Biopsy of
ulcer margin is routinely performed to exclude
malignancy in patients with
gastric ulcers, but its utility in diagnosing Helicobacter pylori
infection has not yet been fully studied. A cohort of 50 patients with
gastric ulcer was prospectively examined. Three tests including histology, rapid
urease test, and
urea breath test were performed in all patients for diagnosing H pylori
infection. Six biopsied specimens from the margin of the
gastric ulcer and 1 each specimen from antrum and body of non-
ulcer part were obtained for histology using
hematoxylin-
eosin (H&E)
stain. The criterion used for defining H pylori
infection was a positive result in at least 2 of the 3 tests. H pylori
infection was diagnosed in 27 (54%) of the patients. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the histological examination of the
ulcer margin were 92.6%, 95.7%, 96.2%, 91.7%, and 94%, respectively. The addition of 1 specimen from the antrum or body or a combination of the 2 specimens did not increase the diagnostic yields of those for histological examination of
ulcer margin alone. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the rapid
urease test were 96.3%, 100%, 100%, 95.8%, and 98%, respectively, and the corresponding values for the
urea breath test were 88.9%, 87%, 88.9%, 87%, and 88%. We performed
Giemsa stain for the 3 patients with false-negative and false-positive results of histological examination of
ulcer margin using H&E
stain, and all were positive for H pylori
infection. In conclusion, histological examination of the
ulcer margin using
hematoxylin-
eosin stain was quite accurate and useful for diagnosing H pylori
infection in patients with
gastric ulcers. A special
stain is required when the diagnosis of H pylori
infection is questionable on routine H&E staining.