Prospective identification of Helicobacter pylori in routine gastric biopsies without reflex ancillary stains is cost-efficient for our healthcare system

• Published in: Human pathology
• Main Authors: Pittman, Meredith E., MD, Khararjian, Armen, MD, Wood, Laura D., MD, PhD, Montgomery, Elizabeth A., MD, Voltaggio, Lysandra, MD
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Pathology; cost-effectiveness; Gastric biopsy; Helicobacter pylori; special stains; immunohistochemistry
• ISSN: 0046-8177; 1532-8392
• DOI: 10.1016/j.humpath.2016.07.031

Despite the recommendation of expert gastrointestinal pathologists, private and academic centers (including our own) have continued to use ancillary stains for identification of Helicobacter pylori . For a one month period, gastric biopsies were prospectively evaluated for H. pylori using routine hematoxylin and eosin (H&E) and a reflex Diff-Quik stain. During this time 379 gastric biopsies were collected on 326 patients. H. pylori organisms were prospectively identified in 23 patients (7%), all of whom had superficial dense lymphoplasmacytic inflammation expanding the lamina propria. An additional two patients with neutrophilic inflammation were found to have H. pylori by immunohistochemical (IHC) staining. One patient diagnosed with normal gastric mucosa was retrospectively found to have inflammation with rare H. pylori organisms originally overlooked on both H&E and Diff Quik but later identified on immunostain (0.5%). No patients with chemical gastritis (16%) or chronic inflammation (27%) were found to have H. pylori . During the study month, 9 immunostains for H. pylori were performed in addition to the 379 Diff-Quik. After discontinuation of reflex Diff-Quik, approximately 20 immunostains are performed for H. pylori each month, which decreases technical time spent processing gastric biopsies and reduces cost to the healthcare system. In our population with a low prevalence of H. pylori, reflex staining for organisms is not cost-effective. The organisms can be seen on routine H&E; when suspicious superficial or active inflammation is present without visible organisms, IHC will confirm presence or absence within a day. Discontinuation of up-front ancillary studies is cost-effective without compromising patient care.