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Background  The aim of this study is to assess the validity of the measurement of pepsinogen as a screening test for chronic atrophic gastritis (AG) in health check-up populations in China.    Methods  Patients from consecutive regular health check-up were enrolled from January 2014 to June 2015. Endoscopy, combined with monitoring the  Helicobacter pylori  ( Hp ) infections, and measuring the serum pepsinogen (PG) were used to determine the diagnostic accuracy of PG for the screening of atrophic gastritis. Histopathology was assessed by the Operative Link on Gastritis Assessment (OLGA) system. Statistical analysis was performed using SPSS statistical software.    Results  The total  Hp  infection rate was 40%. Based on pathology, the 996 participants were divided into three groups: non-atrophic (NAG), mild-moderate atrophic (MAG): stage I and II of the OLGA classification, and severe atrophic (SAG): stage III and IV of the OLGA classification. Compared with NAG and MAG groups, PGR decreased significantly in SAG group ( p  < 0.05). PGI and PGII levels were significantly elevated in  Hp -positive group, while the PGR was markedly decreased ( p  < 0.01). When MAG and SAG groups were combined and compared with NAG group, the best cutoff value for atrophy diagnosis was PGI ≤50.3 ng/ml; the cutoff value in  Hp -negative group was absolutely higher than in  Hp -positive group. When NAG and MAG groups were combined and compared with the SAG group, the best cutoff value for diagnosis of severe atrophy was at PGR ≤4.28. The cutoff values in  Hp -negative and  Hp -positive groups were calculated at PGR ≤6.28 and ≤4.28, respectively.    Conclusions  Pepsinogens play an important role in the identification of patients with atrophic gastritis and severe AG. Use of different cutoff values of PG for  Hp -negative and  Hp -positive groups may offer greater efficacy in the diagnosis of AG.    Electronic supplementary material  The online version of this article (doi:10.1186/s12876-017-0641-6) contains supplementary material, which is available to authorized users.

bmc gastroenterology

The potential value of serum pepsinogen for the diagnosis of atrophic gastritis among the health check-up populations in China: a diagnostic clinical research