SciELO - Scientific Electronic Library Online

vol.37 issue4Cardiac hemodynamic variables and post-liver transplant outcomes in a transplant referral center in Colombia at 2,600 meters above sea levelFactors associated with muscle mass and strength in patients with liver cirrhosis: A cross-sectional study author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand




Related links

  • On index processCited by Google
  • Have no similar articlesSimilars in SciELO
  • On index processSimilars in Google


Revista colombiana de Gastroenterología

Print version ISSN 0120-9957On-line version ISSN 2500-7440

Rev. colomb. Gastroenterol. vol.37 no.4 Bogotá Oct./Dec. 2022  Epub July 07, 2023 

Original article

The usefulness of Giemsa staining to diagnose Helicobacter pylori in patients with preneoplastic lesions

Santiago García-Carmona1

Juan Carlos Arango-Viana2

Enoc Ahumada-Rodríguez3

Jessenia Agudelo-Mesa4

Tania Pérez-Cala5

Alonso Martínez5

Sigifredo Ospina-Ospina6

Beatriz Eugenia Salazar5  *

1Patology Resident, Patology Department, Faculty of Medicine, Universidad de Antioquia. Medellín, Colombia.

2Patology Department, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia. Biology and Clinic research group, Faculty of Medicine, Universidad de Antioquia. Medellín, Colombia.

3Patology Department, Faculty of Medicine, Universidad de Antioquia. Medellín, Colombia.

4Medicine student, Faculty of Medicine, Universidad de Antioquia. Medellín, Colombia.

5Bacteria & Cancer group, Microbiology Department, Faculty of Medicine, Universidad de Antioquia. Medellín, Colombia.

6Professor, Faculty of Medicine, Universidad de Antioquia. Medellín, Colombia.



Helicobacter pylori is a bacterium associated with inflammatory and neoplastic gastroduodenal diseases. Histopathology is one of the diagnostic methods used for its detection, which has a sensitivity of 90% to 95% when there is a high density of H. pylori; however, the bacterium may be missed in low-density infections because routine hematoxylin and eosin (H&E) staining is not specific for its detection and has interobserver variability. This study aimed to determine the usefulness of complementary Giemsa staining for diagnosing H. pylori in preneoplastic lesions where the bacterium was found in low density.

Materials and methods:

A retrospective/prospective descriptive study was carried out that included 65 patients diagnosed with preneoplastic lesions. Gastric biopsies were stained with H&E and Giemsa and evaluated by two pathologists.


Giemsa staining analyzed 20.3% more cases of H. pylori than H&E, most with a low density of the bacteria. There were no statistically significant differences in the diagnosis of H. pylori according to the sample type.


This study found that Giemsa staining improves the histopathological diagnosis of H. pylori in patients with preneoplastic lesions.

Keywords: Histological techniques; Helicobacter pylori; diagnosis; preneoplastic lesions; gastrointestinal diseases



Helicobacter pylori es una bacteria asociada con enfermedades gastroduodenales inflamatorias y neoplásicas. La histopatología es uno de los métodos diagnósticos empleados para su detección, la cual tiene sensibilidad del 90% al 95% cuando hay alta densidad de H. pylori; sin embargo, la bacteria puede pasar desapercibida en infecciones de baja densidad porque la coloración de rutina de hematoxilina y eosina (H&E) no es una tinción específica para su detección y presenta variabilidad interobservador. El objetivo de este estudio fue determinar la utilidad de la tinción complementaria de Giemsa para el diagnóstico de H. pylori en lesiones preneoplásicas en las que la bacteria se encuentra en baja densidad.

Materiales y métodos:

se realizó un estudio descriptivo retrospectivo y prospectivo que incluyó a 65 pacientes con diagnóstico de lesiones preneoplásicas. Las biopsias gástricas se tiñeron con H&E y Giemsa, y fueron evaluadas por dos patólogos.


la coloración de Giemsa diagnosticó 20,3% de casos más de infección por H. pylori que la H&E, la mayoría de ellos con baja densidad de la bacteria. No hubo diferencias estadísticamente significativas en el diagnóstico de H. pylori de acuerdo con el tipo de muestra.


este estudio encontró que la tinción de Giemsa mejora el diagnóstico histopatológico de H. pylori en pacientes con lesiones preneoplásicas.

