Stomach biopsy for Helicobacter pylori

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Author: Mikael Häggström [note 1]

Helicobacter pylori on HE stain, being curved bacteria in the lumen of a gastric foveola.

Microscopic evaluation

Another H&E stain.

Look for:

  • Inflammation, typically a chronic form of gastritis with germinal centers (follicular gastritis), and plasma cells in lamina propria.[1][note 2] There should be at least 3 plasma cells facing each other to make a diagnosis of chronic gastritis.
  • When there is at least (mild or) moderate gastritis, especially if relatively superficial, go to high magnification and look for Helicobacter pylori-like bacteria in the lumen. They are curved, spirochete-like bacteria, generally in the superficial mucus layer and along microvilli of epithelial cells.[1]

Perform immunohistochemistry for H. pylori in cases of moderate to severe chronic gastritis, or even just one neutrophil within the epithelium, where H. pylori is not seen on H&E stains.[2]

Example report

Stomach, biopsy:

Chronic active gastritis.
Positive for helicobacter pylori.

Chronic gastritis without H. pylori-like organisms can be described as non-specific:

Mild chronic gastritis, which is non-specific.

Negative for H. pylori-like organisms on H&E stain.


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. Plasma cells and lymphocytes are normally found in the lamina propria of the small and large intestine, but is abnormal in the stomach.

Main page


  1. 1.0 1.1 Elliot Weisenberg. Stomach - Infections - Helicobacter pylori. Pathology Outlines. Topic Completed: 1 August 2012. Minor changes: 1 September 2020
  2. Hartman DJ, Owens SR (2012). "Are routine ancillary stains required to diagnose Helicobacter infection in gastric biopsy specimens? An institutional quality assurance review. ". Am J Clin Pathol 137 (2): 255-60. doi:10.1309/AJCPD8FFBJ5LSLTE. PMID 22261451. Archived from the original. . 

Image sources