**3. Results**

**Figure 2.** *Helicobacter pylori* in histological section of the gastric mucosa stained with Giemsa. This is a 400× histological section of Giemsa-stained gastric mucosa biopsy. There can be seen colonisation with *Helicobacter pylori* (white arrows)

**Figure 1.** *Helicobacter pylori* in histological section of the gastric mucosa stained with haematoxylin-eosin. This figure represents a 200× histological section of haematoxylin-eosin-stained gastric mucosa. It is seen with diffuse inflammatory lymphoplasmacytic infiltrate (black arrows) and vascular congestion (red arrows). *Helicobacter pylori* is found at the

Gastritis was graded according to the Sydney system [6] that assesses the severity of inflammation, the level of activity (the degree of polymorph neutrophil inflammation) and the pres-

In accordance with the Sydney system, the density of *H. pylori* infection was also graded

*H. pylori* was recognised in the histological section appearing as a short-curved or spiral bacil-

The data was collected and analysed with Microsoft Excel 2013 and PSPP version 1.0.1. Continuous variables with a normal distribution were expressed as a mean with standard

of the gastric glands, represented by small curved structures.

surface of the gastric mucosa within the layer of mucus (yellow arrows).

82 Histology

ence of atrophy and of intestinal metaplasia on a scale from 0 to 3.

lus resting on the epithelial surface or in the mucus layer.

**2.5. Statistical analysis**

semiquantitatively on a scale from 0 to 3 (mild, moderate and marked).

In the study, the culture findings and histological examination findings were accepted as "gold standard". The detection of *H. pylori* in at least one of the two tests was accepted as *H. pylori* positivity. Negative results in both culture and histology were accepted as *H. pylori* negativity.

Of the 38 patients who underwent upper endoscopy with biopsies by protocol (**Figure 3**), nine were excluded because of negative results in both culture and histology.

Twenty-nine cases (76.31%) were included in the final analysis, nineteen females (65.51%) and ten males (34.49%). The ages were between 3 years and 7 months and 17 years and 8 months (mean age 13, 5 ± 4.53 years).

The results for the diagnosis of *H. pylori* infection for each of the tests revealed that the haematoxylin-eosin and Giemsa stains of the antrum and body were the test that identified a higher number of *H. pylori* infection than the *H. pylori* culture.

Indeed, the histological examination of samples was able to identify the presence of *H. pylori* in 28 patients (96.55%), while the culture resulted to be positive in only six cases (21.42%).

We did not analyse separately the presence of the *H. pylori* in the antral mucosa compared with the gastric body mucosa; the result was recorded positive, if the bacterium was isolated in any of the histological examinations.

The histology also showed that 14/28 (50%) patients had mild *H. pylori* density, 11 (38.29%) had moderate density and 3 (10.71%) had marked density.

In one case, the culture was positive, but the bacterium was not identified through the histological exam. Among the other five cases with positive culture, two were associated with a mild score of *H. pylori* density, the other two with a moderate score and one with a marked score (**Table 1**).

We analysed the correlation between densities of *H. pylori* in histological exam and positive *H. pylori* culture: 14.28% (2/14) of patients with mild *H. pylori* density, 18.18% (2/11) of those with moderate density and 33.33% (1/3) of those with marked density had positive results in bacterial culture. There was not a statistically significant correlation between the degree of *H. pylori* density observed at histology and the positive result of bacterial culture (p *=* 0.7). The limited number of patients with positive bacterial culture may have influenced these results.

We used haematoxylin-eosin as the main staining method, while Giemsa stain was reserved for a few cases, not identified through haematoxylin-eosin staining, in which the suspect of

A Study of the Correlation between Bacterial Culture and Histological Examination in Children…

http://dx.doi.org/10.5772/intechopen.80257

85

We also tried to find out if there existed a relationship between the activity of gastritis and the density of *H. pylori* in the histological exam. Most of the patients with mild *H. pylori* density presented a mild gastritis activity (50%), while the other half showed a similar frequency of moderate gastritis activity (28.57%) and of no activity (21.43%); among patients with moderate *H. pylori* density, 54.54% had moderate activity, 36.36% a mild one and only 9.0% of them presented a marked gastritis activity. Those with marked bacterial density at histology displayed an identical frequency of absent, mild and moderate gastritis activity (33.33%). According to our results, there were not statistically significant differences between the groups that allow concluding that the severity of gastritis activity is related to *H. pylori* density at histology

