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Proton Pump Inhibitor Challenge to Confirm Diagnosis of Atrophic Gastritis of the Stomach: A Proposal

  • 0Department of Medicine and Surgery, University of Parma, Parma, Italy. francesco.dimario@unipr.it.
Journal of Gastrointestinal and Liver Diseases : Jgld +

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August 22, 2025

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August 22, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

A proton pump inhibitor (PPI) challenge effectively identifies chronic atrophic gastritis (CAG) in patients with borderline serum pepsinogen I levels (30-50 mcg/L). This method improves diagnosis of this precancerous condition.

Area Of Science

  • Gastroenterology
  • Oncology
  • Biomarker Research

Background

  • Chronic atrophic gastritis (CAG) is a precancerous condition for gastric cancer (GC).
  • Serum pepsinogen I (PG-I) is a potential non-invasive marker for CAG, but diagnostic cut-offs are debated.
  • A "grey zone" for PG-I levels (30-50 mcg/L) complicates accurate diagnosis of CAG.

Purpose Of The Study

  • To identify patients with CAG within the PG-I "grey zone" (30-50 mcg/L).
  • To evaluate the efficacy of a proton pump inhibitor (PPI) challenge test for diagnosing CAG in this ambiguous range.

Main Methods

  • 102 patients with baseline PG-I <60 mcg/L underwent endoscopy, biopsies (OLGA staging), and a PPI challenge (Esomeprazole 40 mg/day for 1 week).
  • Patients were grouped by baseline PG-I levels (e.g., <30, 31-35, 36-40, 41-50, 51-60 mcg/L).
  • ROC curve analysis determined a 30% increase in PG-I post-PPI challenge as the diagnostic cut-off.

Main Results

  • A significant correlation was observed between PG-I levels and OLGA staging, with 100% prevalence in the PG-I <30 mcg/L group.
  • The 30% PG-I increase cut-off post-PPI challenge demonstrated high diagnostic accuracy.
  • Positive predictive value was 95%, negative predictive value 86%, sensitivity 83%, and specificity 96%.

Conclusions

  • The PPI challenge test is a valuable tool for diagnosing CAG in individuals with PG-I levels between 30-50 mcg/L.
  • This method helps resolve diagnostic ambiguity in the PG-I "grey zone".
  • Improved identification of CAG can aid in early detection and management of gastric cancer risk.

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