Analysis of factors associated with recovery of the serum pepsinogen ratio after Helicobacter pylori eradication: a long-term follow-up study in Korea

Objective: Serum levels of pepsinogen (PG) are related to Helicobacter pylori-induced inflammation of the gastric mucosa. This study aimed to examine the influence of H. pylori eradication on serum PG, analyze its associated factors, and evaluate the long-term outcomes. Methods: H. pylori-positive patients who underwent gastroscopy and serum PG measurement were enrolled in a single academic hospital. After H. pylori eradication, the measurement of serum PG level was performed. Recovery of serum PG I/II ratio was defined as a PG I/II ratio after eradication of >3.0 in patients with a PG I/II ratio <= 3.0 before eradication. Follow-up involved serum PG measurement and gastroscopy with a rapid urease test annually. Results: In all, 327 patients were eligible for study inclusion. Compared to those before H. pylori eradication, serum PG I (74.9 vs. 44.3 ng/mL, p < .001) and PG II (25.4 vs. 9.1 ng/mL, p < .001) levels significantly decreased after successful eradication. In addition, there was a significant increase in serum PG I/II ratio after eradication (3.07 vs. 4.98, p < .001). In multivariate analyses, the following were independently associated with failed recovery of serum PG I/II ratio despite successful eradication: age >= 60 years (odds ratio [OR] = 0.231, 95% confidence interval [CI] = 0.084-0.629, p = .004) and severe gastric atrophy (OR = 0.156, 95% CI = 0.055-0.440, p < .001). Conclusions: Recovery of serum PG I/II ratio after H. pylori eradication may be achieved in H. pylori-infected patients aged <60 years without severe gastric atrophy.