1) . Conclusion　Serum G-17 and PG can be used for the identification and screening of ethnic minority gastric cancer patients in Lijiang, as well as as non-invasive indicators of early and advanced gastric cancer. [ABSTRACT FROM AUTHOR]

The ABC method is a classification method used for stratifying the risk of gastric cancer. However, whether the ABC method should be performed only once or multiple times throughout an individual's lifetime remains unclear. Therefore, this study aimed to analyze whether performing ABC screening twice in a lifetime is useful. We retrospectively analyzed the data of individuals who participated in health checkups in 2010 and 2015. We collected data on patient characteristics, pepsinogen levels, anti-Helicobacter pylori antibody titers, and the presence of gastric cancer. Overall, 7129 participants without a history of H. pylori eradication were included in this study. The participants' average age in 2010 was 48.4 ± 8.3 years, and 58.1% were male. In addition, 11 and 20 cases of new H. pylori infection (0.15%) and spontaneous eradication (0.28%), respectively, were recorded. No significant difference was found in the incidence of gastric cancer between participants who underwent the ABC method once and those who underwent it twice (Group A: 0.16% vs. 0.16%; Group B: 0.47% vs. 0.39%; and Group C + D: 1.97% vs. 1.82%). Therefore, performing the ABC method twice, 5 years apart, does not significantly improve gastric cancer risk stratification. [ABSTRACT FROM AUTHOR]

Background and aim The severity of atrophic gastritis is significantly associated with the risk of gastric cancer. Although the current gold standard for assessing the gastric cancer risk is esophagogastroduodenoscopy with a pathological examination, the development of less-invasive biomarkers is warranted for efficient risk stratification of gastric cancer. Serum pepsinogens (PGs) are biomarkers used to predict the extent of gastric mucosal atrophy; however, they are not an accurate reflection of gastric mucosal atrophy after Helicobacter pylori eradication. The present study was conducted to investigate the usefulness of plasma ghrelin levels as a marker for gastric mucosal atrophy, and as a risk stratification marker for gastric cancer, even after H. pylori eradication. Methods Patients who received H. pylori eradication treatment were enrolled in the study. The severity of gastric mucosal atrophy was evaluated both endoscopically and histologically. Serum pepsinogen and plasma ghrelin levels were measured before and at 1, 12, 24, and 48 weeks after treatment. The study was approved by the Research Ethics Committee of the Keio University School of Medicine (no. 20140102; 8 July 2014). Results Eighteen patients completed the study protocol. Total and acyl plasma ghrelin levels demonstrated no significant change from before treatment to 48 weeks after eradication; however, there was a significant difference between open-type and closed-type atrophic gastritis. The PG I/II ratio increased significantly from 48 weeks after H. pylori eradication. The severity of the histological intestinal metaplasia scores correlated inversely with plasma total ghrelin levels from before to 48 weeks after H. pylori eradication. Conclusion Plasma levels of ghrelin correlate well with the level of gastric mucosal atrophy, even after H. pylori eradication.KEY MESSAGES Ghrelin plasma levels are associated with the progression of endoscopic atrophic gastritis, even at 48 weeks after H. pylori eradication. Ghrelin plasma levels are also associated with increased severity of histological intestinal metaplasia 48 weeks after H. pylori eradication. Pepsinogen I/II ratios increased immediately after H. pylori eradication and are inappropriate for assessing atrophic gastritis after H. pylori eradication.

