Changes in Gastrin and Serum Pepsinogens in Monitoring of Helicobacter pylori Response to Therapy

The aims of this study in 50 patients with H.pylori infection and duodenal ulcer were to examine theeffect of eradication therapy on the serum levels ofgastrin, pepsinogen I, and pepsinogen II and to investigate whether monitoring of the serumchanges in these peptides after treatment could predictpatient outcome. H. pylori status was assessed at entryand one and six months after therapy by culturing and microscopic analysis of the gastric mucosaand by [14C]urea breath test. Significantdecreases were observed in the serum levels of gastrin(–11.4 ± 3%), pepsinogen I (–28.9± 4%), and pepsinogen II (–40.4 ±3%) in the 45 patients whose infection was eradicated,but not in the patients without eradication. Serumvalues of these peptides were unchanged in an additionalgroup of 10 patients that only received omeprazol, none of whom had H. pylorieradicated. The best cutoff point of the percentage ofeach peptide to predict patient outcome was 10% forgastrin and pepsinogen I, and 15% for pepsinogen II. Apepsinogen II decrease >15% resulted in the best markerof H. pylori clearance, accurately identifying patientoutcome 86.6% of the time, whereas the diagnosticaccuracy of gastrin and pepsinogen I was 61.7% and76.6%, respectively. Significant correlations werefound between the bacterial load assessed by histologywith the serum concentrations of pepsinogen I and II andwith the urease activity as measured by the amount of 14CO2 excreted. Inconclusion, eradication of H. pylori infection isfollowed by a significant drop in serum levels ofgastrin, pepsinogen I, and pepsinogen II. Changes in thelatter are the most uniform and may be used as an indirect tool to predicttreatment outcome.