Palabras clave: Técnicas histológicas; Helicobacter pylori; diagnóstico; lesiones preneoplásicas; enfermedades gastrointestinales


Helicobacter pylori is a helical gram-negative bacillus with a worldwide prevalence of more than 50% in low- and middle-income countries and less than 50% in high-income countries1. In Colombia, the frequency varies according to different studies (41.7%-99.1%)2-4. H. pylori is associated with inflammatory and neoplastic gastroduodenal diseases and has been recognized as a definitive gastric carcinogen since 1994, according to the IARC (International Agency for Research on Cancer)5. In 2020 in Colombia, gastric cancer (GC) ranked second in incidence in men (4,989) and fifth in women (3,225)6. Chronic H. pylori infection leads to atrophic gastritis and intestinal metaplasia (IM), both considered preneoplastic lesions (PNL) of GC, which are potentially reversible when early and effective treatment is instituted to eradicate the bacterium7,8. Therefore, early diagnosis and therapeutic management of the infection can reduce the risk of GC.

For H. pylori diagnosis, there are non-invasive and invasive methods. The former indirectly detect the bacterium or its products and include serology (sensitivity [Sen] = 76%-84% and specificity [Spe] = 79%-90%), fecal antigens (Sen = 69%-95% and Spe = 97.6%)9, and the urease breath test (Sen = 96%-100% and Spe = 93%-100%)10. The latter are based on upper GI endoscopy (EGD) with biopsies and include the rapid urease test (Sen = 80%-95% and Spe = 95%-100%), microbiological culture (Sen = 70% and Spe = 100%), molecular tests (Sen = 91% and Spe = 100%), and histopathology (Sen = 90%-95% and Spe = 95%-98%)11. Histopathology has several advantages because it allows the diagnosis of the infection, determines the degree of inflammation of the gastric mucosa, and evaluates the presence of PNL12.

On the one hand, for the histopathological study of H. pylori, it is advisable to carry out standardized sampling (Sydney protocol) in which several biopsies are taken from specific sites of the stomach, given the heterogeneous distribution of the bacteria that can lead to false negatives when selecting a single sampling site11. On the other hand, the stain routinely used for histopathological diagnosis is hematoxylin and eosin (H&E). This stain is usually sufficient in high-density infections, although it has a variable sensitivity between 69% and 93%; however, the density of H. pylori decreases with increasing PNL13, so in patients with PNL, the sensitivity of H&E is less than 70%14. It has been reported that the exclusive use of H&E bypasses H. pylori with low density15.

The implementation of the Sydney protocol improves the sensitivity and specificity in the diagnosis of H. pylori16. It consists of evaluating five samples, two from the antrum, two from the gastric body, and one from the angular incisure, which increases the probability of finding the bacterium. A previous study published by our group determined the presence of H. pylori not only in the gastric antrum but also in other samples used in the Sydney protocol17.

Assessment of intestinal atrophy and metaplasia are best determined in the region of the angular incisure, which is also the site most likely to reveal dysplastic changes; hence the importance of this biopsy. This protocol, added to the use of special stains such as Giemsa, Alcian Blue, Periodic Acid Schiff (PAS), or Warthin-Starry, improves diagnosis, especially in patients with PNL1,14,18.

Chahuan et al. demonstrated that, besides H&E, Giemsa staining is preferred because it is sensitive (42.6%-94%), easy to perform, cheap, widely available, and does not produce precipitates that can be confused with the bacterium15. Several studies show the superiority of Giemsa staining compared to H&E, whose sensitivity ranges from 28.7% to 83.9% in detecting the bacterium15,18,19. In addition, Giemsa staining reduces interobserver variability in the diagnosis of infection because it facilitates its viewing17,20.

Up to 75% of atrophic gastritis cases are associated with H. pylori. Still, the detection of the bacterium can go unnoticed21, causing false negative results in the diagnosis and not allowing the patient to receive timely treatment for eradication22, as demonstrated in previous studies22-26.

