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Serum PGII and G-17 levels rise, while the PGI/PGII ratio falls with increasing severity of chronic atrophic gastritis, showing potential for identifying moderate-to-severe cases, especially in H. pylori-positive cases.
A new study led by Tianyi Zhang et al. highlights the potential of simple blood-based biomarkers—pepsinogen (PG) and gastrin-17 (G-17)—to aid in the early detection of chronic atrophic gastritis (CAG), particularly in its more advanced stages, offering a non-invasive adjunct to traditional endoscopic methods.
Researchers evaluated 300 individuals, all of whom underwent both gastroscopy with biopsy and serum testing for PGI, PGII, G-17, and Helicobacter pylori (H. pylori) infection. Volunteers were classified into 3 groups based on gastric biopsy results: non-atrophic gastritis (NAG, n=179), mild atrophic gastritis (MAG, n=62), and moderate-to-severe atrophic gastritis (MSAG, n=59).
The results revealed that, within the same pathological groups, PGII levels were markedly higher and the pepsinogen I/pepsinogen II (PGI/PGII) ratio was lower among H. pylori-positive individuals. Moreover, as the severity of mucosal damage heightened, serum PGII and G-17 levels rose, while PGR declined, indicating a strong correlation between these markers and disease progression. The combination of PGI, PGII, PGR, and G-17 exhibited moderate diagnostic performance for identifying CAG, with an area under the curve (AUC) of 0.723, sensitivity of 65.29%, and specificity of 73.18%.
Diagnostic accuracy improved in progressive CAG (stages II–IV of the OLGA system), where the AUC reached 0.759, with a sensitivity of 66.10% and specificity of 83.40%. Notably, in H. pylori-positive individuals, PGII alone exhibited a higher AUC than the combined marker panel for detecting CAG across all stages. For MSAG, PGII alone attained an AUC of 0.707, slightly surpassing the combined test performance. However, the ability of these serum markers to detect mild atrophic gastritis was limited.
In conclusion, serum PG and G-17 levels show promise as non-invasive indicators for detecting CAG, especially in its more advanced forms and in the presence of H. pylori infection. While they may serve as useful adjuncts to endoscopic examination, their diagnostic value for early-stage disease remains modest. The findings call for further large-scale, multi-center studies to substantiate their clinical utility.
BMC Gastroenterology
The potential value of serum pepsinogen and gastrin-17 for the diagnosis of chronic atrophic gastritis at different stages of severity: a clinical diagnostic study
Tianyi Zhang et al.
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