{
  "abstract": "Background Gastric ulcer (GU) is a subtype of peptic ulcer disease that is primarily diagnosed using esophagogastroduodenoscopy (EGD), an invasive and resource-intensive procedure. Although non-invasive biomarkers have been proposed for early detection and risk stratification, their diagnostic performance remains uncertain. This systematic review evaluates biomarkers assessed for the diagnosis and severity of gastric ulcer, with EGD as the reference standard.Methods We conducted a systematic review of observational studies and randomized controlled trials evaluating biomarkers for the diagnosis or severity assessment of gastric ulcer in adult populations. MEDLINE and EMBASE were searched from inception to June 2025. Studies were eligible if gastric ulcer was confirmed by esophagogastroduodenoscopy (EGD) and compared with a control group without gastric ulcer. Biomarkers derived from any biological source were included. Extracted data included biomarker type, specimen source, between-group differences, and diagnostic performance measures, including sensitivity, specificity, and area under the receiver operating characteristic curve (AUC), when available.Results A total of 95 studies met inclusion criteria, evaluating 46 unique biomarkers across six biological sources: blood/serum, tissue, saliva, stool, urine, and gastric fluid. Blood and serum biomarkers were most frequently studied but generally demonstrated limited diagnostic accuracy. Antibodies targeting Helicobacter pylori (H. pylori) virulence factors—particularly cytotoxin-associated gene A (CagA)—showed the strongest diagnostic performance for H. pylori–positive gastric ulcers, with reported sensitivity up to 96.4% and specificity up to 100%. Combinations of H. pylori antibody markers improved sensitivity or specificity depending on whether alternative or synchronous strategies were used. Tissue biomarkers consistently demonstrated inflammatory and immune-regulatory changes at ulcer sites but lacked formal diagnostic accuracy reporting. Evidence for salivary, stool, urine, and gastric fluid biomarkers was limited to one or two studies per biomarker. Basic fibroblast growth factor (bFGF) was the only biomarker associated with ulcer severity.Conclusions Several biomarkers—particularly serologic markers targeting Helicobacter pylori virulence factors—demonstrate potential for non-invasive detection of gastric ulcer. However, most biomarkers lack sufficient validation and standardized diagnostic accuracy reporting to support routine clinical use. Further high-quality, prospective studies are needed to confirm diagnostic performance and to define the role of biomarker-based strategies in early detection and risk stratification of gastric ulcer.",
  "authors": [
    {
      "affiliations": [
        "Texas Tech University Health Sciences Center, United States"
      ],
      "name": "Vitchapong Prasitsumrit"
    },
    {
      "affiliations": [
        "Center of Excellence in Preventive and Integrative Medicine (CE-PIM), Faculty of Medicine, Chulalongkorn University, Thailand"
      ],
      "name": "Oranut Chatsirisakul"
    },
    {
      "affiliations": [
        "King Mongkut’s Institute of Technology Ladkrabang, Thailand"
      ],
      "name": "Nich Paibulsirijit"
    },
    {
      "affiliations": [
        "Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand"
      ],
      "name": "Napat Wongmat"
    },
    {
      "affiliations": [
        "Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand"
      ],
      "name": "Khemmawit Siriwong"
    },
    {
      "affiliations": [
        "The Central Chest Institute of Thailand, Thailand"
      ],
      "name": "Weerinth Puyati"
    },
    {
      "affiliations": [
        "Beth Israel Deaconess Medical Center, Harvard Medical School, United States"
      ],
      "name": "Nicha Wareesawetsuwan"
    },
    {
      "affiliations": [
        "Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand"
      ],
      "name": "Thitipat Pattanaprateeb"
    },
    {
      "affiliations": [
        "Bassett Medical Center, Cooperstown, United States"
      ],
      "name": "Panisara Fangsaard"
    },
    {
      "affiliations": [
        "Center of Excellence in Preventive and Integrative Medicine (CE-PIM), Faculty of Medicine, Chulalongkorn University, Thailand"
      ],
      "name": "Krit Pongpirul"
    }
  ],
  "title": "IDDF2026-ABS-0045 Non-invasive biomarkers for early detection of gastric ulcer: a systematic review",
  "uid": "8bd09878-5ae4-5595-a3a8-459483af805d"
}