Long‐term Effect of Helicobacter pylori Infection on Serum Pepsinogens

Serum pepsinogen values are markers of gastric mucosal status and of gastric cancer risk. The effect of Helicobacter pylori infection and sibship size on change of serum pepsinogen values over a seven‐year span was investigated. Data from 2584 subjects with phlebotomy were analyzed both in 1989 and in 1996. The subjects were classified by H. pylori serology and sibship size (1–3 vs. 4 and more). Pepsinogen I (PG I) to II (PG II) ratio in‘96 minus that in‘89 was defined as ΔPG I/II and compared among the groups. ΔPG I/II was lower and decrease of PG I/II was more frequent among H. pylori‐positive subjects than among negative subjects. The difference was owing to a decrease of PG I in all subjects and owing to an increase of PG II in those not younger than 30 years in‘89. In H. pylori‐positive subjects, those with a larger sibship size showed lower ΔPG I/II and higher frequency of PG I/II decline. H. pylori infection exerts a reducing effect on PG I/II during the seven‐year span. The effect of H. pylori is stronger among those with a larger sibship size, who are expected to have been infected with H. pylori in childhood. Inducing atrophy of gastric mucosa, which is reflected by a decline of PG I/II, may be one of the mechanisms through which H. pylori elevates the risk of gastric cancer.