Low PGⅡ levels may indicate an increased risk of gastric mucosal intestinal metaplasia in outpatients experiencing stomach discomfort: a retrospective cross-sectional study

Low PGⅡ levels may indicate an increased risk of gastric mucosal intestinal metaplasia in outpatients experiencing stomach discomfort: a retrospective cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Low PGⅡ levels may indicate an increased risk of gastric mucosal intestinal metaplasia in outpatients experiencing stomach discomfort: a retrospective cross-sectional study Pang Xunlei, Song Chen, Li Zhang, Li Li, Yanhong Wang, Sujuan Fei This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4053090/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and aims Limited research has been conducted on the correlation between pepsinogen (PG)Ⅱ and gastric mucosal intestinal metaplasia (GIM) among individuals seeking medical attention for stomach-related issues. The objective of this retrospective cross-sectional analysis was to identify key factors associated with GIM development and explore the connection between PGⅡ levels and GIM among outpatients experiencing stomach discomfort. Methods Participants with stomach discomfort, who were not utilizing any medication to suppress stomach acid, were enrolled in the study. Logistic regression analysis was employed to investigate the association between 14 potential factors, encompassing lifestyle choices, and the occurrence of GIM within this research. Results In multivariate analysis, males (odds ratio [OR], 1.568; p = 0.013), low PGⅡ levels (OR, 0.975; p = 0.025) and the eradication history of Helicobacter pylori (Hp) (OR, 1.549; p = 0.020) were identified as risk factors for the prevalence of GIM. After adjusting for PGⅡ levels, there was a significant difference in the prevalence of GIM between males with high and low PGⅡ compared to females with high PGⅡ levels (OR 2.075 and 1.336; p = 0.005 and 0.001). There was also a significant difference in the prevalence of GIM between females with low and high PGⅡ levels (OR 1.349; p = 0.021). Among individuals with higher PGII levels, the prevalence of GIM was significantly different between females without an Hp eradiation history and males with or without eradication history (OR, 1.408 and 1.368; p = 0.016 and 0.043, respectively ). Among individuals with lower PGⅡ levels, the prevalence of GIM was significantly different between females without an Hp eradication history, females with eradication history, and males with eradication history(OR, 1.545 and 1.463; p = 0.030 and 0.005 ) . Conclusion Males, those with low PGⅡ levels, and individuals with a history of Hp eradication could be significant predictors for GIM in outpatients experiencing stomach discomfort. Low PGⅡ levels may indicate an increased risk of GIM in outpatients experiencing stomach discomfort. PGⅡ gastric mucosal intestinal metaplasia outpatient Helicobacter pylori eradication history Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction Gastric cancer (GC) continues to be one among the primary reasons behind death globally[ 1 ]. Gastric mucosal intestinal metaplasia (GIM), an early-stage precancerous condition affecting the stomach lining, has been linked to an elevated risk for developing GC. Various positive outcomes have been documented in relation to this transformation process[ 2 , 3 ]. The occurrence of this altered state arises from prolonged inflammation within stomach cells caused by bacterial elements interacting with the body's immune response mechanisms[ 4 ]. Continuous exposure to inflammation causes the disappearance of gastric glands followed by substitution of gastric mucosa with intestinal epithelium. Previous research has shown significant associations between factors like long-lasting Helicobacter pylori (Hp) infection and individuals aged over 45 years with the advancement of GIM. The persistence of injury and chronic inflammation contributes to an ongoing cycle leading to cellular reprogramming and metaplasia, increasing the risk for developing GC[ 5 ]. Presently, diagnosis for GIM relies solely on gastroscopy examination combined with pathological analysis [ 6 ]. It is crucial to identify in vitro indicators that can determine the presence or absence of GIM. Some individuals with GIM may not exhibit any symptoms, and these patients are often identified within the community[ 7 ]. Presently, serum markers for gastric function like pepsinogen (PG)Ⅰ, PG Ⅱ, and gastrin (G) 17 are being utilized to screen for gastric cancer in asymptomatic populations with favorable outcomes[ 8 ]. On the other hand, certain GIM patients encounter symptoms such as abdominal pain, discomfort in the upper abdomen, bloating, and dyspepsia. Consequently, they frequently seek medical attention at outpatient clinics[ 9 ].Some individuals experiencing symptoms are hesitant to undergo gastroscopy, while others may not be suitable candidates for the procedure. It is crucial to promptly administer appropriate tests in order to assess the condition of their gastric mucosa. PGII is synthesized and released by glands located in the antral and cardia regions that secrete mucus, as well as by chief cells and oxyntic glands[ 10 ]. PGII has the potential to indicate gastric acidity levels and could potentially signify an excess growth of bacteria in the small intestine[ 11 ]. Serum PGs are considered biomarkers that indicate damage to the stomach lining and have been linked to atherosclerosis[ 12 ]. The reduction in pepsinogen II levels cannot be consistently relied upon as an accurate marker for confirming successful eradication of Hp infection four weeks after completing treatment[ 13 ]. Presently, PG II is predominantly employed for early detection of cancer among symptom-free individuals within Chinese communities, resulting in positive results. Nevertheless, its usage is still limited when it comes to outpatients experiencing gastric symptoms. Hence, the objective of this retrospective cross-sectional analysis is to explore the association between PG and G17 in individuals visiting outpatient clinics with symptoms related to gastric diseases. The aim is to ascertain whether PG and G17 could potentially serve as an indicative factor for GIM. Methods Study design The current investigation is a retrospective cross-sectional study carried out in Xuzhou, a city situated in the northern region of Jiangsu Province, China. The study adhered to the principles outlined in the Declaration of Helsinki, which emphasizes ethical considerations in medical research involving human subjects. To ensure utmost ethical standards were upheld, this study followed the ethical guidelines for medical and health research involving human subjects in China. These guidelines prioritize patient safety, privacy protection, and informed consent. Before recruiting patients, approval for the study protocol was obtained from the institutional review boards at each participating institution after receiving clearance from the Ethics Committee at Affiliated Hospital of Xuzhou Medical University. Furthermore, this study was registered with Affiliated Hospital of Xuzhou Medical University under registration number XYFY2020-KL045-01. All participants were initially enrolled between 1 July 2020 and 1 July 2022 after providing written informed consent. The data utilized in this analysis were collected and finalized prior to conducting any statistical analyses. Study population The inclusion criteria for this study consisted of patients aged between 18 and 80 years who had a scheduled gastroscopy. Patients with any of the following conditions were excluded: (1) previous endoscopic resection; (2) history or plan of gastrectomy; (3) history or plan of chemotherapy for cancers; (4) history or plan of surgery, chemotherapy, or radiation therapy for cancers; (5) pregnant or breastfeeding women; (6) individuals with severe psychiatric disease; (7) those planning to undergo endocrine