Objective: To explore the clinical value of serum PGI, PGII, PGI/PGII, G-17 levels and Hp-IgG antibody in the preliminary screening of gastric diseases. Methods: A total of 300 patients who underwent gastroscopy in the Gastroenterology Department of our hospital from July 2018 to July 2020 due to gastric diseases were selected as the research objects. According to gastroscopy and pathological examinations, they were divided into chronic superficial gastritis group,chronic atrophic gastritis group and gastric cancer group. 100 healthy patients from the physical examination center during the same period were selected as the control group. The serum PGI, PGII, PGI/PGII G17 levels and the positive rate of Hp-IgG antibody in each group were compared. Results: Serum PGI/PGII levels in gastric cancer group(10.42±4.63) and atrophic gastritis group (10.54±4.36) were lower than those in control group (12.07±6.80). Serum G-17 levels in gastric cancer group [(13.85±27.68） pmmol/L] and chronic atrophic gastritis group [(9.63±10.82) pmmol/L] were higher than those in control group [(6.02±7.30) pmmol/L]. The serum PGI level in gastric cancer group[(123.53±35.45) μg/L] was lower than that in the control group[(148.24±83.85) μg/L and chronic superficial gastritis group [(141.95±81.11) μg/L]. The differences were statistically significant (P

In this study, we aimed to assess the accuracy of the proposed novel, noninvasive serum DSC test in predicting the risk of gastric cancer before the use of upper endoscopy. To validate the DSC test, we enrolled two series of individuals living in Veneto and Friuli-Venezia Giulia, Italy (n = 53 and n = 113, respectively), who were referred for an endoscopy. The classification used for the DSC test to predict gastric cancer risk combines the coefficient of the patient's age and sex and serum pepsinogen I and II, gastrin 17, and anti-Helicobacter pylori immunoglobulin G concentrations in two equations: Y1 and Y2. The coefficient of variables and the Y1 and Y2 cutoff points (>0.385 and >0.294, respectively) were extrapolated using regression analysis and an ROC curve analysis of two retrospective datasets (300 cases for the Y1 equation and 200 cases for the Y2 equation). The first dataset included individuals with autoimmune atrophic gastritis and first-degree relatives with gastric cancer; the second dataset included blood donors. Demographic data were collected; serum pepsinogen, gastrin G17, and anti-Helicobacter pylori IgG concentrations were assayed using an automatic Maglumi system. Gastroscopies were performed by gastroenterologists using an Olympus video endoscope with detailed photographic documentation during examinations. Biopsies were taken at five standardized mucosa sites and were assessed by a pathologist for diagnosis. The accuracy of the DSC test in predicting neoplastic gastric lesions was estimated to be 74.657% (65%CI; 67.333% to 81.079%). The DSC test was found to be a useful, noninvasive, and simple approach to predicting gastric cancer risk in a population with a medium risk of developing gastric cancer. [ABSTRACT FROM AUTHOR]

The diagnostics of ruminant parasites remains one of the cornerstones for parasite control best practices. Field veterinarians have several techniques at their disposal (fecal egg count, coproculture, FAMACHA®, plasma pepsinogen, ELISA-Ostertagia, ELISA-Fasciola, Baermann and ELISA-Lungworm) for the identification and/or quantification of gastrointestinal nematodes, lungworms and liver fluke infecting small ruminants and cattle. Each of these diagnostic tools has its own strengths and weaknesses and is more appropriate for a specific production operation and/or age of the animal (young and adults). This review focuses on the usability and interpretation of the results of these diagnostic tools. The most advanced technical information on sampling, storage, advantages and limitations of each tool for different types of production operations and animal categories is provided. [ABSTRACT FROM AUTHOR]

Inappropriate prescription of proton pump inhibitors (PPI) has been widely reported, often lacking initial exclusion of Helicobacter pylori (HP) infection and evaluation of gastric functional status. The aim of this study was to evaluate the utility of gastric functional tests to define the acid output, as well as HP status, in order to better direct PPI therapy prescription. Dyspeptic patients without alarm symptoms from a primary care population were evaluated. For each patient, serum Pepsinogen I (PGI) and II (PGII), gastrin 17 (G17) and anti-HP IgG antibodies (Biohit, Oyj, Finland) were determined. For each subject, data were collected regarding symptoms, past medical history of HP infection, and PPI use. Therapeutic response to PPIs was determined according to PGI and G17 values, where G17 > 7 in the presence of elevated PGI and absence of chronic atrophic gastritis (CAG) was considered an adequate response. Among 2583 dyspeptic patients, 1015/2583 (39.3%) were on PPI therapy for at least 3 months before serum sampling, and were therefore included in the study. Active HP infection and CAG were diagnosed in 206 (20.2%) and 37 (3.6%) patients, respectively. Overall, an adequate therapeutic response to PPIs was observed in 34.9%, reaching 66.7% at the highest dose. However, 41.1% and 20.4% of patients showed low (G17 1-7) or absent (G17 < 1) response to PPI, regardless of the dosage used. According to gastric functional response, most patients currently on PPI maintenance therapy lack a proper indication for continuing this medication, either because acid output is absent (as in CAG) or because gastrin levels fail to rise, indicating absence of gastric acid negative feedback. Lastly, HP eradication is warranted in all patients, and gastric function testing ensures this pathogen is sought for and adequately treated prior to initiating long-term PPI therapy. [ABSTRACT FROM AUTHOR]

