Evaluation of optimal gastric mucosal biopsy site and number for identification of Helicobacter pylori, gastric atrophy and intestinal metaplasia.

Abstract

BACKGROUND/AIMS: The study is designed to identify the optimal gastric mucosal biopsy site and number for identification of Helicobacter pylori, gastric atrophy and intestinal metaplasia. METHODOLOGY: Ninety-two patients were included in the study, gastric biopsies were obtained from 5 different sites: lesser curvature of the mid-antrum (A1), greater curvature of the mid-antrum (A2), incisura angularis (IA), lesser curvature of the mid-corpus (B1), greater curvature of the mid-corpus (B2). Helicobacter pylori was evaluated in sections stained with toluidine blue, and histopathological examination was performed in sections stained with hematoxylin-eosin. RESULTS: Seventy-three patients were positive for Helicobacter pylori at least in one biopsy site. Helicobacter pylori was positive in 47 patients (64.3%) in A1, in 54 patients (73.9%) in A2, in 60 patients (82.1%) in IA, 44 patients (60.2%) in B1, and in 42 patients (57.5%) in B2. The highest positivity determined was in the combination of A2 and IA sites (95.8%). Gastric atrophy was determined in 35 of 73 patients (27.1% in A1, 20% in A2, 25.7% in IA, 20% in B1, and 7% in B2). Intestinal metaplasia was determined in 31 of the Helicobacter pylori-positive patients (18% in A1, 16% in A2, 30.9% in IA, 21.8% in B1, 12.7% in B2). CONCLUSIONS: It is considered that taking biopsies from both A1 and IA sites has the highest sensitivity in detecting Helicobacter pylori. However, it is difficult to define a specific site for detecting gastric atrophy and intestinal metaplasia.