Evaluation of topographic gastric histology in H. pylori infection - A comparative study with CLO test and bacterial culture

Endoscopic biopsy is an effective method for the diagnosis of Helicobacter pylori infection. This study sought to determine suitable biopsy locations and the optimal number of specimens for histology examination and to clarify the discrepancies among various invasive diagnostic tests. Forty- seven dyspeptic patients (25 M, 22 F) were topographically sampled for histology, mucosal rapid urease (CLO) test and bacterial culture. Based on histology, 34 patients (72.3%) had H. pylori infection. The sensitivity and specificity of the CLO test and culture were 91.2% and 100% and 79.4% and 100%, respectively. CLO test is known to be a reliable method for the diagnosis of H. pylori infection. In this study, the distribution of H. pylori varied in the stomach and the uneven distribution of bacteria may be responsible for the discrepancy in the diagnostic yield. There were 3 patients with a low bacterial load which was confined to the angle or high body of the stomach and with negative CLO test in the antrum. We recommend that at least three biopsies for histology including the antrum of the lesser curvature side, angle and higher body (near cardia), should be sampled to improve the diagnostic accuracy of H. pylori infection and inflammation activity.