Type 1 abomasal ulcer (AU1) in cattle and buffaloes does not have specific or characteristic clinical signs, and there is a need to identify some early biochemical markers for diagnosis of AU1. The objective of this study was to study the test performance of serum pepsinogen to distinguish healthy buffaloes from the buffaloes with AU1. Blood samples were collected from buffaloes, slaughtered in a buffalo specific slaughter house. Serum was separated for estimation of pepsinogen. After slaughter abomasa were examined for the presence of AU1 and were confirmed by histology. The AU1 were categorized into four subtypes, viz., AU1a, AU1b, AU1c, and AU1d. Buffaloes with AU1 had higher (p < 0.05) mean serum pepsinogen concentration than ulcer negative buffaloes. Among subtypes, AU1b and AU1c had higher (p < 0.05) pepsinogen concentration than other subtypes and ulcer negative buffaloes. The number of ulcers had a positive correlation with the serum pepsinogen concentration, both on overall basis and for each subtype of AU1. As per ROC curve analysis, the optimal value of serum pepsinogen for diagnosis of AU1 was > 3.08 U/L. The values of sensitivity, specificity, positive predictive value, and negative predictive values suggest that serum pepsinogen could be a valid test for the detection of AU1 in buffalo. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Tegoprazan is a novel potassium‐competitive acid blocker used to treat acid‐related disorders. Aim: To compare tegoprazan 25 mg with lansoprazole 15 mg as maintenance therapy in healed erosive oesophagitis (EE) Methods: In this phase 3, double‐blind, multi‐centre study, patients with endoscopically confirmed healed EE were randomised 1:1 to receive tegoprazan 25 mg or lansoprazole 15 mg once daily for up to 24 weeks. The primary efficacy endpoint was the endoscopic remission rate after 24 weeks. The secondary efficacy endpoint was the endoscopic remission rate after 12 weeks. Safety endpoints included adverse events, clinical laboratory results and serum gastrin and pepsinogen I/II levels. Results: We randomised patients to tegoprazan 25 mg (n = 174) or lansoprazole 15 mg (n = 177). Most had mild EE (Los Angeles (LA) grade A: 57.3%, LA grade B: 37.3%). The endoscopic remission rate after 24 weeks was 90.6% with tegoprazan and 89.5% with lansoprazole. Tegoprazan was not inferior to lansoprazole for maintaining endoscopic remission at 24 weeks and 12 weeks. In subgroup analysis, tegoprazan 25 mg showed no significant difference in maintenance rate according to LA grade (p = 0.47). The maintenance effect of tegoprazan was consistent in CYP2C19 extensive metabolisers (p = 0.76). Increases in serum gastrin were not higher in tegoprazan‐treated than lansoprazole‐treated patients. Conclusions: Tegoprazan 25 mg was non‐inferior to lansoprazole 15 mg in maintenance of healing of mild EE. In this study, tegoprazan had a similar safety profile to lansoprazole. [ABSTRACT FROM AUTHOR]

