Serum pepsinogen level as a biomarker for atrophy, reflux esophagitis, and gastric cancer screening in Indonesia

Muhammad Miftahussurur; Langgeng Agung Waskito; Ari Fahrial Syam; Iswan Abbas Nusi; I Nyoman Dewa Wibawa; Yudith Annisa Ayu Rezkitha; Kartika Afrida Fauzia; Gontar Alamsyah Siregar; Fardah Akil; Bradley Jimmy Waleleng; Alexander Michael Joseph Saudale; Azzaki Abubakar; Hasan Maulahela; Marselino Richardo; Abdul Rahman; Yoma Sari Namara; Eko Sudarmo; Pangestu Adi; Ummi Maimunah; Poernomo Boedi Setiawan; Dalla Doohan; Tomohisa Uchida; Astri Dewayani; Purwo Sri Rejeki; Titong Sugihartono; Yoshio Yamaoka

doi:10.4103/jrms.jrms_983_21

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ORIGINAL ARTICLE

Year : 2022 | Volume : 27 | Issue : 1 | Page : 90

Serum pepsinogen level as a biomarker for atrophy, reflux esophagitis, and gastric cancer screening in Indonesia

Muhammad Miftahussurur¹, Langgeng Agung Waskito², Ari Fahrial Syam³, Iswan Abbas Nusi⁴, I Nyoman Dewa Wibawa⁵, Yudith Annisa Ayu Rezkitha⁶, Kartika Afrida Fauzia², Gontar Alamsyah Siregar⁷, Fardah Akil⁸, Bradley Jimmy Waleleng⁹, Alexander Michael Joseph Saudale¹⁰, Azzaki Abubakar¹¹, Hasan Maulahela³, Marselino Richardo¹², Abdul Rahman¹³, Yoma Sari Namara¹⁴, Eko Sudarmo¹⁵, Pangestu Adi¹⁶, Ummi Maimunah⁴, Poernomo Boedi Setiawan⁴, Dalla Doohan², Tomohisa Uchida¹⁷, Astri Dewayani¹⁸, Purwo Sri Rejeki¹⁹, Titong Sugihartono⁴, Yoshio Yamaoka²⁰
¹ Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital; Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
² Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia; Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
³ Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
⁴ Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
⁵ Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine University of Udayana, Denpasar, Indonesia
⁶ Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga; Department of Internal Medicine, Faculty of Medicine, University of Muhammadiyah Surabaya, Surabaya, Indonesia
⁷ Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
⁸ Center of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
⁹ Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Sam Ratulangi, Prof. Dr. RD Kandou Hospital, Manado, Indonesia
¹⁰ Department of Internal Medicine, Prof. Dr. W. Z. Johannes General Hospital, Kupang, Indonesia
¹¹ Division of Gastroenterohepatology, Department of Internal Medicine, Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia
¹² Department of Internal Medicine, Merauke City General Hospital, Merauke, Indonesia
¹³ Department of Internal Medicine, Kolaka General Hospital, Kolaka, Indonesia
¹⁴ Department of Internal Medicine, Anutapura General Hospital, Palu, Indonesia
¹⁵ Department of Internal Medicine, Dr. Hasan Busori General Hospital, Ternate, Indonesia
¹⁶ Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
¹⁷ Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu, Japan
¹⁸ Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia; Department of Infectious Disease Control, Oita University Faculty of Medicine, Yufu, Japan
¹⁹ Department of Physiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
²⁰ Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia; Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan; Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas, United States; Global Oita Medical Advanced Research Center for Health, Yufu, Japan

Correspondence Address:
Astri Dewayani
Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia; Department of Infectious Disease Control, Oita University Faculty of Medicine, Yufu, Japan

Prof. Muhammad Miftahussurur
Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya; Jalan Mayjend Prof. Dr. Moestopo No. 6-8 Surabaya 60286
Indonesia
Prof. Yoshio Yamaoka
Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-City, Oita 879-5593

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jrms.jrms_983_21

Background: Chronic dyspepsia's symptoms are frequently seen in primary to tertiary healthcare in Indonesia. This study aimed to describe the potential usability of pepsinogen (PG) values in determining gastric mucosal conditions, including superficial gastritis and atrophic gastritis. Materials and Methods: We recruited 646 adult dyspeptic patients and then analyzed PG values (including PGI, PGII, and PGI/II ratio) with endoscopic findings, gastric mucosal damages, and Helicobacter pylori infection. The gastric mucosal damage and H. pylori infection were evaluated using histological examination based on the updated Sydney system. Results: Among 646 enrolled patients, 308 (47.2%), 212 (32.8%), 91 (14.1%), 34 (5.2%), and 1 (0.2%) patient were diagnosed with normal mucosa, gastritis, reflux esophagitis, peptic ulcer disease, and gastric cancer, respectively. Significant differences in PGI, PGII, and PGI/II ratio values were observed among ethnic groups (all P < 0.01). The PGI and PGII levels were significantly higher and PGI/II was significantly lower in H. pylori-infected patients than in uninfected ones (all P < 0.001). The optimal cutoff value for PGII and PGI/II was 12.45 ng/mL with an area under the curve (AUC) value of 0.755 (0.702–0.811), sensitivity 59.3%, and specificity 77.1%; and 4.75 with AUC value of 0.821 (0.763–0.855), sensitivity 81.5%, and specificity 78.7%, respectively, to determine moderate–severe atrophy. Conclusion: Serum PG levels, a useful biomarker, represent the endoscopic findings, especially for reflux esophagitis. In addition, the benefits of PG values detecting atrophic gastritis were limited to moderate–severe atrophic gastritis. This usefulness requires careful attention for several ethnic groups in Indonesia.

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