Clinical utility of histological examination of gastric ulcer margin to diagnose helicobacter pylori infection

Background: To investigate the effectiveness of histological examination of ulcer margins (HEUM) in detecting Helicobacter pylori (H. pylori) infection in patients with non-bleeding gastric ulcers (GUs). Methods: A retrospective study included 284 patients with GU undergoing concomitant HEUM and rapid urease test (RUT) to detect H. pylori infection between January 2005 and December 2006. The slides were reviewed by an experienced pathologist (revised HEUM) in the 52 patients with inconsistent results on the initial HEUM and RUT. H. pylori infection was defined as a postive RUT and/or revised HEUM. Detection rates of H. pylori infection for HEUM and RUT were calculated accordingly. In patients with H. pylori infection, several parameters including ulcer characteristics and pathological findings were compared between patients with negative and positive (revised) HEUM. Results: A total of 164 (57.7%) patients had positive results of H. pylori infection. The overall detection rates of H. pylori infection on the initial HEUM, revised HEUM and RUT were 78.0% (128/164), 89.0% (146/164), and 94.5% (155/164), respectively. For antrum ulcers, the respective detection rates were 81.0% (85/105), 92.4% (97/105), and 93.3% (98/105), for angulus ulcers, 78.6% (22/28), 85.7% (24/28), and 100% (28/28), and for proximal stomach ulcers, 61.9% (13/21), 81.0% (17/21), and 90.4% (19/21). In patients with H. pylori infection, gastric malignancy was more frequently observed in patients with false negative than true positive HEUMs. Conclusions: HEUM might be not sensitive enough for diagnosing H. pylori in patients with GU. It was especially insensitive when the ulcers were in the proximal stomach, the ulcers were malignant, or the slides were interpreted by pathologists in a rotating manner.