Currently, gastric pre-neoplastic lesions (glandular atrophy, intestinal metaplasia, dysplasia) can only be detected during an upper GI endoscopy. Depending on their extent and severity, follow-up is proposed in order to detect the appearance of gastric adenocarcinoma as early as possible. When there is no indication for endoscopy, pre-neoplastic lesions may be present and evolve silently. In countries with a low risk of gastric cancer such as France, where there is no systematic endoscopic screening, patients not at high risk of gastric adenocarcinoma in whom pre-neoplastic lesions exist therefore have a loss of chance with a risk of developing gastric adenocarcinoma at a symptomatic stage, with a poor prognosis. Several serum biomarkers of pre-neoplastic lesions have been proposed, deriving from the histological characteristics of these lesions. The TFF3 peptide is a biomarker of intestinal metaplasia, and the pepsinogen I/II ratio of glandular atrophy. The place of these biomarkers in a national screening strategy remains to be clarified. [ABSTRACT FROM AUTHOR]

Educational Objective: At the conclusion of this presentation, participants should better understand the carcinogenic potential of pepsin and proton pump expression in Barrett's esophagus. Objective: Barrett's esophagus (BE) is a well‐known risk factor for esophageal adenocarcinoma (EAC). Gastric H+/K+ ATPase proton pump and pepsin expression has been demonstrated in some cases of BE; however, the contribution of local pepsin and proton pump expression to carcinogenesis is unknown. In this study, RNA sequencing was used to examine global transcriptomic changes in a BE cell line ectopically expressing pepsinogen and/or gastric H+/K+ ATPase proton pumps. Study Design: In vitro translational. Methods: BAR‐T, a human BE cell line devoid of expression of pepsinogen or proton pumps, was transduced by lentivirus‐encoding pepsinogen (PGA5) and/or gastric proton pump subunits (ATP4A, ATP4B). Changes relative to the parental line were assessed by RNA sequencing. Results: Top canonical pathways associated with protein‐coding genes differentially expressed in pepsinogen and/or proton pump expressing BAR‐T cells included those involved in the tumor microenvironment and epithelial–mesenchymal transition. Top upstream regulators of coding transcripts included TGFB1 and ERBB2, which are associated with the pathogenesis and prognosis of BE and EAC. Top upstream regulators of noncoding transcripts included p300‐CBP, I‐BET‐151, and CD93, which have previously described associations with EAC or carcinogenesis. The top associated disease of both coding and noncoding transcripts was cancer. Conclusions: These data support the carcinogenic potential of pepsin and proton pump expression in BE and reveal molecular pathways affected by their expression. Further study is warranted to investigate the role of these pathways in carcinogenesis associated with BE. Level of Evidence: NA Laryngoscope, 133:59–69, 2023 [ABSTRACT FROM AUTHOR]

Atrophic gastritis, intestinal metaplasia and dysplasia of the gastric mucosa are major risk factors for the development of an intestinal type of gastric cancer. The selection of patients with such lesions could help with early detection and improve better the prognosis. Esophagogastroscopy is the "gold standard" in detecting gastric cancer and precancerous lesions of the stomach. However, this examination is invasive, expensive, and cannot serve as a screening method. Measurement of serum levels of pessinogen I and pessinogen II is used in high-risk populations in Europe and Asia as a non-invasive marker for the diagnosis of chronic atrophic gastritis. A serum pepsinogen I level ≤ 70ng/ml and pepsinogen I/pepsinogen II ratio ≤ 3 are accepted in many countries as values that most accurately identify patients with advanced atrophic gastritis. On the other hand, the differences in the analytical methods used to determine the level of pepsinogens make the interpretation of results and diagnostic validation difficult.

