Helicobacter Pylori in Gastric Biopsies—Should You Trust the Pathology Report?

The presence of Helicobacter pylori in gastric biopsies is closely associated with gastritis and duodenal ulceration. We have assessed the reliability of H pylori identification on haematoxylin and eosin (H & E) stained sections of gastric biopsies showing gastritis. A set of 20 slides was shown to 20 histopathologists (a total of 400 diagnoses); 11 of them were H pylori-positive, assessed using two special stains. Participants were asked to comment on the presence or absence of H pylori on H & E alone. The overall detection rate in positive cases was 66%. All pathologists missed at least one case, and there were 25 false-positive diagnoses overall. We conclude that identification of H pylori is unreliable in gastric biopsies if H & E alone is used. Clinicians who use the presence of H pylori as a basis for treatment should be aware of this problem.