Difference between revisions of "Stomach biopsy for Helicobacter pylori"

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[[File:Histopathology of helicobacter pylori (annotated).jpg|thumb|Helicobacter pylori on HE stain, being curved bacteria in the lumen of a gastric foveola.]]
 
==Microscopic evaluation==
 
==Microscopic evaluation==
[[File:Helicobacter pylori, Gastric Mucosa, H&E (390307642).jpg|thumb|Dozens of the curved bacteria fill the lumen of a gastric foveola on H&E stain.]]
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[[File:Helicobacter pylori, Gastric Mucosa, H&E (390307642).jpg|thumb|Another H&E stain.]]
 
Look for:
 
Look for:
*''Helicobacter pylori''-like '''bacteria''' in the lumen, as curved, spirochete-like bacteria, generally in the superficial mucus layer and along microvilli of epithelial cells.<ref name=PathologyOutlines/>
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*''Helicobacter pylori''-like '''bacteria''' in the lumen, as curved, spirochete-like bacteria, generally in the superficial mucus layer and along microvilli of epithelial cells.<ref name=PathologyOutlines-HP/>  
*Associated '''inflammation''', typically a chronic inflammatory infiltrate with germinal centers (follicular gastritis), and plasma cells in lamina propria.<ref name=PathologyOutlines>{{cite web|url=https://www.pathologyoutlines.com/topic/stomachhelicobacter.html|title=Stomach - Infections - Helicobacter pylori|author=Elliot Weisenberg|website=Pathology Outlines}} Topic Completed: 1 August 2012. Minor changes: 1 September 2020</ref> There should be at least 3 plasma cells facing each other to make a diagnosis of chronic gastritis.
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*Associated '''inflammation''', typically a chronic form of '''[[gastritis]]''' with germinal centers (follicular gastritis), and plasma cells in lamina propria.<ref name=PathologyOutlines-HP>{{cite web|url=https://www.pathologyoutlines.com/topic/stomachhelicobacter.html|title=Stomach - Infections - Helicobacter pylori|author=Elliot Weisenberg|website=Pathology Outlines}} Topic Completed: 1 August 2012. Minor changes: 1 September 2020</ref><ref group=notes>Plasma cells and lymphocytes are normally found in the lamina propria of the small and large intestine, but is abnormal in the stomach.</ref> There should be at least 3 plasma cells facing each other to make a diagnosis of chronic gastritis.
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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.<ref name="pmid22261451">{{cite journal| author=Hartman DJ, Owens SR| title=Are routine ancillary stains required to diagnose Helicobacter infection in gastric biopsy specimens? An institutional quality assurance review. | journal=Am J Clin Pathol | year= 2012 | volume= 137 | issue= 2 | pages= 255-60 | pmid=22261451 | doi=10.1309/AJCPD8FFBJ5LSLTE | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22261451  }} </ref>
  
 
===Example report===
 
===Example report===
Chronic gastritis without ''H. pylori''-like organisms should be described as non-specific:
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{|class=wikitable
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| Stomach, biopsy:<br>
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Chronic active gastritis.<br>
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Positive for helicobacter pylori.
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|}
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Chronic gastritis without ''H. pylori''-like organisms can be described as non-specific:
 
{|class=wikitable
 
{|class=wikitable
 
| Mild chronic gastritis, which is non-specific.<br>
 
| Mild chronic gastritis, which is non-specific.<br>

Revision as of 14:52, 22 April 2022

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:

  • Helicobacter pylori-like bacteria in the lumen, as curved, spirochete-like bacteria, generally in the superficial mucus layer and along microvilli of epithelial cells.[1]
  • Associated inflammation, typically a chronic form of gastritis with germinal centers (follicular gastritis), and plasma cells in lamina propria.[1][notes 1] There should be at least 3 plasma cells facing each other to make a diagnosis of chronic gastritis.

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.

Notes

  1. Plasma cells and lymphocytes are normally found in the lamina propria of the small and large intestine, but is abnormal in the stomach.
  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.

Main page

References

  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