International references
RE.GA.IN.
Recent European guidance confirms that gastric mucosal atrophy can be assessed non-invasively using functional gastric serology, defined as pepsinogen I and II together with gastrin-17. The document states that atrophic gastritis is characterized by reduced PGI/PGII ratio, impaired acid secretion and increased gastrin levels, and that combined biomarker panels are useful both for assessment and monitoring of atrophic mucosal involvement.
The Maastricht/Florence consensus
The Maastricht/Florence consensus reports explicitly recognize a panel of serological tests (GastroPanel) — including pepsinogen I and II, Gastrin-17, and H. pylori antibodies — as a form of “serological biopsy” in dyspeptic patients. They note that, particularly in populations with a low prevalence of atrophic gastritis, the negative predictive value of the GastroPanel for excluding atrophic gastritis can reach up to 97%, supporting its role in noninvasive risk stratification and selection of patients for endoscopy.
The Kyoto Consensus
The Kyoto Consensus strongly supports gastric serology for cancer risk stratification, concluding with a strong recommendation that pepsinogen-based serology with H. pylori antibodies identifies individuals at increased risk. It also notes that multi-marker panels including pepsinogens and gastrin are established, non-invasive tools for both individual assessment and population-level screening.
Italian expert recommendations
Italian expert recommendations support gastric serology with evidence level 1a and grade A. They state that pepsinogens I and II, Gastrin-17 and H. pylori serology are validated markers of gastric mucosal atrophy, noting in particular that a PGI/PGII ratio < 3 strongly indicates clinically relevant atrophy. A cited meta-analysis shows that the combined 4- marker panel achieves ~80% sensitivity and ~90% specificity, enabling non-invasive risk stratification and selection of patients for endoscopy.
Russian national clinical recommendations
Russian national clinical recommendations, which explicitly include the full four-marker gastric biomarker panel (PGI, PGII, G-17, H. pylori antibodies) for non-invasive assessment of atrophic gastritis and gastric cancer risk.
International Agency for Research on Cancer
The international consensus article by Agreus et al. (16 gastroenterologists from 12 countries), which provides a strong rationale for using GastroPanel in the diagnosis and screening of atrophic gastritis.
Chinese Health Associations
China has adopted national screening programmes for gastric cancer that include serum pepsinogen testing — showing that serological risk stratification is considered a valid component of gastric cancer prevention even at population level.
WHO / IARC Monograph
WHO / IARC Monograph on gastric cancer prevention (with HOPE project reference) – In Latin America, Chile serves as a key reference case where gastric serology is included in national clinical recommendations. The ongoing HOPE project, cited in the IARC monograph, is generating region-specific evidence on gastric cancer risk stratification using GastroPanel biomarkers.