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. Dewa Nyoman 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 SetiawanDalla Doohan, Tomohisa Uchida, Astri Dewayani, Purwo Sri Rejeki, Titong Sugihartono, Yoshio Yamaoka

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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.

Original languageEnglish
Article number90
JournalJournal of Research in Medical Sciences
Issue number1
Publication statusPublished - 1 Jan 2022


  • Atrophic gastritis
  • Helicobacter pylori
  • Indonesia
  • human and disease
  • neoplasms
  • pepsinogens
  • reflux esophagitis


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