The relationship between the degree of inflammation and *H. pylori* density was examined as well. Mild density was mostly associated with moderate (50.0%) and mild (42.80%) inflammation, while severe inflammation was demonstrated in only one case (7.20%). In patients with moderate *H. pylori* density, a moderate inflammatory process was identified in most of the cases (63.64%), together with a mild inflammation (36.36%), whereas nobody presented with a severe one. In children with marked density, mild inflammation was predominant (66.67%), followed by a moderate one in 33.33% of patients, while none of them was severely affected. Our findings do not show the evidence of a significant correlation between inflammation and

The specificity for *H. pylori* culture in our study was 90.90%, but the sensitivity was low,

**Mild activity n (%)**

**n (%)**

**Moderate activity**

**Marked activity**

**n (%)**

**Marked inflammation**

**n (%)**

**n (%)**

**Moderate inflammation**

20.68%. The specificity for histology was 90.90%, and the sensitivity was 96.55%.

Mild *H. pylori* density 3 (21.43%) 7(50%) 4(28.57%) 0 Moderate *H. pylori* density 0 4 (36.36%) 6 (54.54%) 1 (9.0%) Marked *H. pylori* density 1 (33.33%) 1 (33.33%) 1 (33.33%) 0

**Without activity**

**Table 2.** Correlations of activity of *Helicobacter pylori* gastritis and *Helicobacter pylori* density.

**Mild inflammation**

Moderate *H. pylori* density 4 (36.36%) 7 (63.64%) 0 Marked *H. pylori* density 2 (66.67%) 1 (33.3%) 0

Mild *H. pylori* density 6 (42.80%) 7 (50.0%) 1 (7.20%)

**Table 3.** Correlations of inflammation of *Helicobacter pylori* gastritis and *Helicobacter pylori* density.

**n (%)**

**n (%)**

infection was high.

(p = 0.3) (**Table 2**).

*H. pylori* density at histology (p = 0.7) (**Table 3**).

**Figure 3.** Flow chart of the study.


**Table 1.** Correlations of *Helicobacter pylori* density and *Helicobacter pylori* culture.

We used haematoxylin-eosin as the main staining method, while Giemsa stain was reserved for a few cases, not identified through haematoxylin-eosin staining, in which the suspect of infection was high.

We also tried to find out if there existed a relationship between the activity of gastritis and the density of *H. pylori* in the histological exam. Most of the patients with mild *H. pylori* density presented a mild gastritis activity (50%), while the other half showed a similar frequency of moderate gastritis activity (28.57%) and of no activity (21.43%); among patients with moderate *H. pylori* density, 54.54% had moderate activity, 36.36% a mild one and only 9.0% of them presented a marked gastritis activity. Those with marked bacterial density at histology displayed an identical frequency of absent, mild and moderate gastritis activity (33.33%). According to our results, there were not statistically significant differences between the groups that allow concluding that the severity of gastritis activity is related to *H. pylori* density at histology (p = 0.3) (**Table 2**).

The relationship between the degree of inflammation and *H. pylori* density was examined as well. Mild density was mostly associated with moderate (50.0%) and mild (42.80%) inflammation, while severe inflammation was demonstrated in only one case (7.20%). In patients with moderate *H. pylori* density, a moderate inflammatory process was identified in most of the cases (63.64%), together with a mild inflammation (36.36%), whereas nobody presented with a severe one. In children with marked density, mild inflammation was predominant (66.67%), followed by a moderate one in 33.33% of patients, while none of them was severely affected. Our findings do not show the evidence of a significant correlation between inflammation and *H. pylori* density at histology (p = 0.7) (**Table 3**).

The specificity for *H. pylori* culture in our study was 90.90%, but the sensitivity was low, 20.68%. The specificity for histology was 90.90%, and the sensitivity was 96.55%.


**Table 2.** Correlations of activity of *Helicobacter pylori* gastritis and *Helicobacter pylori* density.

*Helicobacter pylori* **density Patients (n)** *Helicobacter pylori* **culture Patients (n)**

Negative 12

Negative 9

Negative 1

Mild 14 Positive 2

Moderate 11 Positive 2

Severe 3 Positive 2

**Table 1.** Correlations of *Helicobacter pylori* density and *Helicobacter pylori* culture.

**Figure 3.** Flow chart of the study.

84 Histology


**Table 3.** Correlations of inflammation of *Helicobacter pylori* gastritis and *Helicobacter pylori* density.