therapy, chemotherapy, or radiation at the time of enrollment; (8) individuals with gastric and/or duodenal ulcers; (9) people with moderate to severe gastritis; and finally, (10) participants deemed unsuitable for enrollment by the researcher. All eligible patients who did not meet any exclusion criteria were enrolled in this study unless informed consent was not obtained. Furthermore, blood tests measuring PGⅠ、PGⅡ and G17 levels were conducted on the patients along with completion of questionnaires regarding their Hp eradication history, smoking habits, alcohol consumption, and preference for salty taste. Hp infection was considered positive if the 13C-urea breath test yielded a DOB value ≥ 4. Serum PG I, PGII and G17 levels were examined at least one month after discontinuing proton pump inhibitors or potassium-competitive acid blockers if these medications had been administered due to their potential impact on PG. Endoscopic examination All participants underwent gastroscopy and were subsequently provided with the results. Individuals in the normal control (NC) group are characterized as those who do not exhibit gastric ulcers, erosive gastritis, atrophic gastritis, gastric cancer, or any other stomach ailments. Individuals in the GIM group are defined as those displaying a replacement of original gastric glands and concave epithelium with intestinal epithelial cells. The biopsy tissue obtained after gastroscopy for pathological examination serves as the gold standard for diagnosing GIM. Statistical analyses An independent statistician (T.N.) utilized SPSS version 27.0 for Windows software (IBM Corp., Armonk, NY, USA) to conduct all statistical analyses. A significance level of p < 0.05 was considered statistically significant. The data presented in this article encompasses information until 1 July 2022. Categorical variables were reported as frequencies and proportions, while continuous variables were described using the median and interquartile range. Statistical comparisons between these variables were performed using the Chi-square test, Fisher's exact test, or Wilcoxon rank-sum test. To evaluate the risk for GIM, a logistic regression model was employed. In order to explore factors associated with GIM prevalence, all variables assessed in the univariate analysis were included in the multivariate model. Figures were created using Grasp Prism 7 software. An interaction test was conducted to examine if there existed consistent odds ratios (ORs) across stratified groups. Results Baseline characteristics All participants were initially enrolled from 1 July 2020 to 1 July 2022. The overall occurrence of Hp infection in this investigation was found to be 64.48%, with approximately 19.64% of the enrolled individuals having received treatment for Hp eradication. A visual representation of the study's progression can be observed in Fig. 1 , while Table 1 provides comprehensive clinical characteristics of the participants, categorized into those with a single GIM and the normal control group (NC). A total of 504 individuals, comprising of 253 males and 251 females, with an average age of 55.06 ± 10.44 years (ranging from18–80 years), were included in this research project. All participants met the criteria for upper gastrointestinal endoscopy as outlined by The Gastroenterological Association of China's national dyspepsia guideline. Table 1 Characteristics of the study participants All NC GIM p Number 504 262 242 Age, y 54.96 ± 10.44 54.32 ± 10.45 56.08 ± 10.27 0.141 Gender, male 249(49.40%) 114(43.51%) 135(55.79%) 0.006 PGⅠ, µg/L 144.10 ± 73.71 149.32 ± 70.31 138.44 ± 76.96 0.098 PGⅡ, µg/L 9.77(6.32, 16.48) 10.95(6.55, 17.15) 9.13(6.12, 14.57) 0.010 PGR 15.29 ± 12.08 15.51 ± 14.07 15.06 ± 9.49 0.677 G17, pmol/L 14.22 ± 17.50 14.06 ± 16.99 14.39 ± 18.07 0.832 Salty food 163(32.34%) 94(35.88%) 69(28.51%) 0.057 Spicy food 124(24.60%) 69(26.34%) 55(20.99%) 0.348 Pickles food 167(33.12%) 91(34.73%) 76(31.40%) 0.428 leftover food 180(35.71%) 93(35.50%) 87(35.95%) 0.915 Smoking 85(16.87%) 39(14.89%) 46(19.01%) 0.217 Drinking 93(18.45%) 36(13.74%) 57(23.55%) 0.005 Hp 325(64.48%) 176(67.18%) 149(61.57%) 0.189 Hp eradication 99(19.64%) 41(15.65%) 58(23.97%) < 0.001 Demographic data and risk factors for the development of GIM For conducting multivariate analyses (Fig. 2 ), demographic information along with corresponding risk factors from two groups, NC consisting of 262 patients and GIM comprising 242 patients, was considered. In both groups, there was an Hp infection prevalence among patients, with rates at 67.18% for NC and 61.57% for GIM. Multivariate analyses revealed significant associations between male gender (OR1.568; 95%CI 1.057–2.326; p = 0.013), lower levels of PGII (OR 0.975; 95%CI 0.956–0.995; p = 0.025), and prior eradication treatment for Hp(OR l.549; 95%CI l.073-2.237; p = 0.020) with GIM. Univariate analysis identified alcohol consumption as a potential risk factor for GIM. However, these variables did not attain statistical significance during multivariate analysis. Participants were categorized into either high or low PGII groups based on their respective values. Higher incidence rateof G IM was observed within the low PGII group compared to the high PGⅡ group (p = 0.033, Fig. 3 ). The detailed association of PGⅡ and different gender with the prevalence of GIM in the multivariate analysis. There was a notable variation in GIM across different genders, with an odds ratio (OR) of 1.588 (95% CI 1.117–2.258, p = 0.010). When taking into account PGⅡ levels, a significant difference in GIM between males and females was observed within the high and low PGⅡ groups, with ORs of 2.075 and 1.336 (95% CI 1.247–3.455 and 1.119–1.595, p = 0.005 and 0.001), respectively. Furthermore, among females in the high and low PGⅡ groups, there was also a noteworthy distinction in GIM, with an OR of 1.349 (95% CI 1.046–1.739, p = 0. 021). (Fig. 4 ). The detailed association of PGⅡ and the eradication history of Hp with the prevalence of GIM in the multivariate analysis. There was a notable disparity in GIM between individuals who had undergone Hp eradication and those who hadn't, with an odds ratio (OR) of 1.789 (95% CI 1.145–2.797, p = 0.011). Taking into account the levels of PGⅡ, only individuals in the high PGⅡ group (without a history of Hp eradication) exhibited a significant difference in GIM compared to those in the low PGⅡ group (with a history of Hp eradication), with an OR of 1.422 (95% CI 1.157–1.748, p < 0.001) (Fig. 5 ). Risk of low PGⅡ level for the prevalence of GIM in patients of different gender with and without the eradication history of Hp. The participants were categorized into 8 distinct groups, comprising of a high PGⅡ group (females without prior Hp eradication history; males without prior Hp eradication history; females with previous Hp eradication history; males with previous Hp eradication history) and a low PGⅡ group (females without prior Hp eradication history; males without prior Hp eradication history; females with previous Hp eradication history; males with previous Hp eradication history). A statistically significant variation in GIM was observed among these 8 groups (p = 0.003, Fig. 6 ). After controlling for gender and previous eradication of Hp, a notable variation in GIM was observed between the high PGⅡ group (females with prior eradication of Hp) and the low PGⅡ group (females with prior eradication of Hp), with an odds ratio of 4.246 (95% CI 1.222–14.752, p = 0.023). However, there were slightly higher incidences of GIM in other groups, but these differences did not attain statistical significance (Fig. 7 ). In the comparison of the high PGⅡ group, there was a significant disparity in GIM between females without a history of Hp eradication and males with and without a history of Hp eradication, with ORs of 1.408 and 1.368 (95% CI 1.066–1.859 and 1.101–1.853, p = 0.016 and 0.043). Furthermore, when comparing the low PGⅡ group, there was a notable discrepancy in GIM between females without a history of Hp eradication and females with a history of Hp eradication as well as males with a history of Hp eradication, with ORs of 1.545 and 1.463 (95% CI 1.043–2.289 and 1.119–1.913, p = 0 .030 and 0 .005) (Fig. 8 ). Discussion GC were responsible for the majority of cancer-related deaths globally before[ 14 ]. Stomach cancer posed a significant burden primarily in East Asia while Western Europe and North America experienced comparatively lower incidence rates[ 15 , 16 ]. It is projected that between 2021–2035 there will be approximately 10 million newly diagnosed cases of gastric cancer resulting in around 5.6 million fatalities; however, a considerable percentage ranging from 7.6–35.