In Colombia, no studies were found on determining the usefulness of special stains such as Giemsa for diagnosing H. pylori in patients with gastric PNL. Therefore, this study aimed to assess the effectiveness of Giemsa staining for diagnosing H. pylori in gastric biopsies of patients with PNL who attended seven healthcare institutions in three regions of Antioquia, Colombia, during 2016-2018.

Materials and methods

Study type

Descriptive, retrospective, and prospective.

Study population and eligibility criteria

This study derives from the CODI 2014-1062 project approved by the Research Ethics Committee of the Medicine School, Universidad de Antioquia. Individuals ≥18 years of age who attended seven healthcare institutions in three subregions of Antioquia (Valle de Aburrá metropolitan area, Oriente, and Urabá Antioqueño) were included. The participants came for EGD performance, and participation in the project was voluntary by signing the consent form.

We excluded individuals who received proton pump inhibitors (PPIs) or H2-histamine receptor antagonists during the 15 days before EGD or antibiotics within the last month; individuals diagnosed with upper gastrointestinal bleeding; anticoagulated patients or patients with coagulation disorders; pregnant women; people with previous surgical history in the upper GI tract; prior diagnosis of chronic severe diseases (renal, hepatic, decompensated heart failure, and decompensated diabetes mellitus), and people with a history of radiochemotherapy. From 272 individuals included in the previous study, a sample of 65 patients with a histopathological diagnosis of PNL (atrophic gastritis or intestinal metaplasia) was selected for this study. Patients with dysplasia were not included since this histopathological finding was not reported in the patients included17.

Biopsy collection and processing

Five samples were taken from each participant following the recommendations of the updated Sydney protocol that include a sample of the greater curvature of the antrum (A1), lesser curvature of the antrum (A2), angular incisure (I), greater curvature of the body (C1), and lesser curvature of the body (C2); a sixth sample was taken in cases where a tumor was found. Samples were stored and transported to the Las Vegas Clinic Cytology and Pathology Unit for processing. Samples from each patient were stained with H&E and modified Giemsa-Diff Quick.

Biopsy reading and histopathological diagnosis of H. pylori

All five Giemsa-stained biopsies were evaluated and blinded-read randomly by one of two pathologists and a third-year pathology resident. The presence or absence of the bacterium was determined as positive or negative by directly observing helical gram-negative bacilli with a light microscope (Leica® DM500). For its quantification, the visual analog scale of the updated Sydney protocol was used (absent, scarce, moderate, and abundant)16. The bacteria was searched in non-atrophic areas without intestinal mucosal metaplasia. The staining characteristics of the bacterium to specify in the H&E staining were monochromatism similar to the foveolar epithelium and, in the special Giemsa staining, the dark blue stain that stands out. In cases of discrepancies in the bacterium presence or quantification, the second pathologist and the pathology resident completed a third reading, agreeing upon the results.

Data analysis

The statistical package SPSS (IBM) v. 27 was employed. For the qualitative variables, we used the absolute and relative frequency distribution of the categories of the variables. The mean ± standard deviation (SD) was used for the quantitative age variable since a normal distribution was observed according to the Kolmogorov-Smirnov test. The ratio between the two stainings was defined based on a 2 x 2 table dividing the number of positive and negative matches by the total.


The study evaluated 325 gastric biopsies from 65 patients with PNL. The mean age was 54.4 years (SD: 16.4), and 63% (41) were female; 69.2% (45) of the participants lived in the metropolitan area of Medellín, 23.1% (15) in Oriente, and 7.7% (5) in Urabá Antioqueño.

Regarding the histopathological diagnosis of H. pylori infection, Giemsa staining had a positivity rate of 98.5%, lower than H&E (Figure 1).

Figure 1 Distribution of patients according to the results of histopathological staining for H. pylori. Source: The authors. 

When analyzing the presence of the bacterium at the biopsy site, H. pylori was more frequent in A1, A2, and I. The positivity for the diagnosis of H. pylori was higher with Giemsa staining in all anatomical sites (61.5%-72%), while H&E varied between 41.5% and 49% (Figure 2).

Figure 2 Distribution of positive H&E and Giemsa results for H. pylori by anatomical site. A1: greater curvature of the antrum; A2: lesser curvature of the antrum; I: angular incisure; C1: greater curvature of the body; C2: lesser curvature of the body. Source: The authors. 

