A Study Of Correlation Between Serum Pepsinogen And Functional Dyspepsia Symptoms

Objective:This study aims to identify whether serum pepsinogen I,pepsinogen II and their ratio PGR are related to the symptoms of functional dyspepsia.Also,the study evaluates the value of pepsinogen in decision making of functional dyspepsia,like anti-acid drugs and eradication of Helicobacter Pylori.Methods:We collected patients and cases in digestive outpatient department in Shanghai Renji Hospital from September 2012 to January 2014.We randomly selected 50 cases of epigastric pain syndrome(EPS),50 cases of postprandial distress syndrome(PDS),and 100 cases of asymptomatic healthy controls matching the demographic characteristics of above cases.All of the functional dyspepsia cases receive routine biochemical test and endoscopy to exclude organic disease.We use three methods,rapid urease test with biopsy tissue in endoscope,¹³C breath test and histology specific dyeing to judge whether the patient has Helicobacter Pylori infection.We use ELISA to detect serum pepsinogen I,pepsinogen II and their ratio PGR.After all the tests,patients are required to fill short form Leeds Dyspepsia Questionare to record symptom severity and frequency.The control group doesn't receive upper gastric endoscopy,but serum HP antibody of current infection.We analyze the data of pepesinogen,calculate the sensitivity and specificity of pepsinogen diagnosing functional dyspepsia,find the correlation between pepsinogen and dyspepsia symptoms and detect whether HP infection status concerns pepsinogen in different type of functional dyspepsia.Results:In FD group and control group,gender has no significant difference in PG level.Cases are divided into three groups by age,which is under 40,41 to 50 and over 51,and PG level doesn't show significant change in any two of the three groups.In FD group,Body Mass Index(BMI)has no correlation with PGI or PGII.In control group BMI correlates with PGII(r=0.63,P=0.037).In FD group,PGI,PGII,but not PGR are significantly higher than control group(P<0.005).In subgroup analysis,PGI,PGII and PGR are higher in EPS group than in control group(P<0.001).PGI and PGII are higher in PDS group than in control group(P<0.005),but PGR is lower,respectively(P<0.001).According to the ROC curve,we find that the best boundary value of PGI to diagnose FD is 97.5?g/L,with a sensitivity of 92%and a specificity of 88%and PGII is 9.19?g/L,with a sensitivity of 88%and a specificity of 82%.FD group,EPS group and PDS group have no significant difference in total symptom score.Total symptom score is consistent with PGI and PGII(r=0.55,P=0.009;r=0.48,P=0.028).From all the symptoms,upper-abdominal pain,epigastric burning and nausea score is correlated with PGI(r=0.56,P=0.008;r=0.43,P=0.048;r=0.44,P=0.048),while early satiety is correlated with PGII.HP infection rate in EPS group shows no difference from PDS and control group.But the rate is significantly higher in PDS group than in control group(P=0.03).In EPS and control group,PG level shows no statistic change regardless of HP status.However,PGII level is significantly higher in PDS group if the patient has HP infection,which leads a lower PGR(P=0.03).The symptom score in EPS patient doesn't change with HP status,while in PDS group,HP positive patients get a higher score(P=0.02).Conclusions:Serum pepsinogen test is hardly affected by age,gender and BMI,so the test can objectively reflect the secretion function of gastric mucosa.PG level may be different in EPS and PDS group,suggesting a different mechanism of symptoms.HP status have no matter with PG level in EPS group.However,in PDS group,HP positive cases get a significant higher PGII and lower PGR.