Abstract Background The aims of the present study are to evaluate non-invasive screening tests for autoimmune gastritis (AIG) and re-evaluate histopathological classification. Methods We screened candidates of AIG in JCHO Shiga Hospital between May 2012 and January 2020. The screening criteria were as follows: endoscopic O-p atrophy with Updated Kimura–Takemoto classification, 3 + pepsinogen (PG) test, low serum vitamin B12 or elevated serum gastrin with positive anti-parietal cell (PC) or intrinsic factor antibodies. We evaluated the screening criteria in the patients who were histopathologically confirmed as AIG, and re-evaluated histopathological staging in clinical aspects. Results Twenty-two of 28 (78.6%) patients who met the screening criteria were histopathologically confirmed as AIG. Common clinical findings in the AIG patients were 10 × or greater anti-PC antibody, elevated serum gastrin greater than 172 pg/mL and endoscopic atrophy O-1 or greater. The areas under the curve of PG I, PG II and PG I/II ratio were 0.81, 0.29 and 0.98, respectively. Among histopathologically confirmed AIG patients, 4 and 18 patients were histopathologically classified into florid and end stages, respectively, while no patients into early stage. We could not find a significant difference between florid and end stages in the screening items studied. Conclusions Florid and end stages in histopathological classification are both advanced-stage AIG in clinical aspects. Our screening criteria without biopsy are applicable to screen clinically-advanced AIG with 78.6% positive predictive value. PG I and PG I/II ratio may be useful to screen AIG. However, we may need other criteria to screen early stage of AIG.

To observe the effects of Xingpi Yanger granule combine with domperidone on serum gastrointestinal hormones, pepsinogen and inflammatory factors in children with functional dyspepsia (FD). 97 children with FD who were treated in our hospital from January 2019 to December 2021 were selected, they were randomly divided into control group and study group, the number of cases were 48 and 49 respectively. The children in the control group were treated with domperidone, the children in the study group were treated with Xingpi Yanger granule combined with domperidone. The efficacy, clinical symptom relief, serum gastrointestinal hormones, pepsinogen, inflammatory factors and adverse reactions were compared between the two groups. The total clinical effective rate of the study group (91.84% ) was higher than that of the control group (75.00% ), and the difference was statistically significant (P<0.05). The relief time of abdominal distension, nausea and vomiting, abdominal pain and anorexia in the study group were shorter than those in the control group (P<0.05). 14 d after treatment, the levels of gastrin (GAS), motilin (MTL), pepsinogen I (PGI) and pepsinogen II (PGII) in the study group were higher than those in the control group (P<0.05). 14 d after treatment, the levels of interleukin-10 (IL-10), tumor necrosis factor-α(TNF-α), somatostatin (SS), interleukin-6 (IL-6) and c-reactive protein (CRP) in the study group were lower than those in the control group (P<0.05). There was no difference in the incidence of adverse reactions between the two groups (P>0.05). Xingpi Yanger granule combine with domperidone in the treatment of FD children can promote the improvement of symptoms and improve the total clinical effective rate, which may be related to the effective regulation of serum gastrointestinal hormone, pepsinogen and inflammatory factor levels. [ABSTRACT FROM AUTHOR]

Background /Aims: The serum pepsinogen (PG) assay is used to screen subjects at high risk for gastric cancer. Currently, there are few studies on the PG levels for the detection of Helicobacter pylori infection. This study aimed to determine the PG assay findings for detecting ongoing infection. Methods: Asymptomatic subjects who underwent a 13C-urea breath test (13C-UBT) on the day of gastroscopy and serum assay for cancer screening were included. Subjects with a recent intake of acid suppressants or antibiotics, gastrectomy, or renal failure were excluded. H. pylori infection was defined as a positive 13C-UBT result. Results: Among the 500 included subjects, 167 (33.4%) had current infection. The serum PG II levels of > 12.95 ng/mL (area under the curve [AUC] = 0.930, sensitivity 86.5%, specificity 90.7%) and PG I/II ratios of < 4.35 (AUC = 0.875, sensitivity 86.8%, specificity 79.6%) were related to infection. The PG I/II ratios were inversely correlated with age (r = -0.160, p = 0.039). The cutoff values of PG I/II ratios were lower in older subjects aged ≥ 50 years (< 4.05; AUC = 0.875, sensitivity 80.7%, specificity 88.2%) than in younger subjects aged < 50 years (< 4.35; AUC = 0.873, sensitivity 77.4%, specificity 88.9%). Conclusions: Serum PG II levels > 12.95 ng/mL and PG I/II ratios < 4.35 suggest ongoing infection in asymptomatic subjects; therefore, H. pylori confirmation tests (i.e., 13C-UBT) should be considered under these conditions. Stricter criteria are required in older subjects aged ≥ 50 years (PG I/II ratio < 4.05) to detect ongoing infection than younger subjects. [ABSTRACT FROM AUTHOR]

