BACKGROUND: Helicobacter pylori infection and subsequent gastric inflammation have been proposed as risk factors for the development of insulin resistance and cardiovascular disease. In this study we assessed the possible association of H. pylori bacterial load, and serum biomarker of gastric inflammation with cardiometabolic risk factors in diabetic patients. METHODS: In this cross-sectional study, 84 H. pylori-infected type 2 diabetic patients were assessed for anthropometrics, biochemical and clinical measurements. Pearson correlation test, linear, and logarithmic regression curve estimation models were used to assess the association of H. pylori stool antigen (HpSAg) levels, and pepsinogen I (PGI) to pepsinogen II (PGII) ratio with fasting serum glucose, insulin, serum lipid and lipoprotein parameters, malondialdehyde, high-sensitive C-reactive protein (hs-CRP), systolic and diastolic blood pressure, body weight, waist circumference and lipid accumulation product (LAP) index. RESULTS: The mean age of participants was 54+/-10 years, and 44% were men. Mean HpSAg levels and PGI/PGII ratio were 0.24+/-0.23 microg/mL and 9.9+/-9.0, respectively. Higher HpSAg as well as lower PGI/PGII was correlated with higher anthropometric measures and LAP. A significant negative correlation between PGI/PGII ratio and blood pressure (r=-0.21 and r=-0.22, systolic and diastolic, respectively, P<0.05), serum insulin (r=-0.17, P=0.05), and hs-CRP (r=-0.17, P=0.05) was observed. A significant linear association between PGI/PGII ratio with serum triglycerides (beta=-0.24, P<0.05), serum high density lipoprotein cholesterol (HDL-C; beta=0.43, P<0.01), and triglycerides/HDL-C ratio (beta=-0.28, P<0.05) were observed. CONCLUSION: Higher H. pylori bacterial load and lower PGI/PGII ratio was associated with higher levels of cardiometabolic risk factors in H. pylori infected type 2 diabetic patients.
Bacterial Load ; Biomarkers* ; Blood Glucose ; Blood Pressure ; Body Weight ; C-Reactive Protein ; Cardiovascular Diseases ; Cholesterol, HDL ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; Fasting ; Helicobacter pylori* ; Helicobacter* ; Humans ; Inflammation* ; Insulin ; Insulin Resistance ; Lipid Accumulation Product ; Lipoproteins ; Male ; Malondialdehyde ; Pepsinogen A ; Pepsinogen C ; Pepsinogens ; Risk Factors* ; Triglycerides ; Waist Circumference

OBJECTIVETo investigate the changes in serum pepsinogen (PG) I/II ratio induced by Helicobacter pylori (Hp) infection and assess the value of PG I/II test in evaluating organ damages in hypertensive patients.

METHODSThe serum total cholesterol, triglycerides, high density lipoprotein (HDL) and PG I/II ratio were tested in 288 hypertensive patients with or without Hp infection. The PG I/II ratio between the patients with different grade of hypertension, patients with and without hypertensive nephropathy, patients with and without hypertensive retinopathy. The relationship of PG I/II ratio with serum total cholesterol, triglycerides and HDL was analyzed with Pearson's correlation analysis and the effectiveness of PG I/II ratio in the the diagnosis of nephropathy and retinopathy was evaluated by receiver-operating characteristic curve (ROC) analysis.

RESULTSCompared with patients without Hp infection, the Hp-infected patients showed significantly decreased PG I/II ratio and increased total cholesterol and triglycerides (P<0.05), but their HDL levels, systolic pressure and diastolic pressure were comparable (P>0.05). PG I/II ratio was significantly decreased in patients with nephropathy and retinopathy compared with the patients without nephropathy and retinopathy (P<0.05), and was similar between patients with different grades of hypertension (P>0.05). PG I/II ratio was negatively correlated with serum total cholesterol and triglycerides in the hypertensive patients (P<0.05), and its area under curve (AUC) of ROC was 0.79 and 0.82 in the diagnosis of nephropathy and retinopathy, respectively.

