Routine histologic demonstration of helicobacter pylori in gastric biopsies: should immunohistochemistry replace giemsa stain?

Abstract

Background & Objective: Helicobacter pylori infection is associated with serious clinical sequelae such as gastric adenocarcinoma and lymphoma. There is therefore a need for prompt and accurate diagnosis of the infection to facilitate antimicrobial therapy. Giemsa stain has been widely used in detection with known limitations. Immunohistochemistry is a highly sensitive and specific diagnostic technique but expensive and time consuming. This study aims to evaluate the effectiveness of the consideration of replacing routine use of Giemsa with immunohistochemistry.
Method: Thirty-five consecutive endoscopic gastric biopsies obtained from dyspeptic patients, having a histological diagnosis of chronic gastritis were reviewed. Giemsa and IHC were applied and the results compared using kappa coefficient.
Result: Giemsa method showed sensitivity of 85.7%; specificity of 92.9%; accuracy of 88.6%.; positive predictive value of 94.7% and negative predictive value of 81.3%; There was a good agreement with IHC with a kappa value of 0.767.
Conclusion: Giemsa stain has a relatively high accuracy in detecting Helicobacter pylori and there is a good agreement between it and Immunohistochemistry. We recommend the continued use of Giemsa staining in resource poor settings and developing countries due to its numerous advantages.

Keywords: Helicobacter pylori diagnosis, Giemsa, Immunohistochemistry