AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO026110126
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ORIGINAL RESEARCH ARTICLE

Diagnostic accuracy of serum pepsinogens for detecting chronic atrophic gastritis and gastric cancer: A meta-analysis

Ganchimeg Dondov1,2 ,  Bayarmaa Nyamaa1 ,  Batbold Batsaikhan3 ,  Tegshjargal Badamjav3 ,  Sodnomtsogt Lkhagvasuren4 ,  Tulgaa Lonjid3*
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1 Department of Gastroenterology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
2 Department of Oncology, Institute of Medical Sciences, Ministry of Economy and Development, Ulaanbaatar, Mongolia
3 Department of Internal Medicine, Institute of Medical Sciences, Ministry of Economy and Development, Ulaanbaatar, Mongolia
4 Department of Applied Neuroscience, Institute of Brain and Psychology, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
EJMO, 026110126 https://doi.org/10.36922/EJMO026110126
Received: 12 March 2026 | Revised: 13 May 2026 | Accepted: 19 May 2026 | Published online: 7 July 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: Recent studies have shown that serological biomarkers such as pepsinogens may facilitate the early detection of gastric cancer.

Objective: This study aims to evaluate the diagnostic performance of serum pepsinogen I (PGI) and the PGI/pepsinogen II ratio (PGR) in detecting gastric cancer and chronic atrophic gastritis.

Methods: A systematic literature search was conducted using MeSH terms related to atrophic gastritis, gastric neoplasms, pepsinogen A, sensitivity, and specificity. Twenty-one eligible studies were included in the quantitative synthesis.

Results: For atrophic gastritis, the area under the curve was 0.74 (95% confidence interval [CI] = 0.70–0.77) for PGI and 0.78 (95% CI = 0.75–0.82) for PGR. The pooled sensitivity and specificity were 61.4% (95% CI = 48.2–73.2) and 86.4% (95% CI = 61.8–96.1), respectively, for PGI, and 72.4% (95% CI = 61.0–81.4) and 76.9% (95% CI = 49.5–91.9), respectively, for PGR. For gastric cancer detection, the area under the curve values were 0.76 (95% CI = 0.72–0.80) for PGI, 0.77 (95% CI = 0.73–0.80) for PGR, and 0.79 (95% CI = 0.75–0.83) for the combined PGI+PGR model. The pooled sensitivity and specificity were 69.8% (95% CI = 55.0–81.3) and 70.8% (95% CI = 58.7–80.6), respectively, for PGI, 76.2% (95% CI = 65.4–84.2) and 66.1% (95% CI = 56.1–74.8), respectively, for PGR, and 61.5% (95% CI = 50.9–72.1) and 86.7% (95% CI = 79.4–94.1), respectively, for PGI+PGR.

Conclusion: Serum PGI and PGR can be used as an additional screening for high-risk subjects who may require gastroscopy or biopsy.

Keywords
Biomarkers for gastric cancer
Gastric cancer screening
Gastric precancerous conditions
Sensitivity of pepsinogen
Specificity of pepsinogen
Funding
The study was funded by the Mongolian Science and Technology Foundation (Grant No: ShUSUU-SNG-2025/15).
Conflict of interest
The authors declare they have no competing interests.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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