Pepsinogen ratio as biomarker to confirm H pylori eradication

  • PLoS One

  • Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • An increase in the ratio of 2 pepsinogen (PG) isozymes measured in serum (PG I divided by PG II) confirms Helicobacter pylori infection eradication with high validity.
  • Performance is comparable to urea breath test and stool antigen test.

Why this matters

  • H pylori infection leads to lower PG I/II ratio.
  • Confirming H pylori eradication using an increased ratio would be convenient and cost-effective.

Key results

  • After treatment, in the eradication success group (n=433) vs the failure group (n=129):

             —PG I: 33.6 vs 54.2 ng/dL (P<.05>             —PG II: 7.5 vs 23.3 ng/dL (P<.05 and>             —PG I/II ratio: 4.5 vs 2.5 (P<.05>

  • Percentage change in PG I/II ratios posttreatment compared with pretreatment in the success group vs the failure group: 108.2 vs 6.8 (P<.05>
  • Using those values as cutoffs, sensitivity and specificity for H pylori detection were 93.1% and 93.8%, respectively.

Study design

  • Retrospective study of 562 patients undergoing eradication of H pylori infection.
  • Serum PG I/II ratio was measured and compared before and after treatment.
  • Gold-standard urea breath test was performed 3 mo after treatment.
  • Outcomes were percentage changes in serum PG I/II ratios before and 3 mo after treatment.
  • Funding: None.

Limitations

  • Small retrospective study.
  • Optimum cutoffs unclear.