http://elynsgroup.com Copyright: © 2016 Latif MEA, et al. Open Access Research Article J Gastro Hepato Dis Journal of Gastroenterology and Hepatobiliary Disorders Page 1 of 6 ISSN: 2470-9891 Value of Additional Corpus Biopsy for Diagnosis of Helicobacter Pylori in Atrophic Gastritis Mohamed E. Abdel Latif 1* , Rania Shahin 2 , Rasha M. Abdrabou 3 , Ahmed Shawqy 4 , Hosam M. El-Ghadban 5 , Mohammad Arafa 6 , Ahmed AG Saleh 7 , Ahmed M. Husien 8 , and Mohamed AA Amer 9 1 Department of Surgery, Mansoura University Hospital, Egypt, and Consultant of Laparoscopy and Endoscopy, Hafr Elbatin, Saudi Arabia 2 Department of Clinical Pathology, Benha University Hospital, Egypt, and Specialist of Pathology, Hafr Elbatin, Saudi Arabia 3 Department of Pathology, Benha University Hospital, Egypt 4 Department of Internal Medicine, Gastroenterology Unit, Mansoura University Hospital, Egypt 5 Department of Surgery, Mansoura University Hospital, Egypt 6 Department of Pathology, Mansoura University Hospital, Egypt 7 Department of Internal Medicine, Gastroenterology Unit, Mansoura University Hospital, Egypt 8 Department of Internal Medicine, Benha University Hospital, Egypt 9 Department of General surgery, Students’ hospital, Mansoura University, Egypt Introduction Helicobacter pylori affect nearly half of the population among the world. It is one of the most frequent and persistent bacterial infections worldwide [1]. It is responsible for many of the upper gastrointestinal tract diseases; chronic gastritis, gastrointestinal ulcers, Mucosa Associated Lymphoid Tissue Lymphoma (MALT) Received Date: May 21, 2016, Accepted Date: August 08, 2016, Published Date: August 18, 2016. *Corresponding author: Mohamed E. Abdel Latif, Department of Surgery, Mansoura University Hospital, Gihan El Sadat St., Mansoura 35511, Dakahlia, Egypt, Tel: 201-115-051-680, E-mail: surg_latif@hotmail.com and gastric cancer as well [2]. Thus it has been known as “definitive biological carcinogen” by WHO in 1994 [3]. It is already documented that H. pylori plays an important role in the promotion of atrophic gastritis. Severe degree of H. pylori associated atrophic gastritis is suggested to be an important risk factor in development of gastric carcinoma. Therefore, it is presumed that eradication of H. pylori from the stomach is linked to decrease the incidence of gastric cancer development [4]. There are various diagnostic tools to detect H. pylori whether invasive (rapid urease test, histology or culture) or non invasive (urea breath test, serology or stool antigen) [5,6]. Histological examination despite is invasive, is considered one of the most important diagnostic tests for H. pylori infection because it also provides critical information related to the mucosa and presence of associated pathology [7,8]. H. pylori can be seen in hematoxylin and eosin (H&E) stain as gram negative spiral bacteria with sensitivity and specificity as 69- 93% and 87-90%, respectively [2]. Accuracy can be increased up to 90-100% by using special stains such as modified Giemsa stain, Warthin-Starry silver stain, Genta stain and immunehisto chemical stain [9]. H&E stain evaluate the degree of inflammation, atrophy and/ or intestinal metaplasia (IM). It can also identify the H. pylori in a high magnification field; however, it becomes difficult to see the H. pylori when a low density of the organism and atrophic mucosal change are combined. As Giemsa stain is easy to use, inexpensive, and provides good results; it is the slandered method in many laboratories for H. pylori detection [10]. Also, Uemura et al. reported that eradication of H. pylori decreases the incidence of recurrent gastric cancer in patients underwent endoscopic mucosal resection for early cancer stomach [11]. It is widely recommended by many authors that eradication of H. pylori is mandatory in case of atrophic gastritis since the atrophy may reverse after successful eradication therapy [12,13]. But, it’s difficult and challenging to detect H. pylori in case of atrophic gastritis [14]. This study was designed to determine if it is important to add corpus biopsies to the routine antral ones for identification of H. pylori, especially in case of gastric atrophy and/or intestinal metaplasia. Abstract Background: There is still debate on the best sites for biopsy- based tests of Helicobacter pylori infection in patients with gastritis. This study was designed to determine if it is important to add corpus biopsies to the routine antral ones for identification of H. pylori, especially in case of gastric atrophy and/or intestinal metaplasia. Methods: This is a prospective multicenter study (Mansura University Hospital - Egypt, Benha University hospital – Egypt, Hafer Albatin Central Hospital, KSA), including three hundred and twenty eight patients with gastritis from June 2014 to December 2015. Endoscopic mucosal biopsies from the gastric antrum and corpus were submitted to the histological examination according to updated Sydney system for detection of H. pylori and to evaluate the degree of gastritis with or without atrophy and intestinal metaplasia using both routine H&E and modified Giemsa stained tissue sections. Results: In the study period, a total 328 consecutive patients underwent upper gastrointestinal endoscopy for different reasons. The mean age of the patients was 39 ± 12 years; 183 (55.7%) were women. H. pylori was found positive in 193 (58.8%) of the patients. Combined antral and corpus biopsies increased the result by 20.8% compared to antral biopsies alone and 4.5% compared to corpus biopsies alone. Totally 20.8% of patients infected with H. pylori would have been misdiagnosed if testing from antrum alone and not combined with corpus. Atrophy and intestinal metaplasia were found in 101 (30.8%) and 17 (5.2%) of our patients, respectively. Atrophic gastritis was significantly more often in the antrum than the corpus (29.2 vs 11.9%, respectively, p < 0.05). Patients with only positive corpus biopsies showed more incidences of both atrophy and intestinal metaplasia. Detection rates of H. pylori decreased as more as atrophy increased regardless of biopsy site. Sensitivity of antrum biopsies alone, 65% compared to 92.5% in corpus alone or 100% if combination of both. Conclusion: This study clarified that additional gastric corpus biopsy to the antral one increases the sensitivity to detect H. pylori infection especially if associated with gastric atrophy. Keywords: Gastric Atrophy; Sydney System; H. pylori; Gastritis