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. 2012 Dec 29:12:182.
doi: 10.1186/1471-230X-12-182.

Additional corpus biopsy enhances the detection of Helicobacter pylori infection in a background of gastritis with atrophy

Hung-Chieh Lan  1 , Tseng-Shing Chen, Anna Fen-Yau Li, Full-Young Chang, Han-Chieh Lin
Affiliations

Additional corpus biopsy enhances the detection of Helicobacter pylori infection in a background of gastritis with atrophy

Hung-Chieh Lan et al. BMC Gastroenterol. .

Abstract

Background: The best sites for biopsy-based tests to evaluate H. pylori infection in gastritis with atrophy are not well known. This study aimed to evaluate the site and sensitivity of biopsy-based tests in terms of degree of gastritis with atrophy.

Methods: One hundred and sixty-four (164) uninvestigated dyspepsia patients were enrolled. Biopsy-based tests (i.e., culture, histology Giemsa stain and rapid urease test) and non-invasive tests (anti-H. pylori IgG) were performed. The gold standard of H. pylori infection was defined according to previous criteria. The sensitivity, specificity, positive predictive rate and negative predictive rate of biopsy-based tests at the gastric antrum and body were calculated in terms of degree of gastritis with atrophy.

Results: The prevalence rate of H. pylori infection in the 164 patients was 63.4%. Gastritis with atrophy was significantly higher at the antrum than at the body (76% vs. 31%; p<0.001). The sensitivity of biopsy-based test decreased when the degree of gastritis with atrophy increased regardless of biopsy site (for normal, mild, moderate, and severe gastritis with atrophy, the sensitivity of histology Giemsa stain was 100%, 100%, 88%, and 66%, respectively, and 100%, 97%, 91%, and 66%, respectively, for rapid urease test). In moderate to severe antrum or body gastritis with atrophy, additional corpus biopsy resulted in increased sensitivity to 16.67% compare to single antrum biopsy.

Conclusions: In moderate to severe gastritis with atrophy, biopsy-based test should include the corpus for avoiding false negative results.

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Figures

Figure 1
Figure 1
Flow chart of the enrolled patients and the grouping of biopsy specimens according to the degree of gastritis with atrophy.H.P., Helicobacter pylori; NPV, negative predictive rate; PPV, positive predictive rate.
Figure 2
Figure 2
Diagnostic tests for Helicobacter pylori detection: Group A, definitely positive (n=103); Group B, probably positive (n=1); Group C, probably negative (n=0); Group D, past H. pylori infection or false positive (n=2); Group E, definitely negative (n=58); CLO, indicates rapid urease test on biopsy specimens; Histology, refers to H. pylori positive based on modified Giemsa staining; Active gastritis, refers to presence or absence of active gastritis (an indirect sign of active H. pylori infection).
Figure 3
Figure 3
The proportion of mild-severe and moderate-severe gastritis with atrophy based on biopsy site. The p value was calculated using the chi-square test.
Figure 4
Figure 4
The sensitivity of biopsy-based tests (histology Giemsa stain and rapid urease test) according to grade of mucosal atrophy.
Figure 5
Figure 5
The prevalence rate of H. pylori infection according to grade of antrum and body gastritis with atrophy. The p value was calculated using the chi-square test for trend.
See this image and copyright information in PMC

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