Combining the serum pepsinogen level and H elicobacter pylori antibody test for predicting the histology of gastric neoplasm

Objective To determine whether the combination test of serum pepsinogen ( PG ) levels and H elicobacter pylori ( H. pylori ) antibody was effective for predicting the incidence and histology of gastric neoplasms. Methods This study included asymptomatic K orean adults who underwent esophagogastroduodenoscopy with blood tests for PG levels and H . pylori immunoglobulin G antibody test on the same day. Participants with extragastric malignancy, history of H . pylori eradication or gastric neoplasms, or recent antacid medication were excluded. Gastric atrophy was defined as a serum PG I/II ratio ≤3.0 and PG I ≤70 ng/mL. The participants were classified into four groups according to the presence (+) or absence (−) of gastric atrophy and H . pylori infection.Results Of the 3328 included participants, 17 were incidentally diagnosed as having either gastric adenoma or carcinoma. The incidence of gastric neoplasm was highest in the gastric atrophy (+)/H. pylori (−) group (4.17%; OR 25.8, P  = 0.009), but the neoplasm exhibited the least advanced histology. The gastric atrophy (−)/H. pylori (−) group exhibited the lowest incidence of gastric neoplasm (0.17%) but the most advanced histology.Conclusion A combination of serum PG levels and H . pylori antibody test is useful for detecting gastric neoplasms based on the slow gastric carcinogenesis pathway progressing from gastric adenoma to L auren's intestinal‐type gastric cancer, but not for those with advanced histology such as L auren's diffuse‐type gastric cancer.