Correlation of ratio of serum pepsinogen I and II with prevalence of gastric cancer and adenoma in Japanese subjects

Objective: Gastric cancer (GC) and adenoma (GA) are reported to be related to atrophic gastritis, in which the serum pepsinogen (PG) I level and the PGI/PGII ratio (I/II ratio) are reduced. To verify that the finding of a low PG level increases the risk for GC and GA, we investigated the correlation between low PG levels and the prevalence of GC and GA in individuals.
Methods: The 2,039 subjects (734 Japanese men, mean age 68.5 yr, and 1,305 women, mean age 66.7 yr), selected from among 10,996 local residents who underwent health check-ups based on reductions in their serum PG levels, underwent upper gastrointestinal endoscopy.
Results: Gastrointestinal endoscopy detected 21 GCs and 15 GAs. The prevalence of GC was higher than that in the residents without low serum PG. The percentage of early stage of GC (90%) was significantly higher than that of GC detected in unscreened residents (56.9%). The prevalence of GC in men was closely and significantly correlated with the I/II ratio (  r = 0.935  ,   p = 0.0063  ), whereas there was less correlation with age (  r = 0.842  ,   p = 0.0734  ). The prevalence of GA was also closely and significantly correlated with the I/II ratio in men (  r = 0.881  ,   p = 0.0203  ), but not with age (  r = 0.163  ,   p = 0.7928  ). In women the prevalence of GC (r 5 0.744,   p = 0.090  ) and GA (  r = 0.678  ,   p = 0.1392  ) did not correlate as strongly with the I/II ratio, although the highest prevalence was seen in the group with the lowest I/II ratio.
Conclusion: Our study verified that a low I/II ratio signifies a high risk for GC and GA and that measuring serum PG levels can be used as a screening method for GC and GA.