Helicobacter Pylori Diagnosis in 56 Gastric Biopsies: A Cost-effectiveness Analysis of Different Techniques

Helicobacter pylori affects nearly half of the world's population and, thus, is one of the most frequent and persistent bacterial infections worldwide. Among the methods developed to detect H. pylori infection, determining the gold standard remains debatable.

The aim of the present study was to compare the classical H. pylori diagnosis techniques with the immunohistochemical one, in terms of availability, rapidity, specificity, sensitivity and cost.

We performed a cross sectional study for 56 gastric biopsies of symptomatic Moroccan patients undergoing fibroscopy. The slides were stained with both histological stains and immunohistochemical stains, and these were assessed by the same experienced pathologist. Kappa coefficient was used to assess the agreement between the techniques.

Out of 56 gastric biopsies, 25 were H. pylori-positive and 26 were H. pylori-negative, all diagnosed by the Hematoxylin eosin, the Giemsa and the immunostaining. Whereas, the five remaining cases had discordant results, they were diagnosed H. pylori negative by the histological examination and H. pylori positive using the immunohistochemical technique. A good concordance between Histology and Immunohistochemistry was revealed (kappa-value= 0.672, p-value<0.05).

The immunohistochemistry is highly sensitive and provides greater degree of accuracy versus the classical staining methods, especially in cases of low bacterial density or coccoid forms. However, it is costly, time-consuming and need sophisticated preparation. Therefore, it is useful when results from histological examination are equivocal.