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.)
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Article info
Publication history
Accepted:
January 28,
1997
Received in revised form:
November 6,
1996
Received:
August 13,
1996
Footnotes
☆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.
★37/1/80767
Identification
Copyright
© 1998 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.
