title: Comparison of immunohistochemistry and silver stain for the diagnosis of pediatric Helicobacter pylori infection in urease-negative gastric biopsies.
abstract: We compared immunohistochemical and silver stains of pediatric gastric biopsy sections for the identification of Helicobacter pylori infection with chronic inflammation and a negative urease screening test. Thirty-seven patients (age range 10 months to 21 years) whose gastric antral biopsies were negative for the rapid urease test (CLO(R)) but positive for lymphocytic infiltration were selected for a retrospective study. Specimens had been subjected to a rapid urease test (CLO(R)) and hematoxylin and eosin staining, and Dieterle silver staining and immunohistochemical staining specific for H. pylori were also performed. Twelve additional patients with urease-positive biopsies were used as controls. With Dieterle staining, 8/37 (22%) urease-negative biopsies contained organisms morphologically compatible with H. pylori, 21/37 (56%) contained organisms not compatible with H. pylori, and 8/37 (22%) were negative for organisms. Immunostaining confirmed 6/8 (75%) Dieterle-positive cases as being H. pylori, was negative in 2/8 (25%) Dieterle-positive cases, and was positive in 2/8 (25%) Dieterle-negative cases. Biopsies from 8/12 (67%) urease-positive specimens contained organisms seen with both Dieterle and immunohistochemical stains, and 4/12 (33%) were negative with both stains. Although both stains yielded comparable results with H. pylori-positive biopsies, Dieterle staining was potentially confusing because of nonspecific staining of other organisms. A significant proportion of (CLO(R))-negative biopsies was positive for H. pylori with special stains. We therefore recommend the use of immunohistochemical staining rather than silver staining in the evaluation of urease-negative gastric biopsies demonstrating chronic inflammation in children.
authors.affiliation: Department of Pediatrics, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis 38103, USA.
authors.forename: J K
authors.initials: JK
authors.lastname: Eshun
authors.forename: D D
authors.initials: DD
authors.lastname: Black
authors.forename: H B
authors.initials: HB
authors.lastname: Casteel
authors.forename: H
authors.initials: H
authors.lastname: Horn
authors.forename: T
authors.initials: T
authors.lastname: Beavers-May
authors.forename: C A
authors.initials: CA
authors.lastname: Jetton
authors.forename: D M
authors.initials: DM
authors.lastname: Parham
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005756:Gastritis / Q000175:diagnosis* / Q000201:enzymology / Q000382:microbiology; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000201:enzymology / Q000382:microbiology; D016480:Helicobacter pylori / Q000201:enzymology / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods*; D007223:Infant; D011706:Pyloric Antrum / Q000201:enzymology / Q000473:pathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016622:Silver Staining / Q000379:methods*; D014510:Urease / Q000378:metabolism*
chemical_list: D014510:Urease