The proportion for positive and negative results between H&E staining and Giemsa staining was higher in the C1 samples, with 86.1%, and lower in A1, with 73.8% (Figure 3).

Figure 3 Agreement ratio between H&E and Giemsa. Source: The authors. 

The proportion of samples positive for H. pylori evaluated with Giemsa staining was higher than H&E. The difference was more significant in the samples with a low amount of bacteria, with a statistically significant difference (p = 0.035) (Table 1).

Table 1 The proportion of positivity for H. pylori according to the infection density and staining used in each anatomical site 

Sampling site Amount of H. pylori
Scarce Moderate Abundant
H&E Giemsa H&E Giemsa H&E Giemsa
n % n % n % n % n % n %
A1 13 8.5 23 10.5 11 7.2 12 5.5 8 5.2 12 5.5
A2 8 5.2 21 9.6 13 8.5 10 4.6 9 5.9 12 5.5
I 10 6.5 25 11.4 10 6.5 12 5.5 10 6.5 9 4.1
C1 15 9.8 18 8.2 9 5.9 13 5.9 9 5.9 11 5.0
C2 14 9.1 19 8.7 8 5.2 13 5.9 6 3.9 9 4.1
Total 60 39.1 106 48.4 51 33.3 60 27.4 42 27.4 53 24.2

A1: greater curvature of the antrum; A2: lesser curvature of the antrum; I: angular incisure; C1: greater curvature of the body; C2: lesser curvature of the body. Number of positive cases for H&E: 153, and for Giemsa: 219. Source: The authors.


Several invasive and non-invasive methods are available for detecting H. pylori. Still, no test is the gold standard for diagnosis if sensitivity, specificity, cost, reproducibility, and speed are considered11. This study used two histological techniques (H&E and Giemsa) to diagnose H. pylori in patients with PNL (atrophic gastritis and intestinal metaplasia), whose bacterial density is low. According to the results, the Giemsa stain had a higher proportion of positivity in each of the five anatomical sites evaluated according to the updated Sydney protocol. This proportion was consistently higher in the group of samples with scarce bacteria.

The use of complementary stains has been evaluated in previous studies. Khan H et al. reported the need for other stainings such as Giemsa, PAS-AB, Warthin-Starry, and immunohistochemistry (IHC) in patients with low bacterial load (mild inflammation) associated with atrophic mucosa or after eradication therapy27. In our experience, the Giemsa stain was selected as complementary since it is reported in the literature for detecting H. pylori given its characteristics: economical, sensitive, easy to perform, and reproducible9. In a 2014 study, Boldt et al. found that Giemsa staining had higher sensitivity and specificity when compared to H&E28. Alkhamiss AS et al. found that the specificity of H&E for H. pylori is high (91.18%). Still, its sensitivity is low (66.67%) compared to Giemsa staining, whose sensitivity and specificity was high (93.33% and 100%, respectively), which suggests that Giemsa is a better option when compared to H&E29.

This study noted that the H&E stain had a lower positivity rate (66.2%) compared to the complementary Giemsa stain (98.5%), as reported by Alkhamiss AS et al.29. For their part, Mawlood et al. said similar findings for Giemsa with a positivity rate of 93.5% and H&E of 83.9%17. Laine et al. found a similar sensitivity between the two stains (H&E: 92% and Giemsa: 88%). They highlighted that the specificity of Giemsa was significantly higher than the H&E stain (98% and 89%, respectively), which is why they recommend it for the diagnosis of H. pylori18.

The proportion of samples positive for H. pylori with Giemsa was consistently higher than that with H&E in samples with low amounts of bacteria (p = 0.035), with diagnoses of an average of 20.3% more positive cases. It suggests that the H&E stain should be supplemented with an additional stain, such as Giemsa, when the amount of bacteria is low, as demonstrated by Moayyedi et al.30 and by Vaira D et al. They determined that histological examination can miss low-density infections, mainly if performed only with H&E31. In these circumstances, the bacterium can easily be confused with cellular debris since H&E staining is not specific for H. pylori. Sabbagh P et al. proved that the accuracy of the histopathological diagnosis of H. pylori depends on the number and location of the biopsies collected11.

