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.

Abstract

Background: Pepsinogen (PG) and gastrin-17 (G-17) are crucial in the gastric digestive processes. This study aimed to assess the diagnostic value of the serum PG and G-17 in identifying chronic atrophic gastritis (CAG) at different stages of severity under varying Helicobacter pylori (H. pylori) infection statuses.

Methods: We enrolled 300 participants from August 2023 to May 2024. All participants underwent gastroscopy with biopsy, and blood samples were taken for pepsinogen I (PGI), pepsinogen II (PGII), G-17, and H. pylori tests. The differences in G-17 and PG-related parameters were analyzed across groups, taking H. pylori infection status into account. The diagnostic performance of these markers was then evaluated both individually and in combination to distinguish CAG stages of severity. Statistical analysis was performed using SPSS statistical software.

Results: According to pathological results, patients were divided into the non-atrophic gastritis group (NAG, n = 179), the mild atrophic gastritis group (MAG, n = 62), and the moderate and severe atrophic gastritis group (MSAG, n = 59). In the same pathological groups (NAG, MAG, and MSAG), PGII levels were higher in the H. pylori-positive subgroup, while the PGI/PGII ratio (PGR) was lower (p < 0.05). Serum PGII and G-17 levels increased with the pathological severity of the mucosa (p < 0.001, r = 0.364 and p < 0.001, r = 0.304, respectively), while PGR levels decreased with mucosal deterioration (p < 0.001, r = -0.407). Combination of PGI, PGII, PGR, and G-17 showed an area under the curve (AUC) of 0.723 (95% CI: 0.662-0.784), with a sensitivity of 65.29% and a specificity of 73.18% for detecting the presence of any CAG. For progressive CAG, which was defined by MSAG and classified into stages II-IV according to the Operative Link on Gastritis Assessment (OLGA) system, the AUC was 0.759 (95% CI: 0.683-0.836), with a sensitivity of 66.10% and a specificity of 83.40%, demonstrating the potential for even higher diagnostic ability. Among all the H. pylori-positive cohorts, PGII exhibited a higher AUC compared to the combined diagnostic approach using PGI, PGII, PGR, and G-17 (CAG: 0.656 vs. 0.654, MAG: 0.589 vs. 0.571, MSAG: 0.707 vs. 0.706, respectively).

Conclusion: Serum PG and G-17 show potential in identifying CAG and MSAG. However, their diagnostic accuracy for MAG remains limited and would be better used as adjunctive indicators in conjunction with endoscopic examination. Further validation in larger, multi-center studies is needed to assess their utility in clinical practice.