Validity of Serum Pepsinogen I/II Ratio for the Diagnosis of Different Types of Gastritis

Abstract Background: Inflammation of the stomach mucosa is the hallmark of gastritis, a common gastrointestinal condition that is frequently linked to hormonal, environmental, nutritional, and infectious variables. The gold standard for diagnosis is still endoscopy combined with histological biopsies, but it is invasive, expensive, and not feasible for large-scale screening. Serum pepsinogen levels, particularly the pepsinogen I/II ratio, have been proposed as reliable noninvasive biomarkers for detecting types and severity of gastric mucosal changes. Objective: The purpose of this study was to assess the serum pepsinogen I/II ratio's diagnostic value in detecting gastritis patient. Methods: gastrointestinal endoscopy for dyspeptic symptoms. Serum pepsinogen I and II levels were measured using enzyme-linked immunosorbent assay (ELISA), and the pepsinogen I/II ratio was calculated. Histopathological findings from gastric biopsies were used as the reference standard. Sensitivity, specificity, and diagnostic accuracy of different pepsinogen I and II cut-off values were analyzed. Results: Among 65 subjects, endoscopy confirmed gastritis in 45 and normal findings in 20. Serum pepsinogen I (279.65 ± 159.82) and pepsinogen II (22.61 ± 17.64) were significantly higher in gastritis patients, with excellent diagnostic accuracy (AUC 0.796 and 0.763, respectively). These results align with previous studies linking elevated pepsinogen I and II to gastritis. In contrast, the pepsinogen I/II ratio showed no significant differences between gastritis subtypes, but in erosive gastritis, most patients showed an increased pepsinogen I/II ratio (>20), whereas in atrophic gastritis, the majority had a decreased ratio (