Pepsinogen II (PG II)

• ISI Order Code:

  PGII

• CPT Code:

  83520

Clinical Significance of Pepsinogen 2
Pepsinogen II (PGII) is a precursor of the proteolytic enzyme pepsin and is produced by cells throughout the gastric mucosa, including the pyloric glands, cardiac glands, and proximal duodenal mucosa. Similar to pepsinogen I, PGII is secreted into the gastric lumen and converted to active pepsin in the acidic gastric environment, where it contributes to protein digestion. A small fraction enters the circulation and can be measured in serum. Circulating PGII concentrations reflect activity of the broader gastric mucosa and may increase in response to mucosal inflammation or stimulation of gastric secretory activity.

Pepsinogen II is used in conjunction with pepsinogen I and the PGI/PGII ratio to assess gastric mucosal status. Elevated PGII levels are commonly associated with gastric mucosal inflammation, including infection with Helicobacter pylori. Because PGII is produced in a wider region of the stomach and proximal duodenum, it is less specific for fundic gland atrophy than PGI. However, the PGI/PGII ratio is a useful indicator for identifying gastric mucosal atrophy and assessing risk for chronic atrophic gastritis and gastric cancer in certain populations.

Reference Range, Procedure & Expected Results

• Reference Range:

  Up to 22 ng/mL

• Procedure:

  Pepsinogen II is measured by direct ELISA.

• Expected Turnaround Time:

  7 Business Days

Turnaround time is defined as the usual number of days from the date of receipt of a specimen for testing to when the result is released to the ordering facility.

• Report:

  Sample Report

Pre-Test Preparation Guidelines

Patient should be fasting 10 – 12 hours prior to collection of specimen.  Antacids or other medications affecting stomach acidity or gastrointestinal motility should be discontinued, if possible, for at least 48 hours prior to collection.

Specimen Collection Instructions

3 ml serum or EDTA plasma should be collected and separated as soon as possible.  Freeze specimens immediately after separation.  Minimum specimen size is 1 ml.

Pepsinogen 2 Assay Rejection Criteria

Gross hemolysis/lipemia/icteric

Shipping and Handling Instructions for Pepsinogen 2 Assay Specimens

Special Specimens:

For tumor/tissue and various fluids (i.e. CSF, peritoneal, synovial, etc.) contact the Institute for requirements and special handling.

Shipping Instructions:

Ship specimens frozen in dry ice.

References:

1. Miki, K. (2006). Gastric cancer screening using the serum pepsinogen test method. Gastric Cancer, 9(4), 245–253.

2. Dinis-Ribeiro, M., Yamaki, G., Miki, K., Costa-Pereira, A., Matsukawa, M., & Kurihara, M. (2004). Meta-analysis on the validity of pepsinogen test for gastric carcinoma, dysplasia, and chronic atrophic gastritis screening. Journal of Medical Screening, 11(3), 141–147.

3. Samloff, I. M. (1971). Pepsinogens, pepsins, and pepsin inhibitors. Gastroenterology, 60(4), 586–604.