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We developed a polymerase chain reaction (PCR) assay to detect Helicobacter pylori in gastric and/or gastroesophageal biopsy specimens of adults with dyspepsia, compared the method with immunohistochemical analysis and CLOtest (Ballard Medical Products, Draper, UT), and correlated the results of each test with the histologic features of infection. H pylori was identified in 36 (60%) of 60 patients irrespective of biopsy site and testing method. In the gastric biopsy specimens, PCR detected H pylori in 29 (52%) of 56 cases, including 11 (100%) of 11 immunohistochemically and/or CLOtest-positive cases. PCR-positive gastric biopsy specimens correlated with a higher average cumulative inflammatory score compared with PCR-negative specimens (P = .001). In gastroesophageal biopsy specimens, PCR detected H pylori in 15 (34%) of 44 cases, including 1 (20%) of 5 immunohistochemically positive specimens. PCR-positive gastroesophageal junction biopsy specimens did not correlate with a higher average cumulative inflammatory score. Overall, PCR detected an additional 23 cases negative by immunohistochemical analysis and/or CLOtest. This PCR assay identified a significant number of H pylori infections that would not be detected by immunohistochemical analysis and/or CLOtest.

Updated Sydney system graded from 0 to 3 based on morphologic parameters. Results: 39 of 41 (95%) patients with the R pattern were negative for HP infection with a Sydney score of 0. On the other hand 10/10 (100%) patients with the O pattern were HP positive. 15/23 (65%) of the I pattern were HP positive. The sensitivity, specificity, positive predictive value and negative predictive value of the ‘‘R’’ pattern as indicator for absence of infection were 85.45%, 93.10%, 95.92% and 77.14% respectively. The sensitivity, specificity, PPV and NPV of the ‘‘O’’ pattern for the presence of infection were 61.36%, 100%, 100% and 73.4%. The Updated Sydney scores for the ‘‘I’’ and ‘‘O’’ pattern were significantly higher than the R pattern (p ! 0.01). Conclusion: The pattern and visibility of the microvascular network of the corpus is influenced by HP induced gastritis. NBI can reliably predict HP induced gastritis as well as HP free status. High resolution narrow band imaging could be a potential tool for the instantaneous real time diagnosis of HP infection.