الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Background: Helicobacter pylori (H. pylori) is a gram-negative, helical-shaped bacterium that inhabitat the stomach lining. In 1984, two Australian scientists, Marshall and Warren, discovered the pathogenic effects of H. pylori in the stomach lining. It infects more than half of the global population, with estimates suggesting that around 4.4 billion people globally are infected. Overcrowded living conditions, inadequate housing and hygiene, limited access to safe food and water, and lower socio-economic standards are known risk factors. In Egypt, the Nile Delta has recorded an infection prevalence of around 70%. chronic infection with H. pylori, typically acquired in childhood, is known to cause active gastritis, and if left untreated, it can progress to serious gastric diseases, including gastric cancer. However, in Egypt, the prevalence and assessment of stomach mucosa diseases and H. pylori infection eradication through non-invasive measures, such as serum PG screening, remain underexplored.
Study Aim: The study aimed to determine the correaltion between H. pylori infection and serum pepsinogen (PG) levels among adult Egyptians. This approach would enable clinicians to diagnose gastric mucosal diseases early, implement H. pylori eradication strategies, and carry out endoscopic surveillance for more targeted treatment.
Methods: Following the approved study protocol and its inclusion and exclusion criteria, the study recruited 100 participants from the Alexandria Main University Hospital. These participants were categorized into three groups predicated on their H. pylori status, determined through the UBT and their presenting symptoms: group I (40 symptomatic with H. pylori), group II (40 asymptomatic with H. pylori), and group III (20 healthy controls). After obtaining their signed informed consents, all participants underwent a comprehensive medical history assessment and a thorough clinical examination. We further investigated the serum levels of PG I and PG II, as well as the PG I / PG II ratio. These parameters were analyzed for their correlation with H. pylori infection status, intragastric H. pylori bacterial load (UBT values), age, gender, and BMI.
Results: There were no meaningful differences observed between group I and group II regarding serum levels of PG I and PG II, the PG I / PG II ratio, and UBT values. However, both PGI and PGII levels were meaningful higher in H. pylori-infected individuals contrasted to the control group. Conversely, the PG I / PG II proportion was less and showed no significant difference in H. pylori-infected individuals contrasted to the control group. UBT values were also significantly higher in infected individuals, confirming the connection among H. pylori infection and serum PG levels. In this study, ROC curve analysis confirmed the significance of Serum PGI and PG II levels as predictors of H. pylori infection. Notably, PG II exhibited higher sensitivity and specificity than PG I . In contrast, the PG I / PG II ratio demonstrated only a moderate discriminative ability, lacked statistical significance, and exhibited relatively low specificity, limiting its clinical utility. Our findings demonstrated that both serum PG I and PG II are robust indicators of H. pylori infection, while the PG I / PG II ratio was discovered to be insignificant and displayed moderate accuracy, suggesting it may not be a reliable standalone diagnostic tool. We observed a statistically significant positive relation among UBT values and serum PG I and PG II levels but not with the ratio. The study also identified a statistically meaningful positive relation among serum PG II levels and age. Additionally, a majority of H. pylori-positive cases were females, indicating a potential gender-related prevalence. No significant gender differences were found for median PG I, PG II, and PG I / PG II ratios. The median BMI of the cases was slightly greater compared to the healthy cohort,