Accurate diagnosis of Helicobacter pylori with biopsy

Three (author's standard) or five biopsy specimens (two antral, two corpus, one incisura) as suggested by the Sydney system (original and revised version) [figure: see text] correctly separate infected mucosa from uninfected mucosa. No combination identified correctly the presence of intestinal metaplasia to be considered reliable. If intestinal metaplasia is present, the yield of histology for H. pylori decreases despite obtaining three or four biopsy specimens in different gastric compartments. In patients with severe atrophy, if it is important to document cure of H. pylori infection, one might consider a urea breath test if histology is negative.