The feasibility of using nanomotors as active probes for lateral flow immunoassay (LFIA) is demonstrated. We synthesized Au@mSiO2@Pt Janus nanomotor, where nanolayer of Pt was deposited on the half side surface of the Au@mSiO2 nanoparticles, which can catalyze the decomposition of H2O2 to produce driving force for the nanomotor. Subsequently, the motion characteristics of the Au@mSiO2@Pt nanomotor in static fluidic environment and dynamic flow field was studied to pave the way for its practical application in lateral flow immunoassay (LFIA). At last, the Au@mSiO2@Pt nanomotor was modified with antibody and then used as active immunoassay probe in LFIA. We chose gastric function index, pepsinogen II (PG II) and pepsinogen II (PG II), as the target analytes. The results indicated that, compared with traditional Au nanoprobe, the nanomotor-based probe can significantly improve the sensitivity by increasing the probability and efficiency of antigen and antibody binding. A limit of detection (LOD) of 2.2 ng/mL for PGI, and 2.1 ng/mL for PG II was achieved. This work provides a new solution for enhancing the capability of immune detection, and we believe the nanomotor-based LFIA will have great potential in high-sensitivity point-of-care-testing in the future. [ABSTRACT FROM AUTHOR]

The aims of the present study was to determine whether or not abomasal damages occurs in calves with abdominal distention using by plasma pepsinogen levels and the positivity of the fecal occult blood test (FOBT). In the study, 30 calves with abdominal distention (experimental group) and 15 clinically healthy calves (control group), aged between 1-90 days, were used. Plasma samples were used to determine plasma pepsinogen levels, using bovine specific ELISA. Fresh stool samples used to determine occult blood in the samples. Melena and occult blood were detected in 11 and 19 of the stool samples, respectively. The plasma pepsinogen levels of calves with abdominal distention (18.06±7.78 ng/ml) were significatly high compared to those of control group (6.70±2.08 ng/ml), (p<0.001). In addition, plasma pepsinogen levels were higher in melena (+) animals than both FOBT (+) animals and control animals (p<0.001). It is suggestive that plasma pepsinogen levels could be used to determine abomasal damage in calves, especially with abdominal distention. It can be also useful biomarker to determine the severity of abomasal damage in calves. [ABSTRACT FROM AUTHOR]

