Assessment of different methods for staining Helicobacter pylori in endoscopic gastric biopsies

The recent implication of Helicobacter pylori in the pathogenesis of gastri tis-peptic ulcer syndrome and its relevance for the development of upper ga strointestinal malignancy warrant efficient methods for the detection and d emonstration of the organism in biopsy specimens. We have compared 5 staini ng methods, namely, haematoxylin and eosin (H&E), immunohistochemistry (IHC ), the silver staining HpSS, the alcian yellow-toluidine blue (Leung) metho d (A-Y) and Genta staining, for the demonstration of the organism in gastri c biopsies taken from antrum, body and fundus of 118 patients who presented to our hospital with upper gastrointestinal symptoms. We found no signific ant differences in the efficacy of H&E, IHC, HpSS and A-Y in the demonstrat ion of H. pylori in all 3 gastric sites. The least reproducible stain in ou r hands was the Genta stain. We conclude that H&E is adequate for the initi al assessment of gastric biopsies in symptomatic upper gastrointestinal pat ients. This is because it is a well-tested, cheap and easy staining method, requiring a relatively short period of time to perform, with highly reprod ucible results. It has an added advantage of enabling simultaneous assessme nt of morphological changes accompanying H. pylori infection. When the dens ity of the organism is expected to be low, we recommend addition of HpSS st aining because of its high sensitivity and low cost. The disadvantages of t he other staining methods (IHC, A-Y and Genta) are discussed.