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Appropriate Use of Special Stains for Identifying Helicobacter pylori: Recommendations From the Rodger C. Haggitt Gastrointestinal Pathology Society

Batts, Kenneth P. MD*; Ketover, Scott MD; Kakar, Sanjay MD; Krasinskas, Alyssa M. MD§; Mitchell, Kisha A. MD; Wilcox, Rebecca MD; Westerhoff, Maria MD#; Rank, Joseph MD**; Gibson, Joanna MD; Mattia, Anthony R. MD††; Cummings, Oscar W. MD‡‡; Davison, Jon M. MD§§; Naini, Bita V. MD∥∥; Dry, Sarah M. MD∥∥; Yantiss, Rhonda K. MD¶¶

The American Journal of Surgical Pathology: November 2013 - Volume 37 - Issue 11 - p e12–e22
doi: 10.1097/PAS.0000000000000097
Special Article

Helicobacter pylori is a major cause of gastroduodenal injury, gastric cancer, and lymphoma, and, thus, there is great interest in its detection and eradication. Several detection methods are available, including histochemical and immunohistochemical stains. Application of these stains in clinical practice is heterogenous, to say the least. Although they were developed to enhance H. pylori detection, changing practice models, financial considerations, and a perceived need for rapid case turnaround have led to their widespread use in routine staining studies ordered reflexively on all gastric biopsies. Emerging data suggest that most of these stains are not needed to establish a diagnosis of H. pylori infection, and their added value when biopsies show minimal, or no, inflammation is not clear. In this manuscript, the Rodger C. Haggitt Gastrointestinal Pathology Society puts forth recommendations regarding ancillary stain usage for H. pylori detection based upon critical literature review and collective experience. Pathologists rarely, if ever, detect H. pylori in “normal” biopsies, but readily observe them in optimally stained hematoxylin and eosin sections from infected patients. Therefore, we suggest that use of ancillary stains is appropriate when biopsies show chronic, or chronic active, gastritis without detectable H. pylori in hematoxylin and eosin-stained sections, but performing them “up front” on all gastric biopsies is generally unnecessary. Application of these stains to nongastric biopsies and polyps is appropriate in an extremely limited set of circumstances. It is our hope that recommendations provided herein will provide helpful information to gastroenterologists, pathologists, and others involved in the evaluation of patients for possible H. pylori infection.

*Department of Pathology, Hospital Pathology Associates and Virginia Piper Cancer Institute

Division of Gastroenterology, Minnesota Gastroenterology, PA, Minneapolis, MN

Department of Pathology, University of California School of Medicine, San Francisco

∥∥Department of Pathology, University of California School of Medicine, Los Angeles, CA

§Department of Pathology, Emory University Hospital, Atlanta, GA

Department of Pathology, Yale University School of Medicine, New Haven, CT

Department of Pathology, University of Vermont School of Medicine, Burlington, VT

#Department of Pathology, University of Washington School of Medicine

**Cellnetix Pathology, Seattle, WA

††Department of Pathology, Newton-Wellesley Hospital, Newton Lower Falls, MA

‡‡Department of Pathology, Indiana University School of Medicine, Indianapolis, IN

§§Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA

¶¶Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY

Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Rhonda K. Yantiss, MD, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065 (e-mail: rhy2001@med.cornell.edu).

© 2013 by Lippincott Williams & Wilkins.