Accurate diagnosis of Helicobacter pylori with biopsy

Histology is the gold standard for Helicobacter pylori infection, but its reliability depends on the site, number, and size of gastric biopsies and stain used. Three biopsies (2 antral and 1 corpus) correctly separate infected mucosa from uninfected mucosa. Three or five biopsies as suggested by the Sydney system (revised version) miss the presence of intestinal metaplasis too often to be considered reliable. Evaluating sections stained only with hematoxylin and eosin leads to inconsistent results. Because many equally sensitive special stains are now available, laboratories should decide based on local conditions.