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The histologic detection of Helicobacter pylori in seropositive subjects is affected by pathology and secretory ability of the stomach
Author(s) -
Kim JunHyun,
Lee SunYoung,
Lee Sang Pyo,
Kim Jeong Hwan,
Sung InKyung,
Park Hyung Seok,
Shim Chan Sup,
Han Hye Seung
Publication year - 2018
Publication title -
helicobacter
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 79
eISSN - 1523-5378
pISSN - 1083-4389
DOI - 10.1111/hel.12480
Subject(s) - giemsa stain , helicobacter pylori , medicine , gastroenterology , staining , stomach , biopsy , gastritis , serology , pathology , antibody , immunology
Background Helicobacter pylori is unevenly distributed in hypochlorhydric environments. The study aim was to elucidate the risk factors for a negative Giemsa staining finding in seropositive subjects by measuring the secretory ability of the stomach. Methods Subjects aged over 18 years were included consecutively after endoscopic biopsy at gastric lesions with color or structural changes. Blood was sampled for the serum pepsinogen ( PG ) assay and H. pylori serology test. After excluding the subjects with past H. pylori eradication, the risk factors for a negative Giemsa staining finding in seropositive subjects were analyzed. Results Among 872 included subjects, a discrepancy between the serum anti‐ H. pylori IgG and Giemsa staining findings was found in 158 (18.1%) subjects, including 145 Giemsa‐negative, seropositive subjects. Gastric adenocarcinoma/adenoma ( OR = 11.090, 95% CI = 3.490‐35.236) and low serum PG II level ( OR = 0.931, 95% CI = 0.899‐0.963) were the independent risk factors for a negative Giemsa staining finding in seropositive subjects. The cutoff value of serum PG II level was 7.45 ng/ mL (area under curve [ AUC ] = 0.904, 95% CI = 0.881‐0.927). Follow‐up studies of Giemsa staining at different sites of the stomach revealed that 75% of the Giemsa‐negative seropositive subjects with adenocarcinoma are positive, whereas none of those with low serum PG II level of <7.45 ng/ mL revealed positive findings. Conclusions The risk of a negative Giemsa staining finding in seropositive subjects is increased in gastric adenocarcinoma/adenoma specimens and in subjects with a diminished gastric secretory ability with low serum PG II level of <7.45 ng/ mL . A false‐negative Giemsa staining finding is common in subjects with adenocarcinoma, and therefore, additional biopsies at different sites should be performed in these subjects.