CONCLUSIONSHypertensive patients with nephropathy and retinopathy have obviously decreased PG I/II ratio, which can be used for screening organ damages in hypertensive patients.

Helicobacter Infections ; blood ; Helicobacter pylori ; Humans ; Hypertension ; blood ; microbiology ; Pepsinogen A ; blood ; Pepsinogen C ; blood

OBJECTIVES: In Fujian Province, China, gastric cancer is one of the leading causes of mortality among all malignant tumors. Nanjing county and Minqing county are located in inland Fujian and have similar general demographics. However, the adjusted mortality rate of gastric cancer in Minqing was found to be much higher than that in Nanjing. We sought to explore factors associated with this increased risk of gastric cancer between the two counties. METHODS: We recruited 231 and 224 residents from Nanjing and Minqing, respectively, and analyzed differences between their dietary habits, Helicobacter pylori infection rates, and concentrations of serum pepsinogen I, pepsinogen II, gastrin-17, and ratio of pepsinogen I:II. RESULTS: Subjects in Minqing had more first-degree relatives who had been diagnosed with upper gastrointestinal tumor, more unhealthy dietary habits, a higher Helicobacter pylori positive rate, and greater proportion of abnormal serum gastrin-17 than those in Nanjing did. CONCLUSIONS: The factors that differed between these two counties might indicate that residents in Minqing have a higher risk for developing gastric cancer than those in Nanjing do.
Adult ; Aged ; China/epidemiology ; Female ; Food Habits ; Gastrins/blood ; Helicobacter Infections/epidemiology/microbiology/pathology ; Helicobacter pylori ; Humans ; Male ; Middle Aged ; Pepsinogen A/blood ; Pepsinogen C/blood ; Risk Factors ; Stomach Neoplasms/*diagnosis

OBJECTIVES: In Fujian Province, China, gastric cancer is one of the leading causes of mortality among all malignant tumors. Nanjing county and Minqing county are located in inland Fujian and have similar general demographics. However, the adjusted mortality rate of gastric cancer in Minqing was found to be much higher than that in Nanjing. We sought to explore factors associated with this increased risk of gastric cancer between the two counties. METHODS: We recruited 231 and 224 residents from Nanjing and Minqing, respectively, and analyzed differences between their dietary habits, Helicobacter pylori infection rates, and concentrations of serum pepsinogen I, pepsinogen II, gastrin-17, and ratio of pepsinogen I:II. RESULTS: Subjects in Minqing had more first-degree relatives who had been diagnosed with upper gastrointestinal tumor, more unhealthy dietary habits, a higher Helicobacter pylori positive rate, and greater proportion of abnormal serum gastrin-17 than those in Nanjing did. CONCLUSIONS: The factors that differed between these two counties might indicate that residents in Minqing have a higher risk for developing gastric cancer than those in Nanjing do.
Adult ; Aged ; China/epidemiology ; Female ; Food Habits ; Gastrins/blood ; Helicobacter Infections/epidemiology/microbiology/pathology ; Helicobacter pylori ; Humans ; Male ; Middle Aged ; Pepsinogen A/blood ; Pepsinogen C/blood ; Risk Factors ; Stomach Neoplasms/*diagnosis

OBJECTIVETo determine serum pepsinogen levels in patients with liver cirrhosis and investigate the functions of the gastric mucosa in these patients with concurrent portal hypertensive gastropathy (PHG).

METHODSFifty-one patients with liver cirrhosis and 22 healthy controls were studied by gastroscopy. The hepatic function of the patients with or without PHG were evaluated with Child-Pugh grade. Helicobacter pylori infection was detected using rapid urease test or exhalation of carbon 13. The serum pepsinogen I and II levels were tested by latex-enhanced immunoturbidimetry to calculate the PGI/PGII ratio (PGR).

