CHANGES IN GASTRIN AND SERUM PEPSINOGENS IN MONITORING OF HELICOBACTER-PYLORI RESPONSE TO THERAPY

The aims of this study in 50 patients with H. pylori infection and duo denal ulcer were to examine the effect of eradication therapy on the s erum levels of gastrin, pepsinogen I, and pepsinogen II and to investi gate whether monitoring of the serum changes in these peptides after t reatment could predict patient outcome. H. pylori status was assessed at entry and one and six months after therapy by culturing and microsc opic analysis of the gastric mucosa and by [C-14]urea breath test. Sig nificant decreases were observed in the serum levels of gastrin (-11.4 +/- 3%), pepsinogen I (-28.9 +/- 4%), and pepsinogen II (-40.4 +/- 3% ) in the 45 patients whose infection was eradicated, but not in the pa tients without eradication. Serum values of these peptides were unchan ged in an additional group of 10 patients that only received omeprazol , none of whom had H. pylori eradicated. The best cutoff point of the percentage of each peptide to predict patient outcome was 10% for gast rin and pepsinogen I, and 15% for pepsinogen II. A pepsinogen II decre ase >15% resulted in the best marker of H. pylori clearance, accuratel y identifying patient outcome 86.6% of the time, whereas the diagnosti c accuracy of gastrin and pepsinogen I was 61.7% and 76.6%, respective ly. Significant correlations were found between the bacterial load ass essed by histology with the serum concentrations of pepsinogen I and I I and with the urease activity as measured by the amount of (CO2)-C-14 excreted. In conclusion, eradication of H. pylori infection is follow ed by a significant drop in serum levels of gastrin, pepsinogen I, and pepsinogen II. Changes in the latter are the most uniform and may be used as an indirect tool to predict treatment outcome.