% could potentially be prevented through diverse preventive measures[ 17 ]. This research specifically targeted patients suffering from an upset stomach who exhibited GIM (an intermediate precancerous gastric lesion)[ 18 ]. Many individuals seeking outpatient care reported experiencing symptoms related to their stomach but refrained from using prescribed medications instead opting for self-administration of drugs like omeprazole; consequently excluding them from participation in this study due to these preferences.The prevalence rate of Hp infection observed during this investigation stood[ 19 ]. This may be attributed to the fact that our hospital received a significant influx of patients referred for upper gastrointestinal tract assessment and treatment due to unsuccessful eradication of Hp, leading to a higher incidence of Hp infection compared to previous findings. Similarly, a study conducted in Thailand also reported elevated rates of Hp infection in cases of GIM[ 4 ]. Previous studies have identified risk factors linked to the development of GIM. Both bacterial virulence and host immune response play a role in gastric mucosal inflammation. Gender is a demographic variable that influences the occurrence of GIM. This study found a significant association between male patients and the presence of GIM in their gastric pathology. This aligns with previous research indicating a higher prevalence of GIM among males, possibly due to prolonged gastric inflammation. Additionally, PGⅡ as a comorbidity was independently associated with the development of GIM, although no prior reports have explored this relationship. The mechanism behind this association remains unclear. Lastly, the most crucial risk factor for developing GIM was having a history of Hp eradication since addressing this modifiable factor can halt gastric inflammatory processes and subsequent cancer cell differentiation. This study includes 3 clinical implications. Firstly, there is a significant association between low levels of PGⅡ and the prevalence of GIM. Previous research has already established a strong link between the presence of GIM and symptoms of dyspepsia[ 20 ]. PGⅡ levels serve as an indicator for the overall secretion function of the gastric mucosa, with lower levels suggesting reduced secretion function. Following the development of GIM, chief cells that secrete pepsin undergo acute reprogramming into mucin-secreting cells involved in wound healing[ 21 ]. Consequently, there is a decrease in the number of acid-producing cells within the gastric mucosa in individuals with GIM. Therefore, low levels of PGⅡ may indicate an increased risk for outpatients developing GIM. Hence, when utilizing serum gastric function as part of gastric cancer screening protocols, it is important to consider the role played by PGⅡ within the evaluation system. Some studies have indicated that individuals with PGI levels above 127.20 ng/mL are more likely to exhibit signs of GIM compared to those with high PGⅡ levels[ 22 ]. This discrepancy could be attributed to factors such as outpatient patients being included in this study where even individuals from the NC group displayed some level of stomach inflammation; thus patients within the GIM group might present low PGⅡ levels. Secondly, it is worth noting that gender was identified as an independent factor influencing the prevalence of GIM. However, it should be emphasized that the incidence of GIM can vary among individuals of the same gender but with different levels of PGⅡ. It is widely acknowledged that males have a strong association with the development of GIM [ 23 , 24 ]. Our study also observed a higher susceptibility to GIM in males. Furthermore, females with lower levels of PGⅡ are more prone to developing GIM. This implies that PGⅡ may play a significant role in the occurrence of GIM across both genders. Thirdly, although the eradication of Hp has been closely linked to the prevalence of GIM[ 25 , 26 ], there was no observed association between Hp eradication history and the occurrence of GIM in individuals with high PGⅡ levels. Conversely, individuals with low PGⅡ levels who had undergone Hp eradication exhibited a higher incidence of GIM compared to those with high PGⅡ levels and no prior history of Hp eradication. This indicates that the levels of PGⅡ play a significant role in the development of GIM among individuals who have undergone Hp eradication treatment. Consistent with the gender and eradication history of Hp, the incidence of GIM was higher in females with a history of Hp eradication who had low levels of PGⅡ compared to those with high levels. This suggests that PGⅡ levels may play a significant role in the development of GIM in females with a history of Hp eradication. In the high PGⅡ group, males with and without a history of Hp eradication exhibited a higher occurrence of GIM compared to females without a history of Hp eradication. Conversely, in the low PGⅡ group, both males and females who had undergone Hp eradication displayed an increased incidence of GIM when compared to females without a history of Hp eradication. These findings suggest that the incidence of GIM is influenced by sex and history of Hp eradication differently depending on the level of PGⅡ. The strength of our study lies in its extensive population-based analysis, which identified predictors for GIM. Moreover, it indicated that low PGⅡ contributed to GIM. Additionally, it highlighted the association between low PGⅡ levels and GIM development. However, this retrospective cross-sectional investigation encountered certain limitations. Firstly, incomplete data in some patients prevented us from conducting severity grading of GIM using the OLGIM system. Secondly, as this study was conducted at a single center, its robustness may be slightly diminished compared to multi-center studies. Nonetheless, our findings provide compelling evidence suggesting that low PGⅡ levels could potentially serve as an indicator for increased risk of gastric mucosal intestinal metaplasia among outpatients. In conclusion, males with low PGⅡ levels and a history of Hp eradication could be significant predictors for GIM in outpatients experiencing stomach discomfort. Low PGII levels may indicate an increased risk of GIM; however, it is also important to consider the patient's gender and history of Hp eradication. Declarations Acknowledgement This cross-sectional observational study was approved by the ethics committee of the Affiliated Hospital of Xuzhou Medical University (Approval no. XYFY2020-KL045-01), and written informed consent was obtained from all participants. Funding Statement This work was supported by the Key Development Project of Science and Technology Bureau in Xuzhou (Social development) [grant number KC22233]; the Key Laboratory of Jiangsu Province Open project [grant number XZSYSKF2021029]and the Project supported by the Affiliated Hospital of Xuzhou Medical University [grant number 2020KA003; 2023ZL19]. Declaration of conflict of interest : None. Disclosure statement The authors declare that they have no financial or proprietary stake in any material or method mentioned. The content and writing of the paper are solely the responsibility of the authors. All