In contrast, no change occurred in patients with severe atrophy and IM, regardless of H. pylori eradication [3]. The authors emphasized that this method predicts histological conditions and pepsinogen levels and may be cost effective in gastric cancer surveillance [4]. Confocal laser endomicroscopy, a magnifying endoscopy technique, allows an in depth BGJ398 analysis of the gastric mucosa. In a first

study, Ji et al.[5] identified H. pylori gastritis with a 92% accuracy. The mean kappa value for inter-observer agreement was 0.78. In a second study, the same group focused on the severity of H. pylori-associated gastritis, especially atrophy and IM, with a rather good diagnostic accuracy [6]. The ever well-known OLGA (Operative Link on Gastritis Assessment) staging system was highlighted again under the aspect of histology reporting of gastritis. It is especially valuable as it allows a prediction of the gastric cancer risk [7]. A long-term follow-up (12 years) of 93 patients confirmed that all invasive or intra-epithelial gastric neoplasia were consistently associated with high-risk (III/IV) OLGA stages [8]. Immunohistochemistry can be used to assess the presence of H. pylori with more certainty. However, its systematic use in the routine of a pathology

Epigenetics inhibitor laboratory does not seem necessary because it is of no value in cases with an absence of pathological abnormality nor reactive gastropathy [6]. However, it allows the diagnosis of clusters of predominantly coccoidal forms of H. pylori which are difficult to identify by standard staining. This aspect may be frequent in gastric resection specimens, possibly resulting from hypoxia or other stress conditions [9]. Fluorescence in situ Fluorometholone Acetate hybridization (FISH) is the other method with high specificity. A set of peptide nucleic acid (PNA) probes was developed to detect H. pylori and its resistance to clarithromycin. The optimized PNA-FISH proved to be a reliable method when used in clinical specimens [10]. When H. pylori-like organisms are observed on histological preparations after standard staining but

not with anti-H. pylori antibody stains, it is a challenge to identify the bacteria present. Pyrosequencing was used in Korea and, surprisingly, identified Campylobacter hyointestinalis, a gastric bacterium from pigs, seldomly cultured from humans. Among the 20 discrepancies observed, H. pylori was confirmed in four cases, while the other cases detected two Helicobacter cinaedi, one Campylobacter upsaliensis, and 12 C. hyointestinalis [11]. In another report, a urease-negative Helicobacter-like organism was identified as Selenomonas sp., but this time by culture [12]. The value of endoscopic surveillance to detect histologically premalignant gastric lesions, especially IM, as a gastric cancer preventive measure has been highlighted.