This study could diagnose the H. pylori infection in samples from the five anatomical sites, which is consistent with what was reported by Lee JY et al. They mention that in cases of atrophic gastritis and intestinal metaplasia, there is a change in the usual colonization of the antrum towards the proximal stomach (body of the antrum and gastric fundus) as a result of hostile antral conditions, including increased pH, in which atrophy and metaplasia occur more frequently. The authors also reported that the gastric body is the appropriate biopsy site to detect H. pylori in patients with these lesions32.

In Colombia, there is no consensus on the histological diagnosis of H. pylori. Sabbagh P et al. report that this method could make the diagnosis with a single gastric biopsy sample. However, multiple biopsies are recommended to increase diagnostic accuracy and sensitivity11. Generally, two different staining methods are employed: H&E for evaluating inflammatory cells and Giemsa for viewing the bacteria11. Alkhamiss AS et al., Makristathis et al., and Batts KP et al. suggested that studies complementary to H&E, such as Giemsa staining for the diagnosis of H. pylori, should be performed only if the presence of an infection by the bacterium that cannot be viewed with H&E is highly suspected, such as cases with active gastritis or the formation of germinal centers29,33,34.

Lee JY et al. also report that the specificity of histology can be improved by special stains such as Giemsa and immunohistochemical stains32, the latter being used in other countries in cases of low bacterial density, atrophic gastritis with extensive intestinal metaplasia and chronic active gastritis without identification of H. pylori by standard staining. The IHC is more specific; however, it is more expensive, more technically challenging, and unavailable in all laboratories9.

According to the Colombian Association of Gastroenterology clinical practice guideline for diagnosing and treating H. pylori in adults, routine basic staining with H&E and special staining with Giemsa is recommended to determine the presence or absence of H. pylori. IHC is reserved for cases with negative staining, active inflammation, post-treatment biopsies of MALT lymphomas, and when coccoid forms or other organisms cannot be identified with certainty35. According to Kocsmár É et al., the use of IHC is reasonable in cases that are negative with Giemsa staining and do not exhibit inflammatory activity and in which the etiological role of H. pylori is suggested by clinical, anamnestic, or other data36.


In low- and middle-income countries, such as Colombia, it is increasingly critical that health systems find cost-effective and efficient alternatives to diagnose H. pylori. Giemsa staining proved helpful in the histopathological study of H. pylori in samples with low bacterial density, such as those from patients with PNL; however, its usefulness in evaluating non-atrophic gastric mucosa in ulcers and neoplasias is not ruled out. Giemsa staining could increase the sensitivity of the infection diagnosis and, thus, optimize the bacterium eradication treatment to reduce or reverse its progression to disease.


We thank Dr. Ana María Cock Botero and the Cytology and Pathology Unit of the Las Vegas Clinic (Medellín, Colombia) for processing the samples. We are also grateful to the Bacteria & Cancer research group and the Pathology Department of the Medicine School, Universidad de Antioquia.


1. Zamani M, Ebrahimtabar F, Zamani V, Miller WH, Alizadeh-Navaei R, Shokri- Shirvani J, et al. Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection. Aliment Pharmacol Ther. 2018;47(7):868-76. ]

2. Roldán IJ, Castaño R, Navas MC. Mutaciones del gen ARN ribosómico 23S de Helicobacter pylori asociadas con resistencia a claritromicina en pacientes atendidos en una unidad de endoscopia de Medellín, Colombia. Biomedica. 2019;39(Supl. 2):117-29. ]

3. Bravo LE, Cortés A, Carrascal E, Jaramillo R, García LS, Bravo PE. Helicobacter pylori: patología y prevalencia en biopsias gástricas en Colombia. Colomb Médica. 2003;34(3):124-31. [ Links ]

4. Correa GS, Cardona A, Correa GT, García G, Estrada S. Prevalencia de Helicobacter pylori y características histopatológicas en biopsias gástricas de pacientes con síntomas dispépticos en un centro de referencia de Medellín. Rev Colomb Gastroenterol. 2016;31(1):9-15. ]

5. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Schistosomes, Liver Flukes and Helicobacter pylori. Lyon (FR): International Agency for Research on Cancer; 1994. (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, No. 61.) INFECTION WITH HELICOBACTER PYLORI. Available from: ]