authors have duly completed and submitted the ICMJE form for disclosure of potential conflicts of interest, and there were no reported conflicts identified by any author(s). Data availability statement All the data utilized to substantiate the conclusions of this investigation can be obtained from the corresponding authors upon making a reasonable inquiry. Ethics approval and consent to participate This observational study, conducted in a cross-sectional manner, received approval from the ethics committee at the Affiliated Hospital of Xuzhou Medical University (Approval no. XYFY2020-KL045-01). All participants provided written informed consent prior to their inclusion in the study. The methods employed adhered strictly to relevant guidelines and regulations as outlined in the declaration of Helsinki. Consent for publication All authors have read the article and agreed to submit it for publication. Authors' contributions Conceptualization: Xunlei Pang, Sujuan Fei. Data curation: Yanhong Wang, Song Chen, Li Zhang. Formal analysis: Li Li. Investigation: Song Chen, Li Zhang. Methodology: Yanhong Wang. Project administration: Xunlei Pang. Supervision: Sujuan Fei. Validation: Li Li. Visualization: Song Chen, Li Zhang. Writing – original draft: Yanhong Wang. Writing – review & editing: Xunlei Pang. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4053090","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":279733734,"identity":"01328e41-9bab-4074-86a1-e00fe4be879b","order_by":0,"name":"Pang Xunlei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYBADGQZm5gMHPvwgQQsPAzNb4sGZPSRpYeAxPszBRoRSc/azh1/ztt3h4Wfn+XAYqFOeX+wAfi2WPXlpljPbnvFINvNuOFxgwWA4c3YCfi0GB3LMDD62HeYxOAzUMoOHIcHgNiEt59+YGSQCtdgf5nlwmIeNGC03cowfgG1h5mEgTovljDdmjDPOHeaROMxmAAxkCcJ+MefPMf7MU3ZYjr//8OMPH37YyPNLE3IYAwObBBJfAqdKZC3MHwgrGwWjYBSMghENAF05Q3W75njEAAAAAElFTkSuQmCC","orcid":"","institution":"Affiliated Hospital of Xuzhou Medical College","correspondingAuthor":true,"prefix":"","firstName":"Pang","middleName":"","lastName":"Xunlei","suffix":""},{"id":279733735,"identity":"61941771-4860-4874-a80f-ae72e910b6ce","order_by":1,"name":"Song Chen","email":"","orcid":"","institution":"Xuzhou Medical College","correspondingAuthor":false,"prefix":"","firstName":"Song","middleName":"","lastName":"Chen","suffix":""},{"id":279733738,"identity":"b506eb95-54c8-42cf-a906-60b7009cd23e","order_by":2,"name":"Li Zhang","email":"","orcid":"","institution":"Xuzhou Medical College","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Zhang","suffix":""},{"id":279733742,"identity":"69c1892c-8a06-40e1-a28e-08ef4d2c256e","order_by":3,"name":"Li Li","email":"","orcid":"","institution":"Affiliated Hospital of Xuzhou Medical College","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Li","suffix":""},{"id":279733745,"identity":"644e2c89-bc1a-4a49-9641-d0c195ad1a21","order_by":4,"name":"Yanhong Wang","email":"","orcid":"","institution":"Affiliated Hospital of Xuzhou Medical College","correspondingAuthor":false,"prefix":"","firstName":"Yanhong","middleName":"","lastName":"Wang","suffix":""},{"id":279733747,"identity":"bafd155d-6219-4c72-8da4-45b42bba9e41","order_by":5,"name":"Sujuan Fei","email":"","orcid":"","institution":"Affiliated Hospital of Xuzhou Medical College","correspondingAuthor":false,"prefix":"","firstName":"Sujuan","middleName":"","lastName":"Fei","suffix":""}],"badges":[],"createdAt":"2024-03-09 07:47:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4053090/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4053090/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52791533,"identity":"ada45fb8-142c-49da-83dc-a43b6c0b4607","added_by":"auto","created_at":"2024-03-15 20:01:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":98281,"visible":true,"origin":"","legend":"\u003cp\u003eThe flowchart of enrolled patients and the prevalence rates of GIM.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4053090/v1/f9d32bee94be5a6278ae6d9b.png"},{"id":52791091,"identity":"957fabcc-f6d4-413c-87f0-bec43d48079a","added_by":"auto","created_at":"2024-03-15 19:53:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":221559,"visible":true,"origin":"","legend":"\u003cp\u003eFactors associated with GIM in patients in the multivariate analysis.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4053090/v1/b2fd00849bc24a83a8b2fa88.png"},{"id":52791534,"identity":"b0384df5-4b19-46d4-b871-6fc330121a24","added_by":"auto","created_at":"2024-03-15 20:01:20","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":117919,"visible":true,"origin":"","legend":"\u003cp\u003eThe Incidence of GIM in different value of PGⅡ.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4053090/v1/8c912243dc525dbe7b10896e.png"},{"id":52791087,"identity":"f8e0e7d0-0407-4da8-8e8f-145b036e9d6d","added_by":"auto","created_at":"2024-03-15 19:53:20","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":71428,"visible":true,"origin":"","legend":"\u003cp\u003eThe detailed association of PGⅡ and different gender with the prevalence of GIM in the multivariate analysis.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-4053090/v1/6b9ffbd5b0b3b222c8d4048a.png"},{"id":52791088,"identity":"66d2d43c-1308-400b-9ab2-6bf36a837393","added_by":"auto","created_at":"2024-03-15 19:53:20","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":70158,"visible":true,"origin":"","legend":"\u003cp\u003eThe detailed association of PGⅡ and the eradication history of Hp with the prevalence of GIM in the multivariate analysis.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-4053090/v1/cd6dfa8cc6e4ec5bc79a7d34.png"},{"id":52791094,"identity":"46fe774c-473d-49bb-ac7b-d5f9ec2ec6e9","added_by":"auto","created_at":"2024-03-15 19:53:20","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":163546,"visible":true,"origin":"","legend":"\u003cp\u003eThe Incidence of GIM in different value of PGⅡin patients of different gender with and without the eradication history of Hp.\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-4053090/v1/c9e044c53ad1332d2bd75534.png"},{"id":52791092,"identity":"46b031df-c66e-454a-9920-3a4fb9ec0bab","added_by":"auto","created_at":"2024-03-15 19:53:20","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":387902,"visible":true,"origin":"","legend":"\u003cp\u003eRisk of PGⅡ for the prevalence of GIM in patients of same gender and same eradication history of Hp.\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-4053090/v1/7fe37e68d7e3467a8962d008.png"},{"id":52791535,"identity":"ccca6106-60e9-4565-9b6a-fb71772c74d0","added_by":"auto","created_at":"2024-03-15 20:01:20","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":99715,"visible":true,"origin":"","legend":"\u003cp\u003eIncidence of GIM in patients of different gender with and without the eradication history of Hp in high and low PGⅡ.\u003c/p\u003e","description":"","filename":"floatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-4053090/v1/a80521d67eb0a512b52b1fe0.png"},{"id":52792354,"identity":"5a996ef0-731b-40a1-8d8d-bc598dd7acdf","added_by":"auto","created_at":"2024-03-15 20:17:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":995148,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4053090/v1/7dad2a00-4b8e-4cad-94f7-f0fc95c6635a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Low PGⅡ levels may indicate an increased risk of gastric mucosal intestinal metaplasia in outpatients experiencing stomach discomfort: a retrospective cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGastric cancer (GC) continues to be one among the primary reasons behind death globally[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Gastric mucosal intestinal metaplasia (GIM), an early-stage precancerous condition affecting the stomach lining, has been linked to an elevated risk for developing GC. Various positive outcomes have been documented in relation to this transformation process[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The occurrence of this altered state arises from prolonged inflammation within stomach cells caused by bacterial elements interacting with the body's immune response mechanisms[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Continuous exposure to inflammation causes the disappearance of gastric glands followed by substitution of gastric mucosa with intestinal epithelium. Previous research has shown significant associations between factors like long-lasting Helicobacter pylori (Hp) infection and individuals aged over 45 years with the advancement of GIM. The persistence of injury and chronic inflammation contributes to an ongoing cycle leading to cellular reprogramming and metaplasia, increasing the risk for developing GC[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Presently, diagnosis for GIM relies solely on gastroscopy examination combined with pathological analysis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. It is crucial to identify in vitro indicators that can determine the presence or absence of GIM.