Reviewer ’s report  
 
Title: Helicobacter pylori infec tion associated with an increased risk of colorectal adenomatous 
polyps in the Chinese population  
 
Version: 0 Date: 23 Aug 2018  
 
Reviewer: Christos Zavos  
 
Reviewer's report:  
 
This is an interesting study investigating the association of H. pylori infection with colorectal 
adenomas. The authors compared the prevalence of H. pylori in fection in 180 patients with 
polyps vs. 1195 participants without colorectal polyps, and found a positive correlation.  
 
Comments  
1. The language is full or typos and grammatical mistakes. The authors are strongly advised to 
seek help from a native English speaker.  
 
2. The authors should add more details in their Discussion on the potential pathophysiological 
mechanisms by which H. pylori may be involved in colorectal adenoma and ultimately 
cancer development. As already reported previously, H. pylori has an impact on colorectal 
oncogenesis by: causing a possible chronic inflammatory mucosal damage, comparable to 
upper gastrointestinal tract (UGT); stimulating cancer stem cells (CSCs) or recruiting bone 
marrow -derived stem cells (BMDSCs), similar to UGT H. pyl ori-associated chronic 
inflammation, atrophic gastritis, hyperplasia, metaplasia, dysplasia and BMDSCs recruitment 
that may facilitate tumor formation and progression in animal models and humans; and 
affecting metabolic syndrome parameters, oncogenes and i mmune surveillance processes, 
that may be involved in the sequence: colon epithelium transformation to colon adenoma -
dysplasia -colorectal cancer development/progression (See for example, Kountouras J, et al. 
Gut Liver 2017;11:733 -734; Kountouras J, et al. Saudi Med J 2015;36:1249; Kountouras J, et 
al. Scand J Gastroenterol 2014;49:381 -2; Kountouras J, et al. Am J Gastroenterol 
2013;108:625 -6). 
 
3. The authors could reinforce their findings by comparing them to a similar study which also 
found an association between H. pylori and colorectal polyps/cancer (Kapetanakis N, et al. 
Immunogastroenterology 2013;2:47 -56.). This study included 50 colorectal cancer (CRC) 
patients, 25 patients with colorectal adenomas (CRA) and 10 controls, and showed a 
significantly hig her presence of H. pylori infection in the CRA (68%) and CRC (84%) 
groups compared with controls (30%).  
 
4. The Figure is not high -quality, and the Figure legend does not explain the various 
pathophysiological mechanisms, which are also not explained in the  Discussion. I would 
recommend that the mechanisms are mentioned in the Discussion and more shortly in the 
Figure legend.  
 
5. The references are not checked for consistency.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comme nts to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comm ents to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declar ation of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscrip t, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any p atents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is y es to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publicat ion, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/ 4.0/). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Helicobacter pylori infec tion associated with an increased risk of colorectal adenomatous 
polyps in the Chinese population  
 
Version: 0 Date: 23 Aug 2018  
 
Reviewer: Christos Zavos  
 
Reviewer's report:  
 
This is an interesting study investigating the association of H. pylori infection with colorectal 
adenomas. The authors compared the prevalence of H. pylori in fection in 180 patients with 
polyps vs. 1195 participants without colorectal polyps, and found a positive correlation.  
 
Comments  
1. The language is full or typos and grammatical mistakes. The authors are strongly advised to 
seek help from a native English speaker.  
 
2. The authors should add more details in their Discussion on the potential pathophysiological 
mechanisms by which H. pylori may be involved in colorectal adenoma and ultimately 
cancer development. As already reported previously, H. pylori has an impact on colorectal 
oncogenesis by: causing a possible chronic inflammatory mucosal damage, comparable to 
upper gastrointestinal tract (UGT); stimulating cancer stem cells (CSCs) or recruiting bone 
marrow -derived stem cells (BMDSCs), similar to UGT H. pyl ori-associated chronic 
inflammation, atrophic gastritis, hyperplasia, metaplasia, dysplasia and BMDSCs recruitment 
that may facilitate tumor formation and progression in animal models and humans; and 
affecting metabolic syndrome parameters, oncogenes and i mmune surveillance processes, 
that may be involved in the sequence: colon epithelium transformation to colon adenoma -
dysplasia -colorectal cancer development/progression (See for example, Kountouras J, et al. 
Gut Liver 2017;11:733 -734; Kountouras J, et al. Saudi Med J 2015;36:1249; Kountouras J, et 
al. Scand J Gastroenterol 2014;49:381 -2; Kountouras J, et al. Am J Gastroenterol 
2013;108:625 -6). 
 
3. The authors could reinforce their findings by comparing them to a similar study which also 
found an association between H. pylori and colorectal polyps/cancer (Kapetanakis N, et al. 
Immunogastroenterology 2013;2:47 -56.). This study included 50 colorectal cancer (CRC) 
patients, 25 patients with colorectal adenomas (CRA) and 10 controls, and showed a 
significantly hig her presence of H. pylori infection in the CRA (68%) and CRC (84%) 
groups compared with controls (30%).  
 
4. The Figure is not high -quality, and the Figure legend does not explain the various 
pathophysiological mechanisms, which are also not explained in the  Discussion. I would 
recommend that the mechanisms are mentioned in the Discussion and more shortly in the 
Figure legend.  
 
5. The references are not checked for consistency.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comme nts to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comm ents to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declar ation of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscrip t, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any p atents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is y es to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publicat ion, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/ 4.0/). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Helicobacter pylori infec tion associated with an increased risk of colorectal adenomatous 
polyps in the Chinese population  
 
Version: 0 Date: 23 Aug 2018  
 
Reviewer: Christos Zavos  
 
Reviewer's report:  
 
This is an interesting study investigating the association of H. pylori infection with colorectal 
adenomas. The authors compared the prevalence of H. pylori in fection in 180 patients with 
polyps vs. 1195 participants without colorectal polyps, and found a positive correlation.  
 
Comments  
1. The language is full or typos and grammatical mistakes. The authors are strongly advised to 
seek help from a native English speaker.  
 
2. The authors should add more details in their Discussion on the potential pathophysiological 
mechanisms by which H. pylori may be involved in colorectal adenoma and ultimately 
cancer development. As already reported previously, H. pylori has an impact on colorectal 
oncogenesis by: causing a possible chronic inflammatory mucosal damage, comparable to 
upper gastrointestinal tract (UGT); stimulating cancer stem cells (CSCs) or recruiting bone 
marrow -derived stem cells (BMDSCs), similar to UGT H. pyl ori-associated chronic 
inflammation, atrophic gastritis, hyperplasia, metaplasia, dysplasia and BMDSCs recruitment 
that may facilitate tumor formation and progression in animal models and humans; and 
affecting metabolic syndrome parameters, oncogenes and i mmune surveillance processes, 
that may be involved in the sequence: colon epithelium transformation to colon adenoma -
dysplasia -colorectal cancer development/progression (See for example, Kountouras J, et al. 
Gut Liver 2017;11:733 -734; Kountouras J, et al. Saudi Med J 2015;36:1249; Kountouras J, et 
al. Scand J