Endoscopic submucosal dissection for proximal duodenal subepithelial lesions: a retrospective cohort study

BACKGROUND AND AIM

Endoscopic submucosal dissection (ESD) has been used to remove subepithelial lesions (SELs) in recent years; however, duodenal ESD is associated with high rates of immediate or delayed bleeding and perforation. Whether ESD can be recommended for the treatment of duodenal SELs remains controversial. Therefore, we evaluated the efficacy and safety of ESD for duodenal SELs.

METHODS

We conducted a retrospective cohort study in 62 patients (62 lesions) who underwent ESD for duodenal SELs between January 2012 and December 2020. The therapeutic outcomes from ESD for duodenal SELs and procedure-related complications were analyzed.

RESULTS

En bloc resection and complete resection rates associated with duodenal ESD were 90.3% and 100%, respectively; four patients had a positive microscopic margin on pathologic examination. The median procedure time was 45 min (range 20-106 min). During the procedure, two patients received emergency surgery for uncontrolled bleeding and perforation, respectively. After the procedure, delayed bleeding occurred in three patients (4.8%), which was successfully managed by clipping, and delayed perforation occurred in two patients (3.2%) and needed emergency surgery. Risk factors related to complications were analyzed. Lesion size was found to be significantly associated with the complications (P = 0.028). No recurrences were detected, and no distant metastasis was observed in any patient during a median follow-up period of 45.5 months (range, 6-103 months).

CONCLUSION

Duodenal ESD is relatively safe and feasible for duodenal SELs, especially for lesions no more than 2 cm in size.

Gastro-protecting effect of gefarnate on chronic erosive gastritis with dyspeptic symptoms

BACKGROUND

The role of gastro-protecting agents on symptomatic chronic gastritis is unclear. This multicenter, open, randomized trial was designed to compare the comprehensive effects of gefarnate with sucralfate on erosive gastritis with dyspeptic symptoms.

METHODS

Totally 253 dyspepsia patients confirmed with erosive gastritis were enrolled from six centers in China. They randomly received either daily 300 mg gefarnate or 3 g sucralfate for six weeks. The primary endpoint was the effective rate of both treatments on endoscopic erosion at week six.

RESULTS

Gefarnate showed an effective rate of 72% and 67% on endoscopic score and dyspeptic symptom release, which is statistically higher than sucralfate (40.1% and 39.3%, P < 0.001, intension-to-treat). For histological improvement, gefarnate showed both effective in decreasing mucosal chronic inflammation (57.7% vs. 24.8%, P < 0.001, intension-to-treat) and active inflammation (36.4% vs. 23.1%, P < 0.05, intension-to-treat) than the control. A significant increase of prostaglandins and decrease of myeloperoxidase in mucosa were observed in gefarnate group. Severity of erosion is non-relevant to symptoms but Helicobacter pylori (H. pylori) status does affect the outcome of therapy.

CONCLUSIONS

Gefarnate demonstrates an effective outcome on the mucosal inflammation in patients with chronic erosive gastritis. Endoscopic and inflammation score should be the major indexes used in gastritis-related trials.

Clinical significance of sFRP1 protein expression in pancreatic ductal adenocarcinoma

AIM: To detect the expression of secreted frizzled-related protein 1 (sFRP1) protein in different pancreatic tissues (normal pancreatic duct, NP; pancreatic ductal adenocarcinoma, PDAC; pancreatic intraepithelial neoplasia, PanIN; and intraductal papillary mucinous neoplasm, IPMN) and evaluate its significance in the carcinogenesis of PDAC.

METHODS: Immunohistochemical detection of sFRP1 protein was performed in 21 foci of NP, 73 foci of PanIN-1, 29 foci of PanIN-2, 16 foci of PanIN-3, 20 cases of IPMN-adenoma (IPMA), 13 cases of IPMN-borderline (IPMB), 19 cases of IPMN-carcinoma (IPMC), and 50 cases of PDAC. The correlation between sFRP1 expression and clinicopathologic characteristics of PDAC was analyzed.

RESULTS: Immunohistochemical score (IHCS) of sFRP1 expression escalated with the severity of tissue atypia along the progressive multistage: NP→PanIN-1→PanIN-2, PanIN-3, PDAC or NP→IPMA, IPMB→IPMC, PDAC. sFRP1 expression was significantly associated with tumor differentiation and neural infiltration.

CONCLUSION: sFRP-1 expression enhancement is an early event in the carcinogenesis of PDAC, representing an important molecular characteristic of neural infiltration.

Recombinant adenovirus-mediated Hsp70 gene expression inhibits tumor growth in a rat xenograft model of pancreatic cancer

AIM: To observe the effect of recombinant adenovirus Ad5-pCEA-Hsp70-mediated Hsp70 gene expression on tumor growth in a rat xenograft model of pancreatic cancer, and to analyze the underlying mechanism.

METHODS: A rat xenograft model of pancreatic cancer was established, and model animals were randomly divided into three groups, which were given Ad5-pCEA-Hsp70, Ad5-control and PBS treatment, respectively. Antitumor effect was evaluated by comparing tumor size at different time points among the three groups. ELISA was used to detect the peripheral blood levels of Hsp70 protein, INF-g, TNF-a and IL-6. HE staining was used to detect lymphocyte infiltration. Animal spleen mononuclear cells were isolated to determine the proportion of CD83+ cells by flow cytometry. Cell-killing ability of spleen lymphocytes was observed in vitro.

RESULTS: At 4, 6, and 8 weeks after treatment, tumor volume in the Ad5-CEA-Hsp70 group was significantly lower than that in the Ad5-control group and PBS group (724.4 mm³ ± 81.6 mm³vs 901.3 mm³ ± 103.9 mm³, 987.5 mm³ ± 126.0 mm³; 681.3 mm³ ± 64.9 mm³vs 1 270.6 mm³ ± 131.6 mm³, 1 398.5 mm³ ± 193.0 mm³; 648.0 mm³ ± 65.9 mm³vs 1 487.0 mm³ ± 243.0 mm³, 1 660.0 mm³ ± 167.0 mm3; all P < 0.01). The levels of Hsp70 protein and cytokines INF-g, TNF-a and IL-6 in peripheral blood in the Ad5-pCEA-Hsp70 group were significantly higher than those in the Ad5-control group and PBS group (all P < 0.01). Compared to the Ad5-control group and PBS group, Ad5-pCEA-Hsp70 group had more lymphocytic infiltration. The proportion of CD83+ cells in the Ad5-pCEA-Hsp70 group was significantly higher than that in the Ad5-control group and PBS group (10.8% ± 1.3% vs 5.1% ± 0.6%, 4.8% ± 0.6%; both P < 0.01). In the lymphocyte-mediated CTL experiment, when the cell ratio of effect: target was 1:1, there was no significant difference in the cell killing ability among the three groups (P > 0.05), but with the increase in the effect: target cell ratio, the cell killing ability in the Ad5-pCEA-Hsp70 group was significantly increased (P < 0.05, P < 0.01).

CONCLUSION: Hsp70 gene expression mediated by recombinant adenovirus Ad5-pCEA-Hsp70 could inhibit tumor growth in a rat xenograft model of pancreatic cancer via mechanisms that are related to the promotion of dentritic cell maturation, induction of cytokine secretion, and promotion of lymphocyte infiltration.

High expression of delta-like ligand 4 predicts poor prognosis after curative resection for pancreatic cancer

BACKGROUND

Delta-like ligand 4 (DLL4)-Notch signaling plays a key role in tumor angiogenesis, but its prognostic value in patients with pancreatic ductal adenocarcinoma (PDAC) remains unclear. Our aim was to determine whether high DLL4 expression is correlated with poor prognosis after curative resection for PDAC.

METHODS

Surgical specimens obtained from 89 patients with PDAC were immunohistochemically assessed for DLL4 and vascular endothelial growth factor receptor 2 (VEGFR-2) expression. Prognostic significance of DLL4 expression was evaluated by Kaplan-Meier method and Cox regression. The correlations of DLL4 expression with VEGFR-2 expression, tumor stage, and lymph node metastasis were examined by chi-square test and multivariate logistic regression.

RESULTS

There were 38 (42.7%) and 51 patients who showed high and low DLL4 expression, respectively. Survival curves showed that patients with low DLL4 expression had a significantly better survival than those with high DLL4 expression (P < .001). Multivariate survival analysis demonstrated that high DLL4 expression was independently associated with both reduced overall survival (hazard ratio [HR] 2.24; 95% confidence interval [95% CI] 1.14-4.38) and reduced progression-free survival (HR 2.37; 95% CI 1.22-4.60). Multivariate logistic regression analyses showed that high DLL4 expression was independently associated with both advanced tumor stage (odds ratio [OR] 6.84; 95% CI 2.42-9.36) and lymph node metastasis (OR 3.27; 95% CI 1.04-10.34). We also found a positive correlation between DLL4 and VEGFR-2 expression (P < .001).

CONCLUSIONS

High DLL4 expression is significantly associated with poor prognosis for surgically resected PDAC, advanced tumor stage, and lymph node metastasis. Application of adjuvant therapy targeting DLL4-Notch signaling may improve prognosis.

Plasma miR-216a as a potential marker of pancreatic injury in a rat model of acute pancreatitis

AIM: To study the potential value and specificity of plasma miR-216a as a marker for pancreatic injury.

METHODS: Two rat models were applied in this article: L-arginine-induced acute pancreatitis was used as one model to explore the potential value of plasma miR-216a for detection of pancreatic injury; nonlethal sepsis induced in rats by single puncture cecal ligation and puncture (CLP) was used as the other model to evaluate the specificity of plasma miR-216a compared with two commonly used markers (amylase and lipase) for acute pancreatitis. Plasmas were sampled from rats at indicated time points and total RNA was isolated. Real-Time Quantitative reverse transcriptase-polymerase chain reaction was used to quantify miR-216a in plasmas.

RESULTS: In the acute pancreatitis model, among five time points at which plasmas were sampled, miR-216a concentrations were significantly elevated 24 h after arginine administration and remained significantly increased until 48 h after operation (compared with 0 h time point, P < 0.01, Kruskal-Wallis Test). In the CLP model, plasma amylase and lipase, two commonly used biomarkers for acute pancreatitis, were significantly elevated 24 h after operation (compared with 0 h time point, P < 0.01 and 0.05 respectively, Pairwise Bonferroni corrected t-tests), while miR-216a remained undetectable among four tested time points.

CONCLUSION: Our article showed for the first time that plasma miR-216a might serve as a candidate marker of pancreatic injury with novel specificity.

Significance of DNA methyltransferase-1 and histone deacetylase-1 in pancreatic cancer

Epigenetic modifications play an important role during carcinogenesis. The main goal of this study was to examine expression levels of two critical enzymes, DNA methyltransferase-1 (DNMT1) and histone deacetylase-1 (HDAC1), by immunohistochemistry (IHC) in human pancreatic cancer and precancerous lesions: 20 foci containing normal ductal epithelial cells without an inflammatory back-ground (DE), 30 containing ductal epithelial cells with an inflammatory background (DEI), 48 of pancreatic intraepithelial neoplasia-1A (PanIN-1A), 103 of PanIN-1B, 99 of PanIN-2, 30 of PanIN-3, 18 of intraductal papillary mucinous neoplasm A (IPMA), 10 of IPMB, 20 of IPMC, and 54 of pancreatic ductal adenocarcinoma (PDAC). The expression levels of both DNMT1 and HDAC1 increased from normal to precancerous lesions to pancreatic cancer, in a malignancy-dependent manner. Correlations between expression levels and clinicopathological features of the 54 PDAC patients were also analyzed. The expression of DNMT1 significantly correlated with nerve infiltration, degree of tumor differentiation and TNM staging (p<0.05), while that of HDAC1 correlated with proliferative activity, degree of tumor differentiation and TNM staging (p<0.05). Patients with higher expression of DNMT1 and/or HDAC1 had an overall lower survival than those with lower expression (p<0.05). Higher expression of DNMT1 and HDAC1 correlated with advanced stages of the disease and reflect the malignancy of pancreatic carcinoma. They may become new prognostic markers and potential therapeutic targets for pancreatic cancer.

A novel approach for treatment of unresectable extrahepatic bile duct carcinoma: design of radioactive stents and an experimental trial in healthy pigs

BACKGROUND

Patients diagnosed with extrahepatic bile duct carcinoma (EBDC) have a poor prognosis.

OBJECTIVE

The purpose of these studies was to design radioactive stents for EBDC and to evaluate the feasibility and safety of the stents in healthy pigs.

DESIGN

Plastic stents with inserted iodine-125 seeds were designed and tested in 11 healthy pigs. The pigs were divided into 4 groups on the basis of radiation doses.

INTERVENTIONS

The stents with estimated radiation dose at a 5-mm radial distance from the axis of the seeds of 30 Gy, 60 Gy, and 90 Gy were implanted in the common bile duct (CBD) in groups A, B, and C (n = 3 in each group), with the control group (n = 2) being implanted with the stents containing nonradioactive seeds.

MAIN OUTCOME MEASUREMENTS

Histologic evaluation was performed under a light microscope.

RESULTS

The procedures were successfully performed on all pigs. Severe hyperplasia of the mucosa was seen in the control group. In the experimental groups, obvious mucosal necrosis near the radioactive seeds was observed but without perforation of the CBD wall. In lower-dose groups (30 Gy), mild hyperplasia of mucosal glands with fibrosis under the necrosis layer was seen. However, after the increase of the dose, mucosal glands were disappearing without a visible mucosal layer.

CONCLUSIONS

The radioactive stents are safe at each dose in healthy pigs. Moreover, our observations indicate the feasibility to design specific radioactive stents according to the size, shape, and position of EBDC in future clinical applications.

[An experiment of 125I radioactive pancreatic duct stents implanted in the pancreatic ducts of pigs]

OBJECTIVE

To evaluate the feasibility and safety of radioactive pancreatic duct stents implanted in the pancreatic ducts of pigs by endoscopy.

METHODS

Different doses of 125I radioactive pancreatic duct stents were implanted in the pancreatic ducts of pigs by endoscopy. Blood tests were conducted before and after implantation. 14, 30 and 60 days after implantation of the radioactive stents, the pigs were euthanized in batch. All animals underwent post mortem examination to exclude intra-abdominal hemorrhage, pancreatic fistula or peritonitis. During autopsy, the liver, bile ducts, head of the pancreas, stomach and duodenum were examined for perforation, stricture or dilation and damage of the surrounding structures.

RESULTS

Fourteen pigs were implanted with pancreatic duct stents by endoscopic procedures. There was no effusion, hemorrhage or necrosis in the adjacent duodenum, stomach, liver or right kidney. The normal morphological structures of the duct of Wirsung disappeared in all the treated pigs. Histopathological examination revealed that the stents were surrounded by necrotic tissue and outside fibrous tissue. During the follow-up period, the width of outside fibrous tissue gradually increased. There were no serious abnormalities noted in the blood tests after implantation.

CONCLUSION

It is indicated that the radioactive stents are safe in all the different dose groups. For future clinical application, it is feasible to design a special radioactive stent for each patient according to the size, shape and position of the pancreatic tumor.

Effects of recombinant human canstatin protein in the treatment of pancreatic cancer

AIM: To examine the effect of canstatin, a newly discovered endogenous inhibitor of angiogenesis, in the treatment of pancreatic cancer in vivo.

METHODS: The canstatin cDNA fragment was synthesized and amplified from the total RNA extracted from human placenta tissues by RT-PCR. The resulting product was firstly cloned into pUCm-T vector, then into plasmid pET-22b (+) and transformed into E. coli BL21. Isopropyl-1-thio-b-Dgalactopyran-oside (IPTG) was used to induce the expression of canstatin protein and affinity chromatography was used to purify the protein. To determine the activity of purified recombinant human canstatin (rhCanstatin), orthotopic xenograft human pancreatic cancer models were established. Human pancreatic cancer cells (SW1990) were injected into the pancreas of BALB/c nude mice. Twenty-four nude mice with orthotopic xenograft tumor were randomly divided into 3 groups 10 d after the inoculation, and were treated with PBS 0.3 mL, or canstatin 5 mg/kg, or 10 mg/kg per day for 3 wk intraperitoneally. When the experiment was over, all tumors were resected and the effects of rhCanstatin on tumor growth, microvessel density (MVD) were analyzed.

RESULTS: After IPTG induction, SDS-PAGE showed a new monomeric 24 kDa protein band. This protein was purified through affinity chromatography and refolded through dialysis with a final concentration of 60 mg/L. In orthotopic pancreatic cancer models, the final tumor volume in groups treated with PBS, canstatin 5 mg/kg, 10 mg/kg were 355.21 ± 39.54 mm³, 112.73 ± 10.47 mm³, and 61.75 ± 6.99 mm³ respectively. The immunohistochemical examination showed that the MVD in tumors treated with canstatin was significantly less than that in other group.

CONCLUSION: These findings demonstrate that the rhCanstatin effectively retards the growth of pancreatic cancer in a dose-dependent manner through inhibiting angiogenesis and may be a promising therapeutic agent for pancreatic cancer treatment in the clinic.

p38 mitogen-activated protein kinase signal transduction pathway in pathogenesis of severe acute pancreatitis in rats

AIM: To study the dynamic changes of p38 mitogen-activated protein kinase (p38 MAPK) phosphorylation and to assess the effect of p38 MAPK phosphorylation inhibitor in severe acute pancreatitis (SAP) in rats.

METHODS: The SAP model was induced by bili-pancreatic duct retrograde infusion with 5% sterile sodium taurocholate solution. Eighty Sprague-Dawley (SD) rats were randomly divided into sham-operation (SO) group (n = 30), SAP-NS group (n = 25) and SAP-CNI1493 group (n = 25). In the SAP-CNI1493 group, SD rats were administered with 10 mg/kg inhibitor CNI-1493 (i. v.) 30 min before induction of SAP. In SAP-NS group, rats received same volume isotonic saline (i. v.) as CNI-1493. Pancreatic tissues and serum samples were collected before and 15 min, 0.5 h, 1 h, 3 h, 6 h after operation. Western blot analysis was performed to determine the phosphorylations of p38 MAPK in the pancreas homogenates. Serum levels of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) were measured by ELISA; Pathological changes of pancreas were examined and scored with light microscopy.

RESULTS: In the SO group, basal p38 MAPK phosphorylation was detected. In the SAP-NS group, the p38 MAPK phosphorylation in the pancreas homogenates reached the maximum at 15 min, remained at a similar level at 30, 60 and 180 min, and declined to the same level as that in SO group at 6 h. In the SAP-NS group and SAP-CNI1493 group, the densities of the band detected by Western blot were 5 200±360, 3 500±250 at 15 min, and 4 910±320, 2 500340 at 30 min (P <0.01). In SAP-CNI1493 group, the serum levels of IL-1β and TNF-α were decreased significantly as compared with those in SAP-NS group (P <0.01). The severity of tissue damage in the SAP-CNI1493 group at 3 h were significantly attenuated in comparison with that of the SAP-NS group (P<0.01).

CONCLUSION: The p38 MAPK plays an important role in the pathogenesis of SAP. Inhibition of p38 MAPK phosphorylation may be a potential approach for prevention and treatment of SAP.

Role of nucleus tractus solitarii in pancreatic secretion induced by 5-hydroxytryptamine in rats

AIM: To investigate the role of nucleus tractus solitarii (NTS) in pancreatic secretion induced by 5-hydroxytryptamine (5-HT) in rats and to further elucidate the related neural substance.

METHODS: Twenty-four rats were randomly divided into NaCl group, 5-HT group and sham operation group. Rats in NaCl and 5-HT groups were given NaCl (0.86 mol/L) and 5-HT (10^-4 mol/L) via duodenum respectively and the mixture of bile and pancreatic juice was collected every 15 min. Protein content of the mixture was measured with BCA protein assay. EnVision Immunohistochemical method and double-label immunohistochemistry (immunoenzyme-fluorenscence) were used to detect the quantity of c-Fos and NK1-R positive cells in intermediate-medial NTS (mNTS), rostral (rNTS) and caudal regions (cNTS).

RESULTS: The number of c-Fos positive cells was significantly increased in NaCl and 5-HT group as compared to that in sham operation group in rNTS, mNTS and cNTS (P < 0.01), and in cNTS, the number was significantly larger in 5-HT group than that in NaCl group 22.00±1.80 vs 18.50 ± 1.71, P < 0.01). Moreover, NK1-R was expressed in the regions where c-Fos expression was enhanced by duodenal stimulation of NaCl and 5-HT, but this did not happen in sham operation group. After infusion of NaCl and 5-HT, pancreatic protein secretion was increased (P < 0.01). And the content of pancreatic protein was significantly higher than that in 5-HT and NaCl groups (29.6 ± 1.4 mg/15 min vs 18.1 ± 2.4 mg/15 min, P < 0.01).

CONCLUSION: NTS plays a role of sensing and processing information on pancreatic protein secretion induced by 5-hydroxytryptamine, in which the receptor of P substance may take a part.

Construction of an oral recombinant DNA vaccine strain of live attenuated Salmonella typhimurium carrying H. pylori neutrophil activating protein

AIM: To construct a live attenuated Salmonella typhimurium (S. typhimurium) strain carrying H. pylori-neutrophil activating protein (HP-NAP) gene as an oral recombinant DNA vaccine.

METHODS: By genetic engineering method, a 435 bp napA gene (encoding HP-NAP) was subcloned into an eukaryotic expression vector pIRES. After sequencing and BLAST analysis, the identified recombinant plasmid was then transformed into a live attenuated S. typhimurium strain SL7207.

RESULTS: By using polymerase chain reaction (PCR) and restriction enzyme digestion, a recombinant eukaryotic expression plasmid pIRES-napA containing napA gene of H. pylori was constructed, and the recombinant plasmid was transformed successfully into the live attenuated S. typhimurium strain SL7207. Most of the H. pylori-napA sequences in recombinant plasmid pIRES-napA were homologized with that of SS1 strain reported by GenBank, and the homology of nucleotide and protein was 98%, respectively.

CONCLUSION: A recombinant live attenuated S. typhimurium strain carrying HP-NAP gene as DNA vaccine is successfully constructed. The results lay the foundation for developing multivalent oral DNA vaccine against H. pylori infection.

Distribution of cagG gene in Helicobacter pylori isolates from Chinese patients with different gastroduodenal diseases and its clinical and pathological significance

AIM: To determine the distribution of cagG gene of Helicobacter pylori (H pylori) isolates cultured from patients with various digestive diseases and its relationship with gastroduodenal diseases.

METHODS: cagG was amplified by polymerase chain reaction in 145 H pylori isolates cultured from patients with chronic gastritis (n = 72), duodenal ulcer (n = 48), gastric ulcer (n = 17), or gastric and duodenal ulcer (n = 8), and the relationship between cagG status and the grade of gastric mucosal inflammation was determined.

RESULTS: cagG was present in 91.7% of the 145 H pylori isolates, with the rates were 90.3%, 93.8%, 88.2% and 100.0%, respectively, in those from patients with chronic gastritis, duodenal ulcer, gastric ulcer, and gastric and duodenal ulcer. There was no significant difference among the four groups (P > 0.05). The average grade of gastric mucosal inflammation in the antrum and corpus was 1.819 ± 0.325 and 1.768 ± 0.312, respectively in cagG positive patients, whereas the average inflammation grade was 1.649 ± 0.297, 1.598 ± 0.278 respectively in cagG negative cases (P > 0.05).

CONCLUSION: cagG gene of H pylori was quite conservative, and most H pylori strains in Chinese patients were cagG positive. cagG status was not related to clinical outcome or the degree of gastric mucosal inflammation. Therefore, cagG can not be used as a single marker for discrimination of H pylori strains with respect to a specific digestive disease.

Clinical significance of PCR in Helicobacter pylori DNA detection in human gastric disorders

AIM: To investigate the clinical significance of the PCR assay in the diagnosis of gastric Helicobacter pylori (Hp) infection.

METHODS: Hp infection in gastric antral biopsied specimens was identified by using the polymerase chain reaction (PCR) to amplify the specific Hp urease gene fragments (PCR-Hp-DNA) in 154 patients with gastrointestinal disorders. Hp urease gene oligonucleotide primers specific for Hp (16s rRNA) were used. Urease test and enzyme-linked immunosorbent assay (ELISA) for anti Hp-IgG serum were also used as controls.

RESULTS: PCR-Hp-DNA was detected in 140 (91%) of the 154 patients, where patients 114 and 125 were found infected with Hp by urease test and ELISA Hp IgG, respectively. There was a marked difference in the Hp-positive rate between the PCR-Hp-DNA and the urease test or ELISA-Hp-IgG (P < 0.05). The Hp infection rate increased with age, although a minority of infected people developed signs and symptoms of gastric disorders. Hp infection is closely related to adenocarcinoma in both the gastric antrum as well as the down body of the stomach.

CONCLUSION: PCR is a sensitive and specific method for the detection of Hp in human gastric tissues. Detection of Hp DNA in vivo using this approach might improve the clinical diagnosis and epidemiological research related to H. pylori infection.