\u003c/p\u003e \u003cp\u003eSome individuals with GIM may not exhibit any symptoms, and these patients are often identified within the community[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Presently, serum markers for gastric function like pepsinogen (PG)Ⅰ, PG Ⅱ, and gastrin (G) 17 are being utilized to screen for gastric cancer in asymptomatic populations with favorable outcomes[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. On the other hand, certain GIM patients encounter symptoms such as abdominal pain, discomfort in the upper abdomen, bloating, and dyspepsia. Consequently, they frequently seek medical attention at outpatient clinics[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].Some individuals experiencing symptoms are hesitant to undergo gastroscopy, while others may not be suitable candidates for the procedure. It is crucial to promptly administer appropriate tests in order to assess the condition of their gastric mucosa.\u003c/p\u003e \u003cp\u003ePGII is synthesized and released by glands located in the antral and cardia regions that secrete mucus, as well as by chief cells and oxyntic glands[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. PGII has the potential to indicate gastric acidity levels and could potentially signify an excess growth of bacteria in the small intestine[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Serum PGs are considered biomarkers that indicate damage to the stomach lining and have been linked to atherosclerosis[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The reduction in pepsinogen II levels cannot be consistently relied upon as an accurate marker for confirming successful eradication of Hp infection four weeks after completing treatment[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Presently, PG II is predominantly employed for early detection of cancer among symptom-free individuals within Chinese communities, resulting in positive results. Nevertheless, its usage is still limited when it comes to outpatients experiencing gastric symptoms.\u003c/p\u003e \u003cp\u003eHence, the objective of this retrospective cross-sectional analysis is to explore the association between PG and G17 in individuals visiting outpatient clinics with symptoms related to gastric diseases. The aim is to ascertain whether PG and G17 could potentially serve as an indicative factor for GIM.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThe current investigation is a retrospective cross-sectional study carried out in Xuzhou, a city situated in the northern region of Jiangsu Province, China. The study adhered to the principles outlined in the Declaration of Helsinki, which emphasizes ethical considerations in medical research involving human subjects. To ensure utmost ethical standards were upheld, this study followed the ethical guidelines for medical and health research involving human subjects in China. These guidelines prioritize patient safety, privacy protection, and informed consent. Before recruiting patients, approval for the study protocol was obtained from the institutional review boards at each participating institution after receiving clearance from the Ethics Committee at Affiliated Hospital of Xuzhou Medical University. Furthermore, this study was registered with Affiliated Hospital of Xuzhou Medical University under registration number XYFY2020-KL045-01. All participants were initially enrolled between 1 July 2020 and 1 July 2022 after providing written informed consent. The data utilized in this analysis were collected and finalized prior to conducting any statistical analyses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThe inclusion criteria for this study consisted of patients aged between 18 and 80 years who had a scheduled gastroscopy. Patients with any of the following conditions were excluded: (1) previous endoscopic resection; (2) history or plan of gastrectomy; (3) history or plan of chemotherapy for cancers; (4) history or plan of surgery, chemotherapy, or radiation therapy for cancers; (5) pregnant or breastfeeding women; (6) individuals with severe psychiatric disease; (7) those planning to undergo endocrine therapy, chemotherapy, or radiation at the time of enrollment; (8) individuals with gastric and/or duodenal ulcers; (9) people with moderate to severe gastritis; and finally, (10) participants deemed unsuitable for enrollment by the researcher. All eligible patients who did not meet any exclusion criteria were enrolled in this study unless informed consent was not obtained. Furthermore, blood tests measuring PGⅠ、PGⅡ and G17 levels were conducted on the patients along with completion of questionnaires regarding their Hp eradication history, smoking habits, alcohol consumption, and preference for salty taste. Hp infection was considered positive if the 13C-urea breath test yielded a DOB value\u0026thinsp;\u0026ge;\u0026thinsp;4. Serum PG I, PGII and G17 levels were examined at least one month after discontinuing proton pump inhibitors or potassium-competitive acid blockers if these medications had been administered due to their potential impact on PG.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEndoscopic examination\u003c/h2\u003e \u003cp\u003eAll participants underwent gastroscopy and were subsequently provided with the results. Individuals in the normal control (NC) group are characterized as those who do not exhibit gastric ulcers, erosive gastritis, atrophic gastritis, gastric cancer, or any other stomach ailments. Individuals in the GIM group are defined as those displaying a replacement of original gastric glands and concave epithelium with intestinal epithelial cells. The biopsy tissue obtained after gastroscopy for pathological examination serves as the gold standard for diagnosing GIM.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eAn independent statistician (T.N.) utilized SPSS version 27.0 for Windows software (IBM Corp., Armonk, NY, USA) to conduct all statistical analyses. A significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. The data presented in this article encompasses information until 1 July 2022. Categorical variables were reported as frequencies and proportions, while continuous variables were described using the median and interquartile range. Statistical comparisons between these variables were performed using the Chi-square test, Fisher's exact test, or Wilcoxon rank-sum test. To evaluate the risk for GIM, a logistic regression model was employed. In order to explore factors associated with GIM prevalence, all variables assessed in the univariate analysis were included in the multivariate model. Figures were created using Grasp Prism 7 software. An interaction test was conducted to examine if there existed consistent odds ratios (ORs) across stratified groups.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAll participants were initially enrolled from 1 July 2020 to 1 July 2022. The overall occurrence of Hp infection in this investigation was found to be 64.48%, with approximately 19.64% of the enrolled individuals having received treatment for Hp eradication. A visual representation of the study's progression can be observed in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, while Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides comprehensive clinical characteristics of the participants, categorized into those with a single GIM and the normal control group (NC). A total of 504 individuals, comprising of 253 males and 251 females, with an average age of 55.06\u0026thinsp;\u0026plusmn;\u0026thinsp;10.44 years (ranging from18\u0026ndash;80 years), were included in this research project. All participants met the criteria for upper gastrointestinal endoscopy as outlined by The Gastroenterological Association of China's national dyspepsia guideline.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGIM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.96\u0026thinsp;\u0026plusmn;\u0026thinsp;10.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.32\u0026thinsp;\u0026plusmn;\u0026thinsp;10.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.08\u0026thinsp;\u0026plusmn;\u0026thinsp;10.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e249(49.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114(43.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e135(55.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGⅠ, \u0026micro;g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144.10\u0026thinsp;\u0026plusmn;\u0026thinsp;73.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e149.32\u0026thinsp;\u0026plusmn;\u0026thinsp;70.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e138.44\u0026thinsp;\u0026plusmn;\u0026thinsp;76.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGⅡ, \u0026micro;g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.77(6.32, 16.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.95(6.55, 17.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.13(6.12, 14.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePGR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.29\u0026thinsp;\u0026plusmn;\u0026thinsp;12.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.51\u0026thinsp;\u0026plusmn;\u0026thinsp;14.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.06\u0026thinsp;\u0026plusmn;\u0026thinsp;9.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.677\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG17, pmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.22\u0026thinsp;\u0026plusmn;\u0026thinsp;17.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.06\u0026thinsp;\u0026plusmn;\u0026thinsp;16.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.39\u0026thinsp;\u0026plusmn;\u0026thinsp;18.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.832\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSalty food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e163(32.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94(35.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69(28.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpicy food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124(24.60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69(26.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55(20.99%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.348\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePickles food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167(33.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91(34.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76(31.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.428\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eleftover food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180(35.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93(35.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87(35.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.915\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85(16.87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(14.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46(19.01%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93(18.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(13.74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57(23.55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e325(64.48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e176(67.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149(61.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHp eradication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99(19.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(15.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58(23.97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDemographic data and risk factors for the development of GIM\u003c/h2\u003e \u003cp\u003eFor conducting multivariate analyses (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), demographic information along with corresponding risk factors from two groups, NC consisting of 262 patients and GIM comprising 242 patients, was considered. In both groups, there was an Hp infection prevalence among patients, with rates at 67.18% for NC and 61.57% for GIM. Multivariate analyses revealed significant associations between male gender (OR1.568; 95%CI 1.057\u0026ndash;2.326; p\u0026thinsp;=\u0026thinsp;0.013), lower levels of PGII (OR 0.975; 95%CI 0.956\u0026ndash;0.995; p\u0026thinsp;=\u0026thinsp;0.025), and prior eradication treatment for Hp(OR l.549; 95%CI l.073-2.237; p\u0026thinsp;=\u0026thinsp;0.020) with GIM. Univariate analysis identified alcohol consumption as a potential risk factor for GIM. However, these variables did not attain statistical significance during multivariate analysis. Participants were categorized into either high or low PGII groups based on their respective values. Higher incidence rateof G IM was observed within the low PGII group compared to the high PGⅡ group (p\u0026thinsp;=\u0026thinsp;0.033, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eThe detailed association of PGⅡ and different gender with the prevalence of GIM in the multivariate analysis.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThere was a notable variation in GIM across different genders, with an odds ratio (OR) of 1.588 (95% CI 1.117\u0026ndash;2.258, p\u0026thinsp;=\u0026thinsp;0.010). When taking into account PGⅡ levels, a significant difference in GIM between males and females was observed within the high and low PGⅡ groups, with ORs of 2.075 and 1.336 (95% CI 1.247\u0026ndash;3.455 and 1.119\u0026ndash;1.595, p\u0026thinsp;=\u0026thinsp;0.005 and 0.001), respectively. Furthermore, among females in the high and low PGⅡ groups, there was also a noteworthy distinction in GIM, with an OR of 1.349 (95% CI 1.046\u0026ndash;1.739, p\u0026thinsp;=\u0026thinsp;0. 021). (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eThe detailed association of PGⅡ and the eradication history of Hp with the prevalence of GIM in the multivariate analysis.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThere was a notable disparity in GIM between individuals who had undergone Hp eradication and those who hadn't, with an odds ratio (OR) of 1.789 (95% CI 1.145\u0026ndash;2.797, p\u0026thinsp;=\u0026thinsp;0.011). Taking into account the levels of PGⅡ, only individuals in the high PGⅡ group (without a history of Hp eradication) exhibited a significant difference in GIM compared to those in the low PGⅡ group (with a history of Hp eradication), with an OR of 1.422 (95% CI 1.157\u0026ndash;1.748, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eRisk of low PGⅡ level for the prevalence of GIM in patients of different gender with and without the eradication history of Hp.