Introduction:
Pepsinogen consists of a single polypeptide chain of 375 amino acids with an average molecular weight of 42 kDa.
Pepsinogen I is synthesized at gastric chief cells and mucous neck cells, while pepsinogen II is produced not only by gastric chief cells, mucous neck cells, but also by clear mucous cells of antrum. The clinical applications of measuring serum pepsinogen I and pepsinogen II levels are of useful aid in diagnosing severe atrophic gastritis, stomach cancer and duodenal ulcer. It was suggested that the measurement of serum pepsinogens served as a “serological biopsy” for predicting the presence of atrophic gastritis or superficial gastritis.

Clinical Applications:
Atrophic Gastritis: It was found that a serum pepsinogen I level failed to less than 20 ng/ml was highly specific for
severe atrophic gastritis. It is observed that serum pepsinogen I levels fell with increasing severity of mucosal
damage in atrophic gastritis. The diagnostic sensitivity and specificity of serum pepsinogen I level for advanced
atrophic corpus gastritis are about 92% and 90% respectively. On the other hand, the decrease in serum
pepsinogen I levels in patients with pernicious anemia and atrophic gastritis was found to be associated with normal or raised pepsinogen II levels. Therefore, a pepsinogen I/pepsinogen II ratio was significantly lower than those with superficial gastritis or normal remnant mucosa.

Stomach Cancer:
Low serum pepsinogen I levels were found in patients with gastric cancer, with a threefold higher incidence. Other studies have concluded that abnormally low levels of serum pepsinogen I and the pepsinogen I / pepsinogen II
ratio may identify persons at increased risk for intestinal types of stomach cancer.

Duodenal Ulcer:
A low serum pepsinogen I level can exclude a diagnosis of duodenal ulcer. Although a high pepsinogen I level has less clinical useful for establishing the diagnosis of a duodenal ulcer, the combination of of hypergastrinemia and a highly elevated serum pepsinogen I strongly suggests the possibility of the Zollinger-Ellison syndrome.

Assay format: “sandwich” immunoenzymometric assay
Patient sample: serum
Sample volume required: 0.05 mL
Normal range: 25 - 200 ng/mL
Assay incubations: 1 h / 20 min

References:

• Kikuchi S. et al. Serum pepsinogen as a new marker for gastric carcinoma among young adults. Cancer 1994;73:2695-2702
• Konishi N, et al. Tissue and serum pepsinogen I and II in gastric cancer identified using immunohistochemistry and rapid ELISA. J Clin Pathol 1995;48:364-367
• Yoshuihara M. et al. Correlation of ratio of serum pepsinogen I and II with prevalence of gastric cancer and adenoma in Japanese subjects. Am J Gastroenterol 1998;93:1090-1096
• Miki K, et al. Usefulness of gastric cancer screening using the serum pepsinogen test method. Am J Gastroenterol 2003 98:735-739.