Histopathological grading and Comparison of staining methods for H Pylori detection

Introduction: Helicobacter pylori (H pylori) is the most common bacterial infection in human. In our study we are studying histopathological changes in gastric mucosa in patient with H. pylori infection. Comparison of staining methods in terms of their cost, time required, reproducibility of techniques and ability to demonstrate H. pylori in Paraffine sections were also done. Materials and methods: Prospective analysis of 100 patients presented with acid peptic disorder to our gastroenterology outpatient department for a period of 1 ½ year was carried out . Biopsies taken and were immediately subjected to Rapid urease test in endoscopy room. Thereafter the biopsy processed, standard routine histological section were cut at five micron thickness with the help of fully automated microtome. Sections were stained with routine H & E and special stains like Modified Giemsa, Gimenez, Warthin Starry stain re evaluated for the presence of H. pylori bacterial infection in the antral biopsies. Observation and results: The maximum H. pylori positivity by histopathology was found in age group 21-40 years (60.2%) and followed by 41-60 years (58.2%) and then up to 20 year (57.1%). The grades of chronic inflammation and activity (infiltration by neutrophils) were higher with higher grades of H. pylori infection. Intestinal metaplasia, atrophy and lymphoid follicles aggregates were found mostly with grade I and grade II. Out of total 100 cases maximum number of H. pylori positive cases were detected by Warthin starry stain 55/100(55%) followed by Gimenez 53/100 (53%). On Giemsa staining 52/100 cases were detected. H and E could detect only 50 cases out of 100. Least number of cases were detected by H and E stain. Conclusion: histopathology is the investigation of choice in detection of H pylori. It can detect carcinoma, lymphoma in early stages. Geimnez stain most useful as it is economical and quick, Modified Giemsa is also good but it requires careful search as good contrast is not provided. Warthin starry stain is time consuming, expensive, least reproducible so difficult to use.