{
  "abstract": "Background Serum pepsinogen testing has been widely used as a non-invasive tool for gastric cancer risk stratification; however, its diagnostic performance varies substantially across populations, particularly in settings with high rates of Helicobacter pylori eradication. This study aimed to evaluate the relationship between serum pepsinogen levels, histologic gastric atrophy and intestinal metaplasia, and H. pylori infection status in a real-world cohort.Methods We conducted a cross-sectional study of 111 patients undergoing upper gastrointestinal endoscopy with histopathological assessment. Serum pepsinogen I (PG I), pepsinogen II (PG II), and the PG I/II ratio were measured. Gastric atrophy and intestinal metaplasia were graded histologically, and endoscopic findings were assessed using the Kyoto classification. Associations between pepsinogen levels, histologic severity, and H. pylori status were analyzed. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis.Results PG I and the PG I/II ratio demonstrated weak but significant positive correlations with the severity of gastric atrophy and intestinal metaplasia (r = 0.207–0.252, all p < 0.05), while PG II showed no significant correlation with histologic severity. In contrast, PG II was strongly associated with current H. pylori infection (r = 0.335, p < 0.001), and the PG I/II ratio was inversely correlated with H. pylori positivity (r = –0.344, p < 0.001). The diagnostic performance of serum pepsinogen markers for detecting moderate-to-severe gastric atrophy and intestinal metaplasia was modest, with AUROC values ranging from 0.57 to 0.63, comparable to endoscopic Kyoto scoring.Conclusions In populations with high H. pylori eradication rates, serum pepsinogen profiles primarily reflect inflammatory activity and post–H. pylori mucosal remodeling rather than static histologic severity. Pepsinogen testing should therefore be integrated into risk stratification and clinical decision-making frameworks, rather than used as a standalone diagnostic tool for premalignant gastric lesions.",
  "authors": [
    {
      "affiliations": [
        "Center for Gastrointestinal Endoscopy and Laparoscopic Surgery, Vietnam"
      ],
      "name": "Van Trung Huynh"
    },
    {
      "affiliations": [
        "Center for Gastrointestinal Endoscopy and Laparoscopic Surgery, Vietnam"
      ],
      "name": "Huu Tung Pham"
    },
    {
      "affiliations": [
        "Center for Gastrointestinal Endoscopy and Laparoscopic Surgery, Vietnam"
      ],
      "name": "Minh Hung Do"
    },
    {
      "affiliations": [
        "Center for Gastrointestinal Endoscopy and Laparoscopic Surgery, Vietnam"
      ],
      "name": "Xuan Phat Luu"
    },
    {
      "affiliations": [
        "Center for Gastrointestinal Endoscopy and Laparoscopic Surgery, Vietnam"
      ],
      "name": "Dinh Thanh Hoang"
    },
    {
      "affiliations": [
        "Center for Gastrointestinal Endoscopy and Laparoscopic Surgery, Vietnam"
      ],
      "name": "Ngoc Bich Thi Nguyen"
    }
  ],
  "title": "IDDF2026-ABS-0013 Serum pepsinogen profiles reflect post-helicobacter pylori mucosal remodeling rather than static histologic severity of gastric atrophy and intestinal metaplasia",
  "uid": "71984407-b8ec-5f19-abe2-ac84dce4c4f5"
}