Rationale in diagnosis and screening of atrophic gastritis with stomach-specific plasma biomarkers

Scand J Gastroenterol. 2012 Feb;47(2):136-47. doi: 10.3109/00365521.2011.645501.


Background and aims: Atrophic gastritis (AG) results most often from Helicobacter pylori (H. pylori) infection. AG is the most important single risk condition for gastric cancer that often leads to an acid-free or hypochlorhydric stomach. In the present paper, we suggest a rationale for noninvasive screening of AG with stomach-specific biomarkers.

Methods: The paper summarizes a set of data on application of the biomarkers and describes how the test results could be interpreted in practice.

Results: In AG of the gastric corpus and fundus, the plasma levels of pepsinogen I and/or the pepsinogen I/pepsinogen II ratio are always low. The fasting level of gastrin-17 is high in AG limited to the corpus and fundus, but low or non-elevated if the AG occurs in both antrum and corpus. A low fasting level of G-17 is a sign of antral AG or indicates high intragastric acidity. Differentiation between antral AG and high intragastric acidity can be done by assaying the plasma G-17 before and after protein stimulation, or before and after administration of the proton pump inhibitors (PPI). Amidated G-17 will rise if the antral mucosa is normal in structure. H. pylori antibodies are a reliable indicator of helicobacter infection, even in patients with AG and hypochlorhydria.

Conclusions: Stomach-specific biomarkers provide information about the stomach health and about the function of stomach mucosa and are a noninvasive tool for diagnosis and screening of AG and acid-free stomach.

Publication types

  • Review

MeSH terms

  • Achlorhydria / blood
  • Achlorhydria / complications
  • Antibodies, Bacterial / blood
  • Biomarkers / blood*
  • Gastric Mucosa / microbiology
  • Gastric Mucosa / pathology
  • Gastric Mucosa / physiopathology
  • Gastrins / blood
  • Gastritis, Atrophic / blood*
  • Gastritis, Atrophic / diagnosis*
  • Gastritis, Atrophic / microbiology
  • Helicobacter Infections / blood*
  • Helicobacter Infections / diagnosis*
  • Helicobacter Infections / microbiology
  • Helicobacter pylori / immunology
  • Humans
  • Mass Screening
  • Pepsinogen A / blood
  • Pepsinogen C / blood
  • Stomach Neoplasms / complications
  • Stomach Neoplasms / diagnosis
  • Stomach Neoplasms / prevention & control
  • Vitamin B 12 / pharmacokinetics


  • Antibodies, Bacterial
  • Biomarkers
  • Gastrins
  • gastrin 17
  • Pepsinogen C
  • Pepsinogen A
  • Vitamin B 12