Data from the National Cancer Registry Center shows that China sees 3.284 million new malignant tumor cases annually, with 679,100 cases being gastric cancer; 2.359 million people die from cancer each year in China, including 498,000 deaths from gastric cancer. This means every 1-2 minutes, one Chinese person dies from gastric cancer! More than 90% of gastric cancer patients are already in the middle or late stage by the time they visit a hospital, and their survival rate drops to less than 20%!
The key to reducing gastric cancer mortality lies in early detection, early diagnosis, and early treatment. Therefore, early screening for gastric cancer is particularly crucial. However, regular physical examinations typically do not include gastroscopy, as this equipment is only available in higher-level hospitals. This makes screening very difficult, often relying on a few cancer-related antigens which have poor sensitivity and low accuracy.
The "Four-item Gastric Function Test" can detect gastric lesions in a timely manner. The latest Consensus Opinion on Early Gastric Cancer Screening and Endoscopic Diagnosis and Treatment in China has included the four-item gastric function test as part of early gastric cancer screening programs.
What are the Four Items in the Gastric Function Test?
Pepsinogen I (PGI)
Pepsinogen II (PGII)
Gastrin-17 (G-17)
Pepsinogen Ratio (PGR)
Pepsinogen is the precursor of pepsin. Based on its biochemical properties and immunogenicity, it is divided into two subgroups: I and II. Pepsinogen I is secreted by the chief cells and mucous neck cells of the gastric fundus glands. Pepsinogen II is secreted by the fundus glands, cardiac glands, pyloric glands, and Brunner's glands. Although the concentration of PGII is relatively low, its secretion area is larger than that of PGI.
Pepsinogen Ratio (PGR) = PGⅠ / PGⅡ
PGⅠ ↓, PGⅡ normal, PGR progressively decreasing: Associated with progressive atrophy of the gastric body and fundus mucosa.
PGⅠ normal, PGⅡ ↑, PGR decreasing: Associated with H. pylori infection, peptic ulcers, and antral diseases.
The primary physiological role of G-17 is to stimulate the secretion of gastric acid and pepsin. It promotes mucosal growth, provides nutrition to the mucosa, and regulates gastrointestinal function, playing a very important role in the normal function of the gastrointestinal tract. Gastrin-17 testing can reflect the state of antral mucosal atrophy.
What are the Clinical Applications of the Four-item Gastric Function Test?
Primary Screening for Gastric Cancer and Common Gastric Diseases
H. pylori Infection Screening: Research indicates that over 35% of gastric cancers are caused by H. pylori infection.
Peptic Ulcer Screening and Dynamic Monitoring of Individual Mucosal Function: The secretion levels of pepsinogen can indicate the state and function of the gastric mucosa. When gastric mucosal lesions occur, serum PG levels change accordingly.
Diagnosis of Atrophic Gastritis: H. pylori infection is widely recognized as a primary cause of chronic atrophic gastritis. Combining H. pylori testing with PG secretion levels can not only diagnose atrophic gastritis but also determine if it is caused by H. pylori infection.
Assessment of Recurrence After Gastric Cancer Resection
After gastric cancer resection, PG secretion levels tend to stabilize. When gastric cancer recurs, PG secretion levels show abnormal fluctuations.
Clinical Advantages of the Four-item Gastric Function Test
The four-item gastric function test is the preferred screening method for the early prevention, detection, diagnosis, and treatment of gastric cancer. It is non-invasive, simple, reliable, and cost-effective. It allows for the large-scale screening of high-risk individuals from the normal population, who can then undergo gastroscopy.
Numerous clinical studies conducted over many years, both domestically and internationally, have shown that clinical screening and diagnosis using the four-item gastric function test (PGI, PGII, PGR, and H. pylori) are of great significance for the early detection and definitive diagnosis of gastric cancer.
High-Risk Groups for Gastric Cancer
Adults, especially those with frequent gastric discomfort such as acid reflux, heartburn, indigestion, or stomach pain.
Office workers, those who are sedentary and lack exercise, frequently travel on business, or have irregular meals.
Individuals with frequent social engagements, smokers, and drinkers.
Individuals previously tested for H. pylori, or patients undergoing H. pylori treatment.
Individuals with a history of gastric diseases like chronic gastritis or peptic ulcers, or those who have undergone gastric surgery.
First-degree relatives of gastric cancer patients.
Individuals who prefer pickled foods, barbecue, and frequently experience diarrhea.
Smokers: Smoking is associated with gastric cancer risk in a dose-dependent manner and is linked to higher recurrence and mortality rates.
Individuals under high life stress and those who frequently stay up late.
Individuals with blood type A.
Clinical Interpretation
Abnormal PGI may indicate atrophy or damage to the gastric body or fundus mucosa, potentially related to conditions like superficial gastritis or atrophic gastritis. If the value exceeds 200, it may be related to dietary factors, medication irritation, H. pylori infection, gastric ulcers, or duodenal ulcers.
Abnormal PGII may be associated with H. pylori infection, gastric ulcers, duodenal ulcers, and antral diseases.
Abnormal Ratio (PGR) may be associated with superficial gastritis, atrophic gastritis, H. pylori infection, gastric ulcers, duodenal ulcers, and antral diseases.
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