In diffuse atrophic gastritis, routine histology underestimates Helicobacter pylori infection

Background: Histologic detection of Helicobacter pylori shows high diagnostic accuracy in chronic nonatrophic gastritis. However, when atrophy occurs, the sensitivity of bacterial detection varies. This study assessed the routine histologic sensitivity for current H. pylori infection in patients with atrophic gastritis, with and without intestinal metaplasia. Study: Five hundred and ten consecutive patients with diffuse chronic atrophic gastritis, with (174 cases) and without (336 cases) intestinal metaplasia, were investigated following the Sydney System recommendations. In cases with negative tissue staining for Helicobacter-like organisms, serum immunoglobulin G (IgG) antibodies to H. pylori were assayed. Results: The overall rate of positive staining for Helicobacter-like organisms was 51.8% (264 of 510 cases), 62.8% and 30.4% in cases without and with intestinal metaplasia, respectively. Serum IgG antibody determination was consistent with current infection in 180 (73.2%) of the 246 cases with negative histology. H. pylori detection rate was significantly lower (p