Accuracy of biopsies for Helicobacter pylori in the presence of intestinal metaplasia of the stomach

Background/Aims: Gastric cancer is the second leading cause of cancer-related death worldwide. The majority of gastric cancers is intestinal-type adenocarcinoma, caused in part by H. pylori infection. Chronic gastritis leading to atrophy and intestinal metaplasia (IM) can result in cancer. Studies have demonstrated reversibility of mucosal atrophy following H. pylori eradication. Concern has been raised regarding the sensitivity of gastric biopsy for H. pylori detection in the context of IM. Materials and Methods: All cases of IM on gastric biopsy from a single gastroenterologist's outpatient practice were retrospectively reviewed from February 1, 2006 until May 31, 2012. Results: In total, 105 IM cases were found, of which 37 (35.2%, 95% CI: 26.3-45.2) were H. pylori-positive on biopsy. Charts of the remaining 68 patients were reviewed for availability of other tests, namely urea breath test (UBT) and serology. Of 43 H. pylori-negative patients who underwent a UBT, 10 were positive for the infection (23.3%, 95% CI: 12.3-39.0). Amongst patients with coexisting autoimmune gastritis (AIG), 4 out of 9 (44.4%, 95% CI: 15.3-77.3) also had evidence of H. pylori infection by UBT, despite negative histology. Conclusion: For cases of gastric IM with negative histology for H. pylori, UBT should be considered, even in cases of AIG, as this may alter the management and clinical course for patients.