6. IARC. Colombia. source: Globocan 2020 [Internet].; 2021 [citado el 31 de marzo de 2022]. Disponible en: Disponible en: colombia-fact-sheets.pdfLinks ]

7. Weng C-Y, Xu J-L, Sun S-P, Wang K-J, Lv B. Helicobacter pylori eradication: Exploring its impacts on the gastric mucosa. World J Gastroenterol. 2021;27(31):5152-70. ]

8. Basso L, Gallo G, Biacchi D, Carati MV, Cavallaro G, Esposito L, et al. Role of new anatomy, biliopancreatic reflux, and Helicobacter pylori status in postgastrectomy stump cancer. J Clin Med. 2022;11(6):1498. [ Links ]

9. Bordin DS, Voynovan IN, Andreev DN, Maev IV. Current Helicobacter pylori diagnostics. Diagnostics (Basel). 2021;11(8):1458. ]

10. Chahuán AJ, La DP, Villalón FA. Métodos de diagnóstico para la detección de la infección por Helicobacter pylori. Rev Gastroenterol Latinoam. 2020;31(2):98-106. ]

11. Sabbagh P, Mohammadnia-Afrouzi M, Javanian M, Babazadeh A, Koppolu V, Vasigala VR, et al. Diagnostic methods for Helicobacter pylori infection: ideals, options, and limitations. Eur J Clin Microbiol Infect Dis. 2019;38(1):55-66. ]

12. Nizeyimana T, Rugwizangoga B, Manirakiza F, Laga AC. Occurrence of Helicobacter pylori in specimens of chronic gastritis and gastric adenocarcinoma patients: A retrospective study at university teaching hospital, Kigali, Rwanda. East Afr Health Res J. 2021;5(2):159-63. ]

13. Zhang C, Yamada N, Wu YL, Wen M, Matsuhisa T, Matsukura N. Helicobacter pylori infection, glandular atrophy and intestinal metaplasia in superficial gastritis, gastric erosion, erosive gastritis, gastric ulcer and early gastric cancer. World J Gastroenterol. 2005;11(6):791-796. ]

14. Chahuan J, Pizarro M, Riquelme A. Métodos diagnósticos para la detección de infección por Helicobacter pylori. ¿Cuál y cuándo deben solicitarse? Acta Gastroenterol Latinoam. 2022;52(1):36-46. ]

15. Loor A, Dumitraşcu DL. Helicobacter pylori Infection, Gastric Cancer and Gastropanel. Rom J Intern Med. 2016;54(3):151-6. ]

16. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996;20(10):1161-81. ]

17. Salazar BE, Pérez-Cala T, Gomez-Villegas SI, Cardona-Zapata L, Pazos- Bastidas S, Cardona-Estepa A, et al. The OLGA-OLGIM staging and the interobserver agreement for gastritis and preneoplastic lesion screening: a cross-sectional study. Virchows Arch. 2022;480(4):759-769. ]

18. Mawlood AH, Kawther RS, Balaky S. Evaluation of Invasive and Non-Invasive Methods for the Diagnosis of H. pylori in Dyspepsia Patients. Diyala J Med. 2019;16(2):55-63. ]

19. Laine L, Lewin DN, Naritoku W, Cohen H. Prospective comparison of H&E, Giemsa, and Genta stains for the diagnosis of Helicobacter pylori. Gastrointest Endosc. 1997;45(6):463-7. ]

20. Miwata T, Quach DT, Hiyama T, Aoki R, Le HM, Tran PLN, et al. Interobserver and intraobserver agreement for gastric mucosa atrophy. BMC Gastroenterol. 2015;15:95. ]

21. Zolezzi-Francis A. Gastritis atrófiaca y Helicobacter pylori. Rev Gastroenterol Peru. 2002;22(3):197-8. [ Links ]

22. Kong Y-J, Yi H-G, Dai J-C, Wei M-X. Histological changes of gastric mucosa after Helicobacter pylori eradication: a systematic review and meta-analysis. World J Gastroenterol. 2014;20(19):5903-11. ]

23. Sung JJY, Coker OO, Chu E, Szeto CH, Luk STY, Lau HCH, et al. Gastric microbes associated with gastric inflammation, atrophy and intestinal metaplasia 1 year after Helicobacter pylori eradication. Gut. 2020;69(9):1572-80. ]

