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Early Warning Indicator of Gastric Cancer: Pepsinogen (PG)

1. Serum PG testing reagent for atrophic gastritis and gastric cancer


Gastric cancer is one of the most common malignant tumors, and its mortality rate ranks second among malignant tumors in Asian countries including China, Japan and South Korea.


The use of serum pepsinogen diagnostic kits for early diagnosis of gastric cancer and preventive intervention programs for gastric cancer have been implemented in Japan, Finland, Norway and other countries.


Japan has launched the "Japan Gastric Cancer Detection Plan" under the guidance of the "Elderly Health Care Act", and the use of PGI and PGII in a large-scale population census has increased the early diagnosis rate of gastric cancer to 90%.


More than 80% of gastric cancers are accompanied by atrophic gastritis, and atrophic gastritis can lead to a decrease in the chief cells of the gastric mucosa, and the serum PGI concentration decreases while the PGII testing reagent remains unchanged.


Therefore, low concentrations of PGI or low PGI/II ratio, or both, are good indicators of atrophic gastritis-precancerous gastric mucosal damage.


Serum PGI and PGII levels in patients with recurrence of gastric cancer after total gastrectomy were significantly higher than those in patients without recurrence. The study pointed out that the dynamic observation of the changes of PGI and PGII after total gastrectomy can be used as a valuable clinical indicator for judging the recurrence of gastric cancer after surgery.


2. Serum PG testing reagent and Helicobacter pylori infection


H pylori infection is closely related to the occurrence and development of various gastric benign and malignant diseases. H pylori eradication therapy can significantly improve acute and chronic gastritis, reduce the recurrence of peptic ulcer, cure low-grade malignant lesions, and possibly stop gastric cancer.


The increase of PGII testing reagent can be used as an auxiliary diagnostic indicator for progressive H pylori infection and an indirect indicator for H pylori infection activity.


Successful eradication of H pylori can improve inflammatory cell infiltration, significantly improve chronic inflammation of gastric mucosa, restore gastric secretion function, and then affect serum PG levels.


3. Serum PG testing reagent and other gastric diseases


PG is an indicator of the state of the gastric mucosa and is more sensitive to gastric mucosal damage. Generally speaking, when the PGI is higher than the normal value, the possibility of peptic ulcer is higher; However, when the PGI and PGI/PGII ratio were lower than normal value, the specificity was higher for chronic atrophic gastritis.


With the development of gastric disease, the PGI testing reagent in serum first increases and then decreases, and PGII increases and then maintains a high level, so the abnormality of PGI, PGII, and PGI/PGII ratio will indicate different gastric diseases, so PG is superficial gastritis. , erosive gastritis, gastric ulcer, duodenal ulcer, atrophic gastritis, gastric cancer and other gastric diseases preliminary screening indicators and treatment monitoring indicators.


4. Reference value and influencing factors of pepsinogen testing reagent


The reference value of PG in the normal population is PGI (70-240 ng/ml); PGII (0-20 ng/ml); PGI/PGII>3. Gastric acid secretion had a greater impact on PG, especially when Helicobacter pylori was positive, PGI level and PGI/PGII ratio were significantly correlated with gastric acid secretion, and the ratio was more strongly correlated.


Non-invasive, gastric mucosa "serological biopsy"-serum PG diagnostic kit is of great significance for the diagnosis of atrophic gastritis, the detection of postoperative recurrence and metastasis of gastric cancer, the identification of benign and malignant ulcers, and the identification of gastric acid secretion.

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