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe participants were categorized into 8 distinct groups, comprising of a high PGⅡ group (females without prior Hp eradication history; males without prior Hp eradication history; females with previous Hp eradication history; males with previous Hp eradication history) and a low PGⅡ group (females without prior Hp eradication history; males without prior Hp eradication history; females with previous Hp eradication history; males with previous Hp eradication history). A statistically significant variation in GIM was observed among these 8 groups (p\u0026thinsp;=\u0026thinsp;0.003, Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAfter controlling for gender and previous eradication of Hp, a notable variation in GIM was observed between the high PGⅡ group (females with prior eradication of Hp) and the low PGⅡ group (females with prior eradication of Hp), with an odds ratio of 4.246 (95% CI 1.222\u0026ndash;14.752, p\u0026thinsp;=\u0026thinsp;0.023). However, there were slightly higher incidences of GIM in other groups, but these differences did not attain statistical significance (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn the comparison of the high PGⅡ group, there was a significant disparity in GIM between females without a history of Hp eradication and males with and without a history of Hp eradication, with ORs of 1.408 and 1.368 (95% CI 1.066\u0026ndash;1.859 and 1.101\u0026ndash;1.853, p\u0026thinsp;=\u0026thinsp;0.016 and 0.043). Furthermore, when comparing the low PGⅡ group, there was a notable discrepancy in GIM between females without a history of Hp eradication and females with a history of Hp eradication as well as males with a history of Hp eradication, with ORs of 1.545 and 1.463 (95% CI 1.043\u0026ndash;2.289 and 1.119\u0026ndash;1.913, p\u0026thinsp;=\u0026thinsp;0 .030 and 0 .005) (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eGC were responsible for the majority of cancer-related deaths globally before[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Stomach cancer posed a significant burden primarily in East Asia while Western Europe and North America experienced comparatively lower incidence rates[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. It is projected that between 2021\u0026ndash;2035 there will be approximately 10\u0026nbsp;million newly diagnosed cases of gastric cancer resulting in around 5.6\u0026nbsp;million fatalities; however, a considerable percentage ranging from 7.6\u0026ndash;35.% could potentially be prevented through diverse preventive measures[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This research specifically targeted patients suffering from an upset stomach who exhibited GIM (an intermediate precancerous gastric lesion)[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Many individuals seeking outpatient care reported experiencing symptoms related to their stomach but refrained from using prescribed medications instead opting for self-administration of drugs like omeprazole; consequently excluding them from participation in this study due to these preferences.The prevalence rate of Hp infection observed during this investigation stood[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This may be attributed to the fact that our hospital received a significant influx of patients referred for upper gastrointestinal tract assessment and treatment due to unsuccessful eradication of Hp, leading to a higher incidence of Hp infection compared to previous findings. Similarly, a study conducted in Thailand also reported elevated rates of Hp infection in cases of GIM[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies have identified risk factors linked to the development of GIM. Both bacterial virulence and host immune response play a role in gastric mucosal inflammation. Gender is a demographic variable that influences the occurrence of GIM. This study found a significant association between male patients and the presence of GIM in their gastric pathology. This aligns with previous research indicating a higher prevalence of GIM among males, possibly due to prolonged gastric inflammation. Additionally, PGⅡ as a comorbidity was independently associated with the development of GIM, although no prior reports have explored this relationship. The mechanism behind this association remains unclear. Lastly, the most crucial risk factor for developing GIM was having a history of Hp eradication since addressing this modifiable factor can halt gastric inflammatory processes and subsequent cancer cell differentiation.\u003c/p\u003e \u003cp\u003eThis study includes 3 clinical implications. Firstly, there is a significant association between low levels of PGⅡ and the prevalence of GIM. Previous research has already established a strong link between the presence of GIM and symptoms of dyspepsia[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. PGⅡ levels serve as an indicator for the overall secretion function of the gastric mucosa, with lower levels suggesting reduced secretion function. Following the development of GIM, chief cells that secrete pepsin undergo acute reprogramming into mucin-secreting cells involved in wound healing[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Consequently, there is a decrease in the number of acid-producing cells within the gastric mucosa in individuals with GIM. Therefore, low levels of PGⅡ may indicate an increased risk for outpatients developing GIM. Hence, when utilizing serum gastric function as part of gastric cancer screening protocols, it is important to consider the role played by PGⅡ within the evaluation system. Some studies have indicated that individuals with PGI levels above 127.20 ng/mL are more likely to exhibit signs of GIM compared to those with high PGⅡ levels[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This discrepancy could be attributed to factors such as outpatient patients being included in this study where even individuals from the NC group displayed some level of stomach inflammation; thus patients within the GIM group might present low PGⅡ levels.\u003c/p\u003e \u003cp\u003eSecondly, it is worth noting that gender was identified as an independent factor influencing the prevalence of GIM. However, it should be emphasized that the incidence of GIM can vary among individuals of the same gender but with different levels of PGⅡ. It is widely acknowledged that males have a strong association with the development of GIM [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Our study also observed a higher susceptibility to GIM in males. Furthermore, females with lower levels of PGⅡ are more prone to developing GIM. This implies that PGⅡ may play a significant role in the occurrence of GIM across both genders.\u003c/p\u003e \u003cp\u003eThirdly, although the eradication of Hp has been closely linked to the prevalence of GIM[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], there was no observed association between Hp eradication history and the occurrence of GIM in individuals with high PGⅡ levels. Conversely, individuals with low PGⅡ levels who had undergone Hp eradication exhibited a higher incidence of GIM compared to those with high PGⅡ levels and no prior history of Hp eradication. This indicates that the levels of PGⅡ play a significant role in the development of GIM among individuals who have undergone Hp eradication treatment.\u003c/p\u003e \u003cp\u003eConsistent with the gender and eradication history of Hp, the incidence of GIM was higher in females with a history of Hp eradication who had low levels of PGⅡ compared to those with high levels. This suggests that PGⅡ levels may play a significant role in the development of GIM in females with a history of Hp eradication.\u003c/p\u003e \u003cp\u003eIn the high PGⅡ group, males with and without a history of Hp eradication exhibited a higher occurrence of GIM compared to females without a history of Hp eradication. Conversely, in the low PGⅡ group, both males and females who had undergone Hp eradication displayed an increased incidence of GIM when compared to females without a history of Hp eradication. These findings suggest that the incidence of GIM is influenced by sex and history of Hp eradication differently depending on the level of PGⅡ.