The severity of atrophic gastritis is significantly associated with the risk of gastric cancer. Although the current gold standard for assessing the gastric cancer risk is esophagogastroduodenoscopy with a pathological examination, the development of less-invasive biomarkers is warranted for efficient risk stratification of gastric cancer. Serum pepsinogens (PGs) are biomarkers used to predict the extent of gastric mucosal atrophy; however, they are not an accurate reflection of gastric mucosal atrophy after Helicobacter pylori eradication. The present study was conducted to investigate the usefulness of plasma ghrelin levels as a marker for gastric mucosal atrophy, and as a risk stratification marker for gastric cancer, even after H. pylori eradication. Patients who received H. pylori eradication treatment were enrolled in the study. The severity of gastric mucosal atrophy was evaluated both endoscopically and histologically. Serum pepsinogen and plasma ghrelin levels were measured before and at 1, 12, 24, and 48 weeks after treatment. The study was approved by the Research Ethics Committee of the Keio University School of Medicine (no. 20140102; 8 July 2014). Eighteen patients completed the study protocol. Total and acyl plasma ghrelin levels demonstrated no significant change from before treatment to 48 weeks after eradication; however, there was a significant difference between open-type and closed-type atrophic gastritis. The PG I/II ratio increased significantly from 48 weeks after H. pylori eradication. The severity of the histological intestinal metaplasia scores correlated inversely with plasma total ghrelin levels from before to 48 weeks after H. pylori eradication. Plasma levels of ghrelin correlate well with the level of gastric mucosal atrophy, even after H. pylori eradication. Ghrelin plasma levels are associated with the progression of endoscopic atrophic gastritis, even at 48 weeks after H. pylori eradication. Ghrelin plasma levels are also associated with increased severity of histological intestinal metaplasia 48 weeks after H. pylori eradication. Pepsinogen I/II ratios increased immediately after H. pylori eradication and are inappropriate for assessing atrophic gastritis after H. pylori eradication. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the association between Helicobacter pylori infection and variceal bleeding as well as rebleeding in cases of cirrhosis with portal hypertension. Methods: This prospective cohort study included patients with bleeding oesophageal varices and was conducted at the Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, from August 2016 to July 2018. Results: A total of 190 patients were assessed for eligibility, of which 159 patients were included in this study. Among the 159 patients, 124 (78.0%) had alcohol-related liver disease and eight had hepatitis B virus-related liver disease. Seven patients with varices had bled neither at presentation nor during the follow-up period. A total of 78 (49.1%) patients were H. pylori infected. The primary outcome, which was correlation between prevalence of H. pylori and the incidence of bleeding/rebleeding from varices as well as encephalopathy found that patients with oesophageal varices (adjusted risk [AR] = 0.714) and H. pylori infection (AR = 0.682) had a lower risk of variceal rebleeding. Among H. pylori-negative patients, pepsinogen I was higher in patients with rebleeding (30.7 versus 14.4 ng/mL; P <0.001). The secondary outcome, which was correlation of the site of bleeding with H. pylori infection and the association of the ratio of pepsinogen I/II with bleeding showed that among H. pylori-positive patients, the ratio of pepsinogen I/II was higher in patients with rebleeding (2.9 versus 1.3 ng/mL; P = 0.023). Conclusion: H. pylori infection was associated with a lower risk of rebleeding in cases of cirrhosis with portal hypertension. Irrespective of the status of the H. pylori infection, rebleeding was associated with increased levels of gastric acid output, as demonstrated by the level of pepsinogen. [ABSTRACT FROM AUTHOR]

The presence of autoimmune metaplastic atrophic gastritis (AMAG) may lead to an increased risk of associated gastric neoplastic lesions. This study aims to investigate the prevalence of gastric neoplasia in AMAG patients and to explore the possibility of PGI/II ratio as a predictor for AMAG diagnosis. Retrospective audit of 135 patients diagnosed with AMAG on endoscopic gastric biopsy between January 2017 and December 2020 at Beijing Friendship Hospital. The study was registered in Chinese Clinical Trial Registry (ChiCTR2000041163). A total of 135 patients (the mean age 61.9 ± 10.9 years,109 female) had histologically confirmed AMAG. 31.1% (42/135) had AMAG without neoplasia on the initial biopsy; 37% (50/135) had multiple type 1 gastric neuroendocrine tumors (g-NETs), 36 grade 1 and 14 grade 2, the median diameter was 5 mm (range 1–25); 31.9% (43/135) had multiple gastric hyperplastic polyps (GHPs), including 15 cases of GHPs with neoplastic transformation, the median diameter was 14.5 mm (range 3–50). 3.7% (5/135) had single gastric low-grade dysplasia/adenoma, the median diameter was 5 mm (range 3–15). 5.9% (8/135) had single or double gastric high-grade dysplasia or adenocarcinoma, the median diameter was 15 mm (range 8–43). 40.7% (55/135) had pepsinogen (PG) I< 10 ng/ml, 45.9% (62/135) had PG I/II ratio ≤1 and each group had a median of PG I/II ratio <1. Lower serum PG I level and PGI/II ratio may be a predictor to indicate the diagnosis of AMAG. It's necessary to perform regular endoscopic surveillance for AMAG patients to recognize associated gastric neoplasia timely. [ABSTRACT FROM AUTHOR]