24. Hwang Y-J, Kim N, Lee HS, Lee JB, Choi YJ, Yoon H, et al. Reversibility of atrophic gastritis and intestinal metaplasia after Helicobacter pylori eradication - a prospective study for up to 10 years. Aliment Pharmacol Ther. 2018;47(3):380-90. ]

25. Chiang T-H, Chang W-J, Chen SL-S, Yen AM-F, Fann JC-Y, Chiu SY-H, et al. Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands. Gut. 2021;70(2):243-50. ]

26. Shah DK, Jain SS, Mohite A, Amarapurkar AD, Contractor QQ, Rathi PM. Effect of H. pylori density by histopathology on its complications and eradication therapy. Trop Gastroenterol. 2015;36(2):101-6. ]

27. Khan H, Rauf F, Muhammad N, Javaid M, Alam S, Nasir S. Comparación de tinciones especiales (tinción de Giemsa y tinción de azul de toluidina modificada) con inmunohistoquímica como estándar de oro para la detección de H. pylori en biopsias gástricas. Arab J Gastroenterol. 2022;23(2):75-81. [ Links ]

28. Boldt MS, Pereira RD, Barbosa AJA. Identificación histológica de H. pylori stained por hematoxilina-eosina y Giemsa: revisión para el control de calidad. J Bras Patol Med Lab. 2015;51(2):108-12. [ Links ]

29. Alkhamiss AS. Evaluation of better staining method among hematoxylin and eosin, Giemsa and periodic acid Schiff-Alcian blue for the detection of Helicobacter pylori in gastric biopsies. Malays J Med Sci. 2020;27(5):53-61. ]

30. Moayyedi P, Dixon MF. Any role left for invasive tests? Histology in clinical practice. Gut. 1998;43 Suppl 1:S51-5. ]

31. Vaira D, Ricci C, Holton J. Diagnosis of Helicobacter pylori: invasive and non- invasive tests. Best Pract Res Clin Gastroenterol. 2007;21(2):299-313. ]

32. Lee JY, Kim N. Diagnosis of Helicobacter pylori by invasive test: histology. Ann Transl Med. 2015;3(1):10. Disponible en: ]

33. Makristathis A, Hirschl AM, Mégraud F, Bessède E. Review: Diagnosis of Helicobacter pylori infection. Helicobacter. 2019;24 Suppl 1(S1):e12641. ]

34. Batts KP, Ketover S, Kakar S, Krasinskas AM, Mitchell KA, Wilcox R, 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(11):e12-22. ]

35. Sabbagh LC, Otero W, Hani A, Galindo A, Leguízamo A, Maldonado C, et al. Guías de práctica clínica basadas en la evidencia. Guía de práctica clínica para el diagnóstico y tratamiento de la infección por Helicobacter pylori en adultos [Internet]. Asociación Colombiana de Gastroenterología; 2016-2017 [citado el 9 de julio de 2022]. Disponible en: Disponible en: ]

36. Kocsmár É, Szirtes I, Kramer Z, Szijártó A, Bene L, Buzás GM, et al. Sensitivity of Helicobacter pylori detection by Giemsa staining is poor in comparison with immunohistochemistry and fluorescent in situ hybridization and strongly depends on inflammatory activity. Helicobacter. 2017;22(4):e12387. ]

Citation: García-Carmona S, Arango-Viana JC, Ahumada-Rodríguez E, Agudelo-Mesa J, Pérez-Cala T, Martínez A, Ospina-Ospina S, Salazar BE. Utilidad de la coloración de Giemsa para diagnosticar Helicobacter pylori en pacientes con lesiones preneoplásicas. Revista. colomb. Gastroenterol. 2022;37(4):402-409.

Sources of funding

This study was funded by the Committee for the Research Development (CODI) of the Universidad de Antioquia, code 2014-1062, and the National Doctorate program of the Ministry of Science, Technology, and Innovation (Minciencias), code 617-2013

Received: July 12, 2022; Accepted: September 26, 2022

*Correspondence: Beatriz Eugenia Salazar.

The authors declare no conflicts of interest

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License