\u003c/p\u003e \u003cp\u003eThe strength of our study lies in its extensive population-based analysis, which identified predictors for GIM. Moreover, it indicated that low PGⅡ contributed to GIM. Additionally, it highlighted the association between low PGⅡ levels and GIM development. However, this retrospective cross-sectional investigation encountered certain limitations. Firstly, incomplete data in some patients prevented us from conducting severity grading of GIM using the OLGIM system. Secondly, as this study was conducted at a single center, its robustness may be slightly diminished compared to multi-center studies. Nonetheless, our findings provide compelling evidence suggesting that low PGⅡ levels could potentially serve as an indicator for increased risk of gastric mucosal intestinal metaplasia among outpatients.\u003c/p\u003e \u003cp\u003eIn conclusion, males with low PGⅡ levels and a history of Hp eradication could be significant predictors for GIM in outpatients experiencing stomach discomfort. Low PGII levels may indicate an increased risk of GIM; however, it is also important to consider the patient's gender and history of Hp eradication.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional observational study was approved by the ethics committee of the Affiliated Hospital of Xuzhou Medical University (Approval no. XYFY2020-KL045-01), and written informed consent was obtained from all participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Key Development Project of Science and Technology Bureau in Xuzhou (Social development) [grant number KC22233]; the Key Laboratory of Jiangsu Province Open project [grant number XZSYSKF2021029]and\u003c/p\u003e\n\u003cp\u003ethe Project supported by the Affiliated Hospital of Xuzhou Medical University [grant number 2020KA003; 2023ZL19].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of conflict of interest\u003c/strong\u003e: None. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no financial or proprietary stake in any material or method mentioned. The content and writing of the paper are solely the responsibility of the authors. All authors have duly completed and submitted the ICMJE form for disclosure of potential conflicts of interest, and there were no reported conflicts identified by any author(s).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAll the data utilized to substantiate the conclusions of this investigation can be obtained from the corresponding authors upon making a reasonable inquiry.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This observational study, conducted in a cross-sectional manner, received approval from the ethics committee at the Affiliated Hospital of Xuzhou Medical University (Approval no. XYFY2020-KL045-01). All participants provided written informed consent prior to their inclusion in the study. The methods employed adhered strictly to relevant guidelines and regulations as outlined in the declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All authors have read the article and agreed to submit it for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: Xunlei Pang, Sujuan Fei.\u003c/p\u003e\n\u003cp\u003eData curation: Yanhong Wang, Song Chen, Li Zhang.\u003c/p\u003e\n\u003cp\u003eFormal analysis: Li Li.\u003c/p\u003e\n\u003cp\u003eInvestigation: Song Chen, Li Zhang.\u003c/p\u003e\n\u003cp\u003eMethodology: Yanhong Wang.\u003c/p\u003e\n\u003cp\u003eProject administration: Xunlei Pang.\u003c/p\u003e\n\u003cp\u003eSupervision: Sujuan Fei.\u003c/p\u003e\n\u003cp\u003eValidation: Li Li.\u003c/p\u003e\n\u003cp\u003eVisualization: Song Chen, Li Zhang.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWriting\u0026nbsp;\u0026ndash;\u0026nbsp;original draft: Yanhong Wang.\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; review \u0026amp; editing: Xunlei Pang.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJonaitis, P., Kupcinskas, L. \u0026amp; Kupcinskas, J. 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Y.\u003cem\u003e et al.\u003c/em\u003e Gastric microbes associated with gastric inflammation, atrophy and intestinal metaplasia 1 year after Helicobacter pylori eradication. \u003cem\u003eGut\u003c/em\u003e \u003cstrong\u003e69\u003c/strong\u003e, 1572-1580, doi:10.1136/gutjnl-2019-319826 (2020).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"PGⅡ, gastric mucosal intestinal metaplasia, outpatient, Helicobacter pylori eradication history","lastPublishedDoi":"10.21203/rs.3.rs-4053090/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4053090/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and aims\u003c/h2\u003e \u003cp\u003eLimited research has been conducted on the correlation between pepsinogen (PG)Ⅱ and gastric mucosal intestinal metaplasia (GIM) among individuals seeking medical attention for stomach-related issues. The objective of this retrospective cross-sectional analysis was to identify key factors associated with GIM development and explore the connection between PGⅡ levels and GIM among outpatients experiencing stomach discomfort.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e Participants with stomach discomfort, who were not utilizing any medication to suppress stomach acid, were enrolled in the study. Logistic regression analysis was employed to investigate the association between 14 potential factors, encompassing lifestyle choices, and the occurrence of GIM within this research.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn multivariate analysis, males (odds ratio [OR], 1.568; p\u0026thinsp;=\u0026thinsp;0.013), low PGⅡ levels (OR, 0.975; p\u0026thinsp;=\u0026thinsp;0.025) and the eradication history of Helicobacter pylori (Hp) (OR, 1.549; p\u0026thinsp;=\u0026thinsp;0.020) were identified as risk factors for the prevalence of GIM. After adjusting for PGⅡ levels, there was a significant difference in the prevalence of GIM between males with high and low PGⅡ compared to females with high PGⅡ levels (OR 2.075 and 1.336; p\u0026thinsp;=\u0026thinsp;0.005 and 0.001). There was also a significant difference in the prevalence of GIM between females with low and high PGⅡ levels (OR 1.349; p\u0026thinsp;=\u0026thinsp;0.021). Among individuals with higher PGII levels, the prevalence of GIM was significantly different between females without an Hp eradiation history and males with or without eradication history (OR, 1.408 and 1.368; p\u0026thinsp;=\u0026thinsp;0.016 and 0.043, respectively ). Among individuals with lower PGⅡ levels, the prevalence of GIM was significantly different between females without an Hp eradication history, females with eradication history, and males with eradication history(OR, 1.545 and 1.463; p\u0026thinsp;=\u0026thinsp;0.030 and 0.005 ) .\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMales, those with low PGⅡ levels, and individuals with a history of Hp eradication could be significant predictors for GIM in outpatients experiencing stomach discomfort. Low PGⅡ levels may indicate an increased risk of GIM in outpatients experiencing stomach discomfort.\u003c/p\u003e","manuscriptTitle":"Low PGⅡ levels may indicate an increased risk of gastric mucosal intestinal metaplasia in outpatients experiencing stomach discomfort: a retrospective cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-15 19:53:15","doi":"10.21203/rs.3.rs-4053090/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"115ffa13-e0d4-4c3e-8060-90ba68673bfd","owner":[],"postedDate":"March 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-15T19:53:17+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-15 19:53:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4053090","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4053090","identity":"rs-4053090","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}