Morphological Alterations and Mucin Histochemistry in Helicobacter pylori Positive and Negative Gastric Biopsies: A Cross-sectional Study

Introduction: Helicobacter pylori (H. pylori) is an important causative agent of chronic gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric carcinoma. Its prevalence is increasing in the developing nations. Hence, its earliest detection and eradication is of utmost importance. Aim: To compare the morphological alterations and mucin histochemical changes in H. pylori-positive and negative gastric biopsies. Materials and Methods: This cross-sectional study was conducted at the Department of Pathology, Amala Institute of Medical Sciences, Thrissur, Kerala, India from January 2017, to June 2018. A total of 42 cases each of H. pylori-positive and negative biopsies were studied after staining with HaematoxylinEosin (H&E) and Giemsa stains. Morphological alterations such as inflammation, intestinal metaplasia, dysplasia, and carcinoma were studied. Gastritis was graded according to the visual analogue scale of Updated Sydney System. Gastric dysplasia was graded according to the Padova International Classification. Combined PAS-Alcian Blue and High Iron Diamine-Alcian Blue stains were used to assess the mucin histochemical changes. The results were compared between the two groups. Statistical analysis was done by Fisher’s exact test and Chi-square test (IBM Statistical Package for the Social Sciences (SPSS) version 23.0). Results: Out of 84 gastric biopsies analysed, 79 cases were diagnosed with chronic gastritis (94.05%), followed by 3 cases of carcinoma (3.57%) and 2 cases of dysplasia (2.38%). Age of the patients ranged from 21 to 83 years, with 49 males (58.33%) and 35 females (41.67%). Cases of dysplasia and carcinoma were obtained in H. pylori-negative group. Chronic inflammation was significantly associated with H. pylori infection (p-value = 0.038). Intestinal metaplasia was more prevalent in the H. pylorinegative group, with Type III intestinal metaplasia constituted the maximum number of cases. Two cases of carcinoma showed Type III metaplasia in adjacent areas. Conclusion: Morphological alterations and mucin changes of the gastric mucosal epithelium have been shown to be precursor lesions for the development of gastric carcinoma. Type III intestinal metaplasia is significantly associated with gastric carcinoma. Subtyping intestinal metaplasia helps identify patients at risk, facilitating follow-up and effective management.