Assessing the diagnostic accuracy of routine hematoxylin and eosin, Alcian Blue/Periodic Acid-Schiff, and Giemsa stains in the detection of Helicobacter pylori in gastric biopsies

<ns3:p> Background Hematoxylin and Eosin (H&amp;E), Alcian Blue/Periodic Acid-Schiff (AB/PAS), and Giemsa stains are routinely used in the histopathological evaluation of gastric biopsies. However, comparative data on their diagnostic performance and cost-effectiveness in detecting <ns3:italic>Helicobacter pylori</ns3:italic> are limited. This study aimed to assess the feasibility of using H&amp;E and AB/PAS as alternatives to Giemsa. Methods A retrospective study was conducted on 816 gastric biopsy cases collected between 2019 and 2021. Three slides (H&amp;E, Giemsa, and AB/PAS) were previously prepared from each paraffin-embedded tissue sample and blindly evaluated by three independent examiners. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated using 2×2 contingency tables. Results H&amp;E showed a sensitivity of 51.6%, specificity of 74.4%, and diagnostic accuracy of 66.4%, while AB/PAS had a sensitivity of 45.9%, specificity of 73.2%, and accuracy of 63.7%. H&amp;E was the most cost-effective and fastest method; AB/PAS was the most expensive and time-consuming. Giemsa demonstrated superior diagnostic performance. Conclusions H&amp;E offers practical benefits for screening but lacks sufficient sensitivity for definitive diagnosis. AB/PAS is less effective and less economical. Giemsa remains the most reliable stain for <ns3:italic>H. pylori</ns3:italic> detection. Combining H&amp;E with Giemsa may optimize both efficiency and diagnostic accuracy. Further prospective studies are warranted. </ns3:p>