Objective: To analyze the influencing factors of Helicobacter pylori infection (Hp)in healthy people and its effects on glucose and lipid metabolism and serum pepsinogenⅠ (PGⅠ), pepsinogenⅡ (PGⅡ)and gastrin-17 (G-17). Methods: 120 physical examination personnel who underwent Hp examination in our hospital from January 2017 to December 2019 were selected for questionnaire survey, the Hp infection of physical examination personnel was analyzed, and the influencing factors of Hp infection in physical examination population were analyzed by multivariate logistic regression. The patients were divided into Hp positive group and Hp negative group. The blood glucose indexes, blood lipid indexes and the levels of serum PG Ⅰ, PG Ⅱ and G-17 indexes were compared between the two groups. Results: There were 49 Hp patients in 117 physical examination personnel, and the infection rate was 41.88%, of which the male infection rate was 50.85%, which was significantly higher than the female infection rate of 32.76% (x2=10.537, P=0.001). Multivariate logistic regression analysis showed that drinking alcohol, often drinking raw water, often eating out, often eating spicy food and family history of Hp infection were the risk factors of Hp infection in the physical examination population (P<0.05). The levels of fasting blood glucose (FPG), triglyceride (TG), total cholesterol (TC) and low density lipoprotein (LDL-C) in Hp positive group were higher than those in Hp positive group, while the level of high density lipoprotein (HDL-C)was lower than that in Hp negative group (P<0.05). The levels of PG Ⅰ, PG Ⅱ and G-17 in Hp positive group were higher than those in Hp negative group (P<0.05). Conclusion: Drinking alcohol, often drinking raw water, often eating out, often eating spicy food and family history of Hp infection are the risk factors of Hp infection in physical examination population. The changes of glucose and lipid metabolism and serum PG Ⅰ, PG Ⅱ, G-17 levels are related to Hp infection. [ABSTRACT FROM AUTHOR]

Objective: To analyze the influencing factors of Helicobacter pylori (Hp) infection in health physical examination population, and to further explore the relationship between Hp infection and pepsinogen (PG) and carotid atherosclerosis (CAS) in health physical examination population. Methods: 146 healthy physical examination persons who underwent Hp screening in our hospital from March 2021 to March 2022 were selected, and they were divided into HP-positive group (n=62) and HP-negative group (n=84) according to the results of carbon 13 urea breath test. Univariate and multivariate Logistic regression were used to analyze the influencing factors of HP infection in healthy physical examination population. The serum PG Ⅰ, PG Ⅱ, PGⅠ/PGⅡ levels and the CAS proportion were compared between the two groups. Spearman correlation coefficient was used to analyze the correlation between DOB value of HP-positive group and serum PG Ⅰ, PG Ⅱ, PGⅠ/PGⅡ and carotid intima-media thickness (CIMT). Results: Univariate analysis showed that, compared with the HP-negative group, the HP-positive group was older, had higher proportion family history of Hp infection, smoking, drinking, food tastes spicy, frequent intake salted food, shared tableware, had lower proportion frequent drank teas and frequent intake of fruits/vegetables (all P＜0.05). Multivariate Logistic regression analysis showed that increasing age, family history of Hp infection, smoking, food tastes spicy, frequent intake salted food and shared tableware were independent risk factors for Hp infection in health physical examination population, and frequent drank teas and frequent intake of fruits/vegetables were independent protective factors (all P＜0.05). Serum PGⅠ and PGⅡ levels and CAS proportion in Hp-positive group were higher than those in Hp-negative group, while PGⅠ/PGⅡ was lower than that in Hp-negative group (all P＜0.05). Spearman correlation coefficient showed that DOB value in Hp-positive group was positively correlated with PGⅠ, PGⅡ and CIMT, but negatively correlated with PGⅠ/PGⅡ. Conclusion: Increasing age, family history of HP infection, smoking, food tastes spicy, frequent intake salted food and shared tableware are the risk factors for HP infection in healthy physical examination population, while frequent drank teas and frequent intake of fruits/vegetables are the protective factors for HP infection in healthy physical examination population. HP infection is closely related to changes in serum PG level and CAS. [ABSTRACT FROM AUTHOR]