Association of Helicobacter pyloriin Gastric Lesions with Emphasis on Immunohistochemistry

Abstract

Introduction:Helicobacter pylori (H.pylori) is associated with many gastro-duodenal diseases like peptic ulcers and gastric adenocarcinoma. Hence, it is important to identify H.Pylori in the endoscopic gastric biopsies. Though Immunohistochemistry (IHC) is time-consuming and expensive, it has shown excellent results and is considered as gold standard method for detecting H.Pylori. Aim: To study the morphological patterns of gastric lesions, different histo-pathological gastric lesions with clinical presentation and the association of H.Pylori using Haematoxylin and Eosin (H&E), Giemsa and IHC staining techniques and their efficacy. Materials and Methods: The present study was an observational study conducted at a tertiary care hospital Kalaburagi for a period of 5 years (1 July 2014 to 30 June 2019). All patients were referred to endoscopic section for the biopsy. History was documented and clinical examination was performed. For the retrospective cases, clinical details were obtained from medical records section, blocks were retrieved, stained with H&E, Giemsa and IHC, studied, tabulated and results were analysed. Results: A total of 95 samples (mean age 49.74 years) were studied. Male: female ratio was 2.8:1. Most common histological benign lesions were Chronic Active Gastritis (CAG) 23 (24.21%) and Chronic Superficial Gastritis (CSG) 14 (14.73%). Malignant tumours were seen in 23 cases, among which moderately (39.13%) and poorly differentiated (39.13%) adenocarcinoma was the commonest. H pylori was identified by IHC in benign and malignant lesions in 20 (23.53%) and 01 (4.35%), respectively. Sensitivity and specificity of H&E and Giemsa was 57.14%, 66.67% and 100%, 100%, respectively. Positive Predictive Value (PPV) was 100% for both stains and Negative Predictive Value (NPV) was 89.16% and 91.36% for H&E and Giemsa. Conclusion: The present study highlights the utility of IHC in detecting H.Pylori in gastric lesions as inflammation and other factors are known to affect the detection rate by H&E and Giemsa staining methods. Hence, IHC can be considered as the best method in detecting H.pylori.