Prospective comparison of H&E, Giemsa, and Genta stains for the diagnosis of Helicobacter pylori,☆☆,

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Abstract

Background: H. pylori is more easily visualized with special stains than with H&E, but this adds time and expense to the diagnostic workup. We sought to determine if the diagnostic accuracy was improved with special stains. Methods: One hundred-one patients had two “jumbo” biopsies taken from the gastric antrum and two from the body for examination with H&E, Genta, and Giemsa stains. Four separate biopsy specimens were also taken from the antrum and the body for culture and for three types of rapid urease test, and 13C-urea breath tests were also performed. Mixed, coded biopsies were assessed for H. pylori, and density was scored from 0 to 4. A case was considered positive for H. pylori if culture was positive, two rapid urease tests and a urea breath test were positive, or two different stains were positive. Biopsy specimens were excluded from analysis if the slides were missing or there was inadequate tissue for review, or if the specimen showed a lack of staining. Results: Fifty-two (13%) of 404 specimens were excluded because of a poor Genta stain. Sensitivities were comparable for the three stains (H&E, 92%; Giemsa, 88%; Genta, 91%), while H&E specificity (89%) was significantly lower than that of the special stains (98%). Sensitivity for all three stains was significantly lower at low (grade 0 to 1) H. pylori density than at high (grade 2 to 4) density (H&E, 70% vs 98%; Giemsa, 64% vs 96%; Genta, 66% vs 97%), and 20 of 22 false positives were grade 1. Conclusions: The sensitivities of H&E and special stains are comparable at around 90%, but the specificity of H&E is significantly lower. The Giemsa stain appears to be the preferred stain for H. pylori diagnosis on the basis of its good sensitivity, excellent specificity, and lack of technical difficulty in preparation. However, H&E provides excellent accuracy when more than minimal (grade 1) H. pylori density is present. (Gastrointest Endosc 1997;45:463-7.)

Section snippets

Methods

Patients undergoing routine diagnostic upper endoscopy for any indication were eligible for this study. Patients were not included if they were undergoing endoscopy for determination of H. pylori status after a course of anti-H. pylori therapy or if they had endoscopic evidence of bleeding. The use of medications that might suppress H. pylori (i.e., bismuth, proton pump inhibitors, or antibiotics) was recorded. Patients had two biopsy specimens taken from the antrum within 3 cm of the pylorus

Routine H&E

A total of 101 patients (mean age 44 ± 1 years; 42 men and 59 women) and thus 404 biopsy specimens were included. One patient was taking omeprazole and all of her tests were negative; a second patient was taking trimethoprim-sulfamethoxazole and all of her tests were positive. No other patients were taking proton pump inhibitors, antibiotics, or bismuth. Twelve specimens were excluded from analysis of routine H&E because of missing slides or inadequate tissue, leaving 392 specimens that were

Discussion

Although histologic examination of gastric mucosal biopsy specimens is generally considered to be the gold standard for diagnosis of H. pylori, the sensitivities and specificities reported for histologic examination are variable and frequently well below 100%. Studies using more than one criteria for H. pylori diagnosis suggest sensitivities for H&E in the range of 84% to 92%,3, 4, 5 although sensitivities as low as 47% have also been reported with routine examination by unselected pathologists.

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From the Departments of Medicine and Pathology, University of Southern California School of Medicine, Los Angeles, California.

☆☆

Reprint requests: Loren Laine, MD, GI Division (LAC 12-137), U.S.C. School of Medicine, 2025 Zonal Ave., Los Angeles, CA 90033.

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