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Serum pepsinogen levels and OLGA/OLGIM staging in the assessment of atrophic gastritis types
  1. Deniz Ogutmen Koc,
  2. Sibel Bektas
  1. Department of Pathology, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
  1. Correspondence to Dr Deniz Ogutmen Koc, Department of Gastroenterology, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey; drdenizkoc{at}


Background We assessed the validity of using serum pepsinogen tests (sPGTs) to differentiate autoimmune atrophic gastritis (AAG) from environmental atrophic gastritis (EAG). We also investigated the correlation and prognostic value between disease stage, according to Operative Link for Gastritis Assessment (OLGA)/Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM), and sPGT results in patients with gastric atrophy.

Methods We enroled 115 patients in this prospective study: 95 with atrophic gastritis (16 with AAG and 79 with EAG) and 20 non-atrophic gastritis. These patients, along with 32 control patients, underwent esophagogastroduodenoscopy. Atrophy and intestinal metaplasia of the gastric biopsy specimens were staged according to the OLGA/OLGIM staging systems.

Results The median (IQR) age of the patients (83 females (56.5%)) was 58 (46–67) years. Patients in the AAG group represented histologically advanced stages. The AAG group had lower pepsinogen (PG) I and II levels, as well as a lower PGI/PGII ratio, compared with the EAG group (p<0.01, p<0.05 and p<0.01, respectively). The optimal PGI/PGII ratio for predicting AAG was ≤1.9 (100% sensitivity and 100% specificity), and that for predicting EAG was ≤9.2 (47.5% sensitivity and 90.6% specificity). The OLGA/OLGIM stage was negatively correlated with the PGI level and PGI/PGII ratio. In the AAG group, four of five patients with low-grade dysplasia had OLGA/OLGIM stage III–IV disease.

Conclusions sPGT may provide valuable information for differentiating advanced-stage AAG from EAG, and in patients with atrophic gastritis, use of sPGTs and OLGA/OLGIM staging together may predict gastric cancer risk.

  • gastroduodenal disease
  • endoscopy
  • pathology

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  • Contributors DOK performed esophagogastroduodenoscopy with biopsy to the participants, and also literature search, data extraction and recording, manuscript writing and revision, tables and figures preparation. SB performed histopathologically examination of the gastric biopsies of the participants, and manuscript writing and revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information and available.