Journal of Research in Applied and Basic Medical Sciences (Apr 2025)
A study on optimal biopsy site in patients presenting with dyspepsia for Helicobacter pylori by using the Sydney System of grading
Abstract
Background & Aims: Helicobacter pylori (H. pylori) infection, a common organic cause of dyspepsia, often lacks macroscopic mucosal lesions, necessitating distinction from functional dyspepsia. This study assessed H. pylori prevalence, optimal biopsy sites, histopathological changes, and infection density in dyspeptic patients. Materials & Methods: Gastric mucosal biopsies from 100 dyspeptic patients were formalin-fixed, paraffin-embedded, and sectioned (5μm). Hematoxylin and eosin (H&E) and Giemsa stains were used for histopathological evaluation, with Giemsa specifically applied for H. pylori grading. Results: Patients (mean age: 44.37 years; range: 11–80) showed peak H. pylori prevalence in the fourth (28%, n=28) and fifth (29%, n=29) decades, with a male-to-female ratio of 1.26:1. Common symptoms included nausea (76%, n=76), epigastric discomfort, abdominal pain, and bloating. Chronic gastritis was identified in 89% (n=89), with 82% (n=82) testing H. pylori-positive, all exhibiting chronic active gastritis. The pyloric antrum was the predominant colonization site (86.58%, n=71/82), followed by the fundus (84.14%, n=69/82) and body (74.39%, n=61/82). Per the Sydney System, inflammation severity was mild (42.68%, n=35), moderate (48.78%, n=40), or severe (8.54%, n=7). H. pylori density was graded as mild (36.59%, n=30), moderate (54.88%, n=45), or dense (8.53%, n=7). Conclusion: Early H. pylori detection and eradication alleviate symptoms and prevent complications. Giemsa stain proved optimal for H. pylori identification due to its cost-effectiveness and rapidity. The pyloric antrum, followed by the fundus and body, is the primary biopsy site for diagnosing H. pylori-associated gastritis. These findings emphasize targeted biopsy protocols and efficient diagnostic methods in managing dyspepsia.
