From the Guidelines
Modified Giemsa stain is the preferred choice for detecting Helicobacter pylori (H. pylori) in biopsies.
Staining Methods
- Several staining methods are available to detect H. pylori, including modified Giemsa, Warthin-Starry, Gimenez, Genta, and immunohistochemical H. pylori antibody stains, in addition to routine haematoxylin and eosin (H&E) 1.
- Immunohistochemistry is a highly sensitive and specific staining method, considered the established ‘gold standard’ for histology 1.
- However, the modified Giemsa stain is sensitive, cheap, easy to perform, and reproducible, making it the method of choice 1.
Clinical Guidelines
- The American Gastroenterological Association (AGA) suggests not obtaining automatic special staining of specimens when biopsies are obtained from the normal-appearing gastric body and antrum for the detection of H. pylori infection, as most cases can be identified by experienced pathologists on H&E stains 1.
- In cases where H. pylori infection is not identified on H&E staining in the presence of chronic gastritis, immunohistochemistry or other special staining may be considered at the pathologist's discretion 1.
Diagnostic Considerations
- A wide variety of methods is available to detect H. pylori infection, including serologic tests, molecular testing, and noninvasive tests such as the urea breath test (UBT) and stool antigen test 1.
- The choice of diagnostic test should reflect the clinical indication, local availability, costs, and patient preferences 1.
From the Research
Staining Methods for H. pylori Detection
The choice of stain for detecting Helicobacter pylori (H. pylori) in gastric biopsies is crucial for accurate diagnosis. Several studies have compared the efficacy of different staining methods, including:
- Giemsa stain: This stain has been shown to be sensitive and reliable for detecting H. pylori, with a sensitivity of 90.6% 2 and 93.7% 3.
- Modified Toluidine Blue (MTB) stain: MTB has also been found to be effective, with a sensitivity of 93.7% 2 and 61.11% 3.
- Hematoxylin and Eosin (H&E) stain: While H&E is commonly used, its sensitivity for detecting H. pylori is lower, ranging from 46.8% 2 to 33.33% 3.
- Immunohistochemistry (IHC): IHC is considered the gold standard for detecting H. pylori, with a high sensitivity and specificity 2, 3.
Recommendations for Stain Usage
Based on the available evidence, the following recommendations can be made:
- Giemsa or MTB stain can be used as reliable alternatives to IHC in resource-limited settings 2, 3.
- H&E stain may not be sufficient for detecting H. pylori, especially in cases with mild inflammation or coccoid forms of the bacteria 2, 3.
- Ancillary stains, such as Giemsa or IHC, may be necessary in cases with chronic or chronic active gastritis without detectable H. pylori on H&E-stained sections 4, 5.
- The use of special stains on all gastric biopsies is generally unnecessary, and their application should be based on specific clinical and pathological criteria 5.