Brush cytology: Helicobacter pylori and unexpected Giardia

Abstract

To the Editor:Helicobacter pylori (HP) can be detected by a wide variety of methods. The gold standard for HP presence or absence is still histology, associated with culture, but its cost is rather high and it is not very sensitive in the assessment of HP gastric colonization, particularly when the bacterial density is low.1Gad A A rapid diagnosis of Campylobacter pylori by brush cytology.Scand J Gastroenterol. 1989; 24: 101-103Crossref Scopus (16) Google Scholar Brush cytology, involving a wider surface of mucosa, seems to be a more sensitive technique besides being cheaper and faster.2Cardillo MR Agnelli M. Brush cytology in the endoscopic diagnosis of benign gastric ulcer. A useful adjunct to biopsy?.Arch Anat Cytol Pathol. 1990; 38: 86-91PubMed Google Scholar Methylene blue staining allows identification of microorganisms present in gastric mucus by optical microscopy. Moreover, by using this technique, sometimes unexpected findings are possible.Among 600 patients referred to our endoscopy unit and whose brush cytology was examined for HP detection, we noted the presence of Giardia trophozoites in three of them.It is well known that gastric mucosa is not a favorable environment for Giardia.3Adam RD The biology of Giardia lamblia spp.Microbiol Rev. 1991; 55: 706-732Crossref PubMed Google Scholar Nonetheless, two possible mechanisms could explain its presence in gastric mucus smears: reflux of duodenal juice or duodenal contamination during endoscopic maneuvers. True gastric colonization is expected only in association with achlorhydria and intestinal metaplasia, but none of these conditions were present in our cases. Indeed, Giardia was not observed in histologic sections. To the Editor:Helicobacter pylori (HP) can be detected by a wide variety of methods. The gold standard for HP presence or absence is still histology, associated with culture, but its cost is rather high and it is not very sensitive in the assessment of HP gastric colonization, particularly when the bacterial density is low.1Gad A A rapid diagnosis of Campylobacter pylori by brush cytology.Scand J Gastroenterol. 1989; 24: 101-103Crossref Scopus (16) Google Scholar Brush cytology, involving a wider surface of mucosa, seems to be a more sensitive technique besides being cheaper and faster.2Cardillo MR Agnelli M. Brush cytology in the endoscopic diagnosis of benign gastric ulcer. A useful adjunct to biopsy?.Arch Anat Cytol Pathol. 1990; 38: 86-91PubMed Google Scholar Methylene blue staining allows identification of microorganisms present in gastric mucus by optical microscopy. Moreover, by using this technique, sometimes unexpected findings are possible.Among 600 patients referred to our endoscopy unit and whose brush cytology was examined for HP detection, we noted the presence of Giardia trophozoites in three of them.It is well known that gastric mucosa is not a favorable environment for Giardia.3Adam RD The biology of Giardia lamblia spp.Microbiol Rev. 1991; 55: 706-732Crossref PubMed Google Scholar Nonetheless, two possible mechanisms could explain its presence in gastric mucus smears: reflux of duodenal juice or duodenal contamination during endoscopic maneuvers. True gastric colonization is expected only in association with achlorhydria and intestinal metaplasia, but none of these conditions were present in our cases. Indeed, Giardia was not observed in histologic sections. Helicobacter pylori (HP) can be detected by a wide variety of methods. The gold standard for HP presence or absence is still histology, associated with culture, but its cost is rather high and it is not very sensitive in the assessment of HP gastric colonization, particularly when the bacterial density is low.1Gad A A rapid diagnosis of Campylobacter pylori by brush cytology.Scand J Gastroenterol. 1989; 24: 101-103Crossref Scopus (16) Google Scholar Brush cytology, involving a wider surface of mucosa, seems to be a more sensitive technique besides being cheaper and faster.2Cardillo MR Agnelli M. Brush cytology in the endoscopic diagnosis of benign gastric ulcer. A useful adjunct to biopsy?.Arch Anat Cytol Pathol. 1990; 38: 86-91PubMed Google Scholar Methylene blue staining allows identification of microorganisms present in gastric mucus by optical microscopy. Moreover, by using this technique, sometimes unexpected findings are possible. Among 600 patients referred to our endoscopy unit and whose brush cytology was examined for HP detection, we noted the presence of Giardia trophozoites in three of them. It is well known that gastric mucosa is not a favorable environment for Giardia.3Adam RD The biology of Giardia lamblia spp.Microbiol Rev. 1991; 55: 706-732Crossref PubMed Google Scholar Nonetheless, two possible mechanisms could explain its presence in gastric mucus smears: reflux of duodenal juice or duodenal contamination during endoscopic maneuvers. True gastric colonization is expected only in association with achlorhydria and intestinal metaplasia, but none of these conditions were present in our cases. Indeed, Giardia was not observed in histologic sections.