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Balancing Care and Cost: The utilization of immunohistochemistry to detect Helicobacter pylori in gastric biopsies
Yuho Ono, MD, Yigu Chen, MPH, Jonathan N. Glickman, MD, PhD
Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Introduction
Results: Frequency of H. pylori Infection
Helicobacter pylori is a main cause of gastritis and peptic ulcer disease, as well as a risk factor for
gastric cancer and MALT lymphoma1,2. In patients with H. pylori gastritis, detection of the organisms in
gastric biopsies leads to appropriate treatment and prevention of disease progression. In most cases, the
organisms are visible on biopsies stained with routine hematoxylin and eosin (H&E). The organisms may
also be visualized with the use of special stains or immunohistochemical (IHC) stains, which are
especially useful to visualize rare organisms or organisms in unusual locations within the biopsies.
However, overutilization of special and IHC stains is a potential drain on laboratory resources as well as a
source of increased patient costs.
Overall Frequency of H. pylori Infection
Objectives
•
•
•
Type of
gastritis in
cases with
H. pylori
infection
Frequency of H. pylori Infection by Histological Patterns
To assess the frequency of H. pylori infection in BIDMC’s patient population.
To assess the practice of the BIDMC Anatomical Pathology Division in ordering and interpreting IHC
for H. pylori detection based on the departmental standard operating procedure (SOP).
To assess the diagnostic yield of H. pylori IHC.
Methods
A retrospective review was
performed on pathology reports
for all patients who had gastric
biopsies obtained
endoscopically over a 3-months
period between June 2017 and
August 2017 and accessioned
at BIDMC Pathology, obtained
through a search of the
SoftPath electronic database.
Data Collected:
• Presence or absence of H. pylori
• Performance of H. pylori IHC
• Type of gastritis (active or inactive)
• Patient history of H. pylori infection
References:
1. Batts, KP et al. Appropriate use of special stains for identifying Helicobacter pylori: recommendations from the Rodger C. Haggitt Gastrointestinal Pathology Society. Am J Surg Pathol
(2013) 37:e12-e22.
2. Glickman, JN et al. Helicobacter infections with rare bacteria or minimal gastritis: Expecting the unexpected. Digestive and Liver Disease (2015),
http://dx.doi.org/10.1016/j.dld.2015.04.005.
Frequency of H. pylori Infection by Patient History
• H. pylori was detected in 126 cases of 1434 gastric biopsy cases (8.8%).
• H. pylori is more likely to be detected in active gastritis than in inactive gastritis.
• Patient history of H. pylori infection alone is not a very good predictor of whether or not H. pylori is likely
to be detected (H. pylori was detected in 37% of patients with history, and in 27% of patients without history).
For more information, contact:
Yuho Ono, MD, BIDMC Department of Pathology PGY-1, yono@bidmc.harvard.edu
�Balancing Care and Cost: The utilization of immunohistochemistry to detect Helicobacter pylori in gastric biopsies
Yuho Ono, MD, Yigu Chen, MPH, Jonathan N. Glickman, MD, PhD
Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Results: Utilization of H. pylori IHC
• H. pylori IHC was ordered in 304 of 410 cases (74%).
• Most of the IHCs were ordered in cases with inactive gastritis.
Type of
gastritis in
cases in which
H. pylori IHC
was ordered
Conclusions & Next Steps
• The diagnostic yield of H. pylori IHC is low, especially when performed on patients with milder degrees
of chronic inactive gastritis and/or patient’s who do not have a history of H. pylori infection.
• The SOP for H. pylori IHC ordering was revised to clarify the criteria for ordering and recommend a
higher threshold, and was implemented in January 2018.
• A repeat study will be performed to determine whether or not there is an interval change to the H. pylori
IHC ordering practice under the revised SOP.
Revised SOP for H. pylori IHC
YES
IHC stain positive for H. pylori (arrows)
Diagnostic Yield of H. pylori IHC
Chronic active gastritis without
H. pylori on H&E
Substantial chronic inactive
gastritis without H. pylori on H&E
Germinal centers
NO
H. pylori visualized on H&E
Mild or minimal chronic inactive
gastritis without H. pylori on H&E
(unless other conditions for
ordering are met)
Chemical/reactive gastropathy
(without superimposed chronic or
chronic active gastritis)
Intraepithelial neutrophils
Normal biopsy
Patient history of H. pylori (unless
histology is normal)
Inflamed cardia biopsy, no distal
gastric biopsies
Inflamed cardia biopsy, when distal
gastric biopsies are available
Unusual patterns of gastritis
References:
1. Batts, KP et al. Appropriate use of special stains for identifying Helicobacter pylori: recommendations from the Rodger C. Haggitt Gastrointestinal Pathology Society. Am J Surg Pathol
(2013) 37:e12-e22.
2. Glickman, JN et al. Helicobacter infections with rare bacteria or minimal gastritis: Expecting the unexpected. Digestive and Liver Disease (2015),
http://dx.doi.org/10.1016/j.dld.2015.04.005.
H. Pylori (arrows) seen on H & E
Bacterial forms indeterminate for
H. pylori on H&E
Fundic gland polyp
Clinician request (unless other
conditions for ordering are met)
Gastric mucosa with substantial
chronic inactive gastritis
For more information, contact:
Yuho Ono, MD, BIDMC Department of Pathology PGY-1, yono@bidmc.harvard.edu
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Yuho Ono <a href="mailto:yono@bidmc.harvard.edu">(yono@bidmc.harvard.edu)</a>
Department
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Pathology
Project Team
Yuho Ono
Yigu Chen
Jonathan N. Glickman
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Balancing Care and Cost: The utilization of immunohistochemistry to detect Helicobacter pylori in gastric biospies
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety