Comparison of serum pepsinogen i and ii and gastrin 17 level in patients more than 50 years with dyspepsia who have precancerous gastric lesions
Introduction: Serum screening systems are useful in monitoring gastric cancer. The present research studied and compared serum levels of pepsinogens, gastrin-17, and Helicobacter pylori antibodies in patients with dyspepsia and precancerous lesions by focusing on gastric pathology.
Materials and methods: In this cross-sectional study, patients with dyspepsia symptoms from whom gastric biopsy samples were taken during endoscopy entered the present study. The biopsy samples were examined using a rapid urease test (RUT) and histopathology study. Patients with precancerous lesions were considered the case group (40 individuals) and patients with chronic gastritis the control group (88 individuals). Serum pepsinogen I, pepsinogen II, gastrin-17, anti-Helicobacter pylori antibodies, and the gene related to vacuolatingcytotoxinA(vacA) were measured at a private laboratory in Rasht. The information was analyzed by using SPSS 16 and through employing the t-test and the chisquare test.
Results: This study included 120 patients with chronic non-atrophic gastritis, 39 with metaplasia, 5 with dysplasia, and 6 with neoplasia. No cases of atrophic gastritis were observed. The percentages of patients with pepsinogen I levels lower than normal and without metaplasia (75.9%) or neoplasia (96.6%) were significantly higher than those with metaplasia (24.1%) or neoplasia (3.4%). When the three groups of patients with metaplasia, dysplasia, and atrophic gastritis were combined to form a new group (the precancerous group), there were significant differences between the case and control groups with respect to levels of pepsinogen I and pepsinogen I/ pepsinogen II ratios (p<0.05). The frequencies of patients with lower than normal pepsinogen I levels and pepsinogen I/ pepsinogen II ratios in the precancerous group (15 and 20 percent, respectively) were higher than those in the chronic gastritis group (1.1 and 5.7 percent, respectively) (p<0.05). The mean pepsinogen I levels and pepsinogen I/ pepsinogen II ratio in the precancerous group (99.57 and 5.89μg/l, respectively) were smaller compared to those in the chronic gastritis group (100.24 and 8.77 μg/l) (p<0.05). No significant differences were observed between the groups with respect to pepsinogen II, gastrin-17, or levels of anti- Helicobacter pylori antibodies.
Conclusions: Results showed that low pepsinogen I levels and small pepsinogen I to pepsinogen II ratios were useful markers for identifying precancerous lesions. It is recommended that more research with larger sample volumes be carried out to determine the sensitivity and specificity of this test and the possible cutoff values of the mentioned markers.
Keywords: Pepsinogen, precancerous lesions, gastrin-17