RESULTSIn cirrhotic patients, the levels of serum PGI and PGR were lower than those in the healthy controls. The patients without PHG had a serum PGI level of 49.48+23.86 µg/L, significantly lower than that in PHG patients (74.85+30.27 µg/L, P=0.000). The levels of serum PG II in patients with H.pylori infection was significantly higher that in patients free of H.pylori infection (P=0.003).

CONCLUSIONThe serum level of PGI decreases obviously in patients with hepatic cirrhosis and PHG, who can have damages of the gastric mucosa lamina propria and reduced secretory function of the gastric mucosa. H.pylori infection may affect the level of PGII. There is no significant correlation between serum PG level and liver function, but to a certain extent, serum PG level especially PGI can reflect the function of gastric mucosa in patients of liver cirrhosis.

Adult ; Case-Control Studies ; Female ; Gastric Mucosa ; pathology ; Helicobacter Infections ; Humans ; Hypertension, Portal ; complications ; Liver Cirrhosis ; complications ; Male ; Middle Aged ; Pepsinogen A ; blood ; Stomach Diseases ; blood ; etiology ; microbiology

OBJECTIVETo evaluate the effects of two gastric cancer screening schemes for early detection of gastric cancer in a high-risk population.

METHODSA cluster random sampling method was used to select local residents aged 40-69 years from Linqu County, Shandong Province. "Serum pepsinogen initial screening combined with further endoscopic examination (PG scheme)" and "direct endoscopic examination (endoscopy scheme)" were conducted. The associations between screening schemes and detection rates of gastric cancer, and early gastric cancer/high-grade intraepithelial neoplasia were evaluated by unconditional logistic regression analysis.

RESULTSOverall, 3654 and 2290 participants completed PG and endoscopy schemes, respectively. A total of 11 (0.30%) cases of gastric cancer and 10 (0.27%) cases of high-grade intraepithelial neoplasia were detected by PG scheme, of which 7 (0.19%) cases were early gastric cancer. While, 19 (0.83%) cases of gastric cancer and 10 (0.44%) cases of high-grade intraepithelial neoplasia were detected by endoscopy scheme, with 12 (0.52%) cases of early gastric cancer. Compared with the PG scheme, the endoscopy scheme had a significantly higher detection rates of gastric cancer (OR = 2.83, 95%CI 1.34-5.98), and early gastric cancer/high-grade intraepithelial neoplasia (OR = 2.12, 95%CI 1.12-4.02).

CONCLUSIONSThe endoscopy scheme is more effective in the detection of gastric cancer in a high-risk population, particularly for early gastric cancer/high-grade intraepithelial neoplasia than the PG scheme.

Adult ; Aged ; Carcinoma ; blood ; diagnosis ; Carcinoma in Situ ; blood ; diagnosis ; Early Detection of Cancer ; methods ; Female ; Gastroscopy ; Humans ; Male ; Mass Screening ; methods ; Middle Aged ; Pepsinogen A ; blood ; Stomach Neoplasms ; blood ; diagnosis

OBJECTIVETo investigate the feasibility of gastric cancer screening for the susceptible population in the high-risk areas of China and to optimize the screening programme.

METHODSBy using the two-round screening method i.e. serum pepsinogen test combined with gastric mucosa biopsy, large-scale population screening programs were carried out in Zhuanghe, Liaoning province. All adults or residents above 35 years old with a positive family history of gastric cancer or gastrointestinal symptoms were targeted.

RESULTSThree large-scale population screenings were developed over the past 15 years. All together, 13078 participants accepted the two-round screening, and 108 gastric cancer cases were detected. Among them, the detection rate of early gastric cancer was 56.82%, 51.22% and 82.61%, respectively. The pathologically confirmed gastric cancer cases were immediately arranged to have early surgical treatment, and meanwhile, the follow-up files for the patients were established. With a consecutive and regular 10-year postoperative follow-up, the 5-year survival rate for these early gastric cancer patients reached 90.48%. Effectiveness and health economic evaluation confirmed that there are good specificity and sensitivity for the two round screening programs. It is cost-effective. As the primary screening method serum PG test can improve the screening examination rate and concentrate the gastric cancer risk populations.

CONCLUSIONSIt is feasible to develop the gastric cancer screening program among the susceptible population in high-risk areas in our country, and the two-round screening method is of practical value. Research for early detection of gastric cancer should be further enhanced, and multidisciplinary and multicenter cooperation should be organized. It is necessary to extend the implementation the gastric cancer screening and to further improve the early detection programme, in order to make a breakthrough based on the present practice.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy ; Child ; China ; Cost-Benefit Analysis ; Early Detection of Cancer ; methods ; Feasibility Studies ; Female ; Follow-Up Studies ; Gastric Mucosa ; pathology ; Gastritis ; diagnosis ; Gastritis, Atrophic ; diagnosis ; Gastroscopy ; Humans ; Male ; Mass Screening ; methods ; Middle Aged ; Pepsinogen A ; blood ; Sensitivity and Specificity ; Stomach Neoplasms ; blood ; diagnosis ; pathology ; surgery ; Young Adult

BACKGROUND: Atrophic gastritis is a well known risk factor for gastric adenocarcinoma. Its confirmatory diagnosis requires histology via endoscopy, which is an invasive method; therefore, periodic follow up evaluation as a screening method is difficult to perform. We evaluated the clinical utility of serum pepsinogens (PG) as a biomarker for screening of atrophic gastritis. METHODS: The study population consisted of 130 selected dyspeptic patients (M:F=52:78; age, 16-105 yrs; mean age, 50.8 yrs) who had undergone a diagnostic endoscopy. The serum pepsinogen test was performed by a latex turbidimetric immunoassay method (HBI, Korea) using Toshiba-200FR automatic analyzer. The PGI, II level and PGI:PGII ratio of non-atrophic gastritis group were compared with those of atrophic gastritis group, and a correlation with Helicobacter pylori infection was examined. Cut-off points for screening of atrophic gastritis were determined. RESULTS: The mean serum concentration of PGI showed a decline from normal (60.7 ng/mL), nonatrophic gastritis (54.2 ng/mL), and atrophic gastritis (51.8 ng/mL) to gastric adenocarcinoma (32.6 ng/mL). The mean ratio of PGI:PGII was lower in atrophic gastritis (3.2) compared to non-atrophic gastritis (4.7) (P=0.021). In patients with H. pylori infection, the mean serum PGII level was higher and the PGI:PGII ratio was lower than those in patients without H. pylori infection, and the differences were statistically significant. For screening of atrophic gastritis, the best cut-off point of PGI:PGII ratio was 4, with a sensitivity of 82.6% and specificity of 91.7%. CONCLUSIONS: The serum pepsinogen test is a useful biomarker for screening of atrophic gastritis, a well-known precancerous lesion of gastric adenocarcinoma. Measuring both pepsinogen I and II concentrations simultaneously to obtain pepsinogen I/II ratio provides a clinically useful information for the detection of atrophic gastritis.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Gastritis, Atrophic/*diagnosis ; Helicobacter Infections/diagnosis ; Helicobacter pylori ; Humans ; Male ; Middle Aged ; Nephelometry and Turbidimetry ; Pepsinogen A/*blood ; Pepsinogen C/*blood ; ROC Curve ; Reagent Kits, Diagnostic ; Sensitivity and Specificity

BACKGROUND/AIMS: Although previous reports suggested that pepsinogen (PG) I/II ratio was the index of gastric atrophy, PG I/II ratio was also related to other factors such as Helicobacter pylori (H. pylori) infection, various gastrointestinal diseases, and aging. The aim of this study was to evaluate the relationship between serum PG I/II ratio and age or upper gastro-intestinal diseases according to H. pylori infection status. METHODS: A total of 529 individuals (307 male; mean age, 57.2 years) were divided into 4 groups (94 gastric ulcers, 35 duodenal ulcers, 105 reflux esophagitis, and 295 atrophic gastritis) according to endoscopic diagnosis. H. pylori infection was determined by H. pylori IgG antibody (ELISA) and PG was measured by latex immunoassay. RESULTS: H. pylori infected patients showed markedly increased serum PG II levels (24.0+/-14.7 ng/mL vs. 13.8+/-16.6 ng/mL, p<0.001) and low PG I/II ratio (3.9+/-2.0 vs. 6.0+/-2.5, p<0.001) than non-infected subjects. In H. pylori infected patients, mean PG I/II ratios in the gastric ulcer and atrophic gastritis group were significantly lower than those of the duodenal ulcer and reflux esophagitis group (p<0.001, ANOVA, Turkey's multiples comparison test). The mean ratio of open type atrophic gastritis was lower than that of close type atrophic gastritis (3.0+/-1.4 vs. 3.8+/-1.7, p<0.005). PG I/II ratio gradually decreased with age in H. pylori-infected patients with atrophic gastritis (R(2)=0.9, p=0.005, linear regression analysis). CONCLUSION: Serum PG I/II ratio reflects H. pylori infection and gastric atrophy. In the presence of H. pylori infection, gastric atrophy progresses with age.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Duodenal Ulcer/microbiology ; Esophagitis, Peptic/microbiology ; Female ; Gastritis, Atrophic/microbiology ; Gastrointestinal Diseases/*diagnosis/*microbiology ; Helicobacter Infections/*diagnosis ; *Helicobacter pylori/isolation & purification ; Humans ; Male ; Middle Aged ; Pepsinogen A/*blood ; Pepsinogen C/*blood ; Stomach Ulcer/microbiology

BACKGROUND/AIMS: Although previous reports suggested that pepsinogen (PG) I/II ratio was the index of gastric atrophy, PG I/II ratio was also related to other factors such as Helicobacter pylori (H. pylori) infection, various gastrointestinal diseases, and aging. The aim of this study was to evaluate the relationship between serum PG I/II ratio and age or upper gastro-intestinal diseases according to H. pylori infection status. METHODS: A total of 529 individuals (307 male; mean age, 57.2 years) were divided into 4 groups (94 gastric ulcers, 35 duodenal ulcers, 105 reflux esophagitis, and 295 atrophic gastritis) according to endoscopic diagnosis. H. pylori infection was determined by H. pylori IgG antibody (ELISA) and PG was measured by latex immunoassay. RESULTS: H. pylori infected patients showed markedly increased serum PG II levels (24.0+/-14.7 ng/mL vs. 13.8+/-16.6 ng/mL, p<0.001) and low PG I/II ratio (3.9+/-2.0 vs. 6.0+/-2.5, p<0.001) than non-infected subjects. In H. pylori infected patients, mean PG I/II ratios in the gastric ulcer and atrophic gastritis group were significantly lower than those of the duodenal ulcer and reflux esophagitis group (p<0.001, ANOVA, Turkey's multiples comparison test). The mean ratio of open type atrophic gastritis was lower than that of close type atrophic gastritis (3.0+/-1.4 vs. 3.8+/-1.7, p<0.005). PG I/II ratio gradually decreased with age in H. pylori-infected patients with atrophic gastritis (R(2)=0.9, p=0.005, linear regression analysis). CONCLUSION: Serum PG I/II ratio reflects H. pylori infection and gastric atrophy. In the presence of H. pylori infection, gastric atrophy progresses with age.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Duodenal Ulcer/microbiology ; Esophagitis, Peptic/microbiology ; Female ; Gastritis, Atrophic/microbiology ; Gastrointestinal Diseases/*diagnosis/*microbiology ; Helicobacter Infections/*diagnosis ; *Helicobacter pylori/isolation & purification ; Humans ; Male ; Middle Aged ; Pepsinogen A/*blood ; Pepsinogen C/*blood ; Stomach Ulcer/microbiology