Appropriate Use of Special Stains for Identifying Helicobacter pylori Recommendations From the Rodger C. Haggitt Gastrointestinal Pathology Society

作者：Batts Kenneth P; Ketover Scott; Kakar Sanjay; Krasinskas Alyssa M; Mitchell Kisha A; Wilcox Rebecca; Westerhoff Maria; Rank Joseph; Gibson Joanna; Mattia Anthony R; Cummings Oscar W; Davison Jon M; Naini Bita V; Dry Sarah M; Yantiss Rhonda K^*

来源：American Journal of Surgical Pathology, 2013, 37(11): E12-E22.

DOI：10.1097/PAS.0000000000000097

• reflex testing
• gastritis
• immunohistochemistry
• ancillary
• up front

Helicobacter pylori is a major cause of gastroduodenal injury, gastric cancer, and lymphoma, and, thus, there is great interest in its detection and eradication. Several detection methods are available, including histochemical and immunohistochemical stains. Application of these stains in clinical practice is heterogenous, to say the least. Although they were developed to enhance H. pylori detection, changing practice models, financial considerations, and a perceived need for rapid case turnaround have led to their widespread use in routine staining studies ordered reflexively on all gastric biopsies. Emerging data suggest that most of these stains are not needed to establish a diagnosis of H. pylori infection, and their added value when biopsies show minimal, or no, inflammation is not clear. In this manuscript, the Rodger C. Haggitt Gastrointestinal Pathology Society puts forth recommendations regarding ancillary stain usage for H. pylori detection based upon critical literature review and collective experience. Pathologists rarely, if ever, detect H. pylori in %26quot;normal%26quot; biopsies, but readily observe them in optimally stained hematoxylin and eosin sections from infected patients. Therefore, we suggest that use of ancillary stains is appropriate when biopsies show chronic, or chronic active, gastritis without detectable H. pylori in hematoxylin and eosinstained sections, but performing them %26quot;up front%26quot; on all gastric biopsies is generally unnecessary. Application of these stains to nongastric biopsies and polyps is appropriate in an extremely limited set of circumstances. It is our hope that recommendations provided herein will provide helpful information to gastroenterologists, pathologists, and others involved in the evaluation of patients for possible H. pylori infection.

• 出版日期2013-11