Utility of ancillary stains for Helicobacter pylori in near-normal gastric biopsies

Fifth Chinese National Consensus Report on the management of Helicobacter pylori infection

“…This system has recommended that at least five mucosal biopsies (2 from antrum 2 from corpus and 1 from angus) should be obtained . Based on this standard, experienced pathologists can make a diagnosis of H. pylori infection using routine staining (H&E staining) . Active inflammation is usually an indication of H. pylori infection, in which case if H. pylori is not found using routing histological examination, special staining is needed, including Giemsa staining, Warthin‐Starry staining, or immunohistochemical staining .…”

Sensitivity of Helicobacter pylori detection by Giemsa staining is poor in comparison with immunohistochemistry and fluorescent in situ hybridization and strongly depends on inflammatory activity

“…In the recent years, utility of different stains for detection of H. pylori has been intensively studied and discussed. [14][15][16][17] T A B L E 4 Distribution of infection densities of 1+ (+), 2+ (++), and 3+ (+++) in different subgroups of the Helicobacter pylori-positive cases cohort clearly proved that the conventional staining techniques have remarkable disadvantages. Giemsa showed a significantly lower overall sensitivity, and its performance was strongly influenced by inflammatory activity resulting a dramatic impairment in the nonactive cases (Table 3).…”

Epidemiology and Diagnosis of Helicobacter pylori infection

“…Chitkara evaluated the Diff-QuiK and immunohistochemical staining in gastric biopsy specimens and concluded that upfront staining is not cost-effective and should be performed only in selected specimens with chronic active, or moderate inactive gastritis [47]. Comparing Giemsa, Warthin-Starry, acridine orange, and immunohistochemical stains to hematoxylin and eosin (H&E), Panarelli et al [48] showed that ancillary staining is not necessary in most cases and should be considered only for biopsies with mild inflammation and for biopsies from patients under proton-pump inhibition or antibiotic treatment. On the other hand, a low cost, modified toluidine blue staining for H. pylori detection in gastric biopsies showed comparable sensitivity to immunoperoxidase staining, but significantly better sensitivity compared to H&E [49].…”