title: Prospective identification of Helicobacter pylori in routine gastric biopsies without reflex ancillary stains is cost-efficient for our health care system.
abstract: 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 1-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 (7%) patients, all of whom had superficial dense lymphoplasmacytic inflammation expanding the lamina propria. An additional 2 patients with neutrophilic inflammation were found to have H pylori by immunohistochemical staining. One patient diagnosed as having 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 for processing gastric biopsies and reduces cost to the health care 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, immunohistochemical stains will confirm presence or absence within a day. Discontinuation of up-front ancillary studies is cost-effective without compromising patient care.
authors: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287. Electronic address: mep9071@med.cornell.edu.
authors: Meredith E
authors: ME
authors: Pittman
authors: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287.
authors: Armen
authors: A
authors: Khararjian
authors: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287.
authors: Laura D
authors: LD
authors: Wood
authors: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287.
authors: Elizabeth A
authors: EA
authors: Montgomery
authors: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287.
authors: Lysandra
authors: L
authors: Voltaggio
mesh_terms: D000046:Academic Medical Centers / Q000191:economics*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001431:Bacteriological Techniques / Q000191:economics*; D015142:Baltimore; D001706:Biopsy / Q000191:economics; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics*; D005188:False Negative Reactions; D005260:Female; D017048:Health Care Costs; D016481:Helicobacter Infections / Q000191:economics* / Q000382:microbiology* / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry / Q000191:economics; D007223:Infant; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D013194:Staining and Labeling / Q000191:economics* / Q000379:methods; D013270:Stomach / Q000382:microbiology* / Q000473:pathology; D055815:Young Adult
keywords: Cost-effectiveness; Gastric biopsy; Helicobacter pylori; Immunohistochemistry; Special stains