Longitudinal Changes in the Serum Pepsinogen I/ II Ratio With Progression of Gastric Atrophy

BACKGROUND: This study evaluated longitudinal changes in the serum pepsinogen (PG) I/II ratio according to endoscopic gastric mucosal atrophy. METHODS: We retrospectively analyzed 21,265 participants who underwent endoscopy during health checkups between 2015 and 2023. Longitudinal changes in PG I/II ratio were examined in 2217 subjects with ≥ 2 endoscopies using linear mixed-effects models. Serum PG I, PG II, and Helicobacter pylori IgG were measured. The AG severity was graded endoscopically according to Kimura-Takemoto classification. RESULTS: The PG I/II ratio decreased stepwise with advancing Kimura-Takemoto stage. In longitudinal analyses of 2217 participants with repeated endoscopy, within-subject declines in the PG I/II ratio paralleled progression of endoscopic atrophy, with greater reductions in more advanced stages (No atrophy: reference; C2: -0.383; C3: -1.150; O1: -1.412; O2: -2.101; O3: -2.007; all p < 0.001). CONCLUSIONS: Within-subject declines in the PG I/II ratio were observed with progression of gastric atrophy. Serial measurement of the PG I/II ratio may be useful for monitoring the progression of gastric mucosal atrophy, particularly in patients for whom repeated endoscopic evaluation is not feasible.