Background: Although serum pepsinogen tests are useful for predicting the presence of atrophic gastritis, the optimal cut-off values have not been fully evaluated. Aim: To determine the optimal serum pepsinogen cut-off value for predicting atrophic gastritis. Methods: Patients scheduled for upper endoscopy at Severance Hospital, Korea, between August 2012 and October 2013, were recruited prospectively. Endoscopic biopsies for atrophic gastritis were obtained and histologically graded, based on the updated Sydney system. Results: Ninety-five patients were enrolled in the study. The mean age was 57.7. ± 12.1 years, and 44.2% of the patients were male. Serum pepsinogen I/II ratios were lower in patients with atrophic gastritis than in those without it (antrum, 4.2. ± 1.7 vs. 5.2. ± 2.1, P= 0.040; corpus, 3.3. ± 1.9 vs. 5.4. ± 1.9, P< 0.001). Serum pepsinogen I/II ratios were significantly correlated with histologic atrophic gastritis (antrum, P= 0.030; corpus, P< 0.001). Using a cut-off value of 4.9, the sensitivity and specificity of the serum pepsinogen I/II ratio for predicting atrophic gastritis in the antrum were 68.2% and 60.3%, respectively. Conclusion: The optimal serum pepsinogen I/II ratio cut-off values for atrophic gastritis of the antrum and for the corpus were 4.9 and 3.5, respectively. Serum pepsinogen I/II ratios, with these cut-off values, are useful for screening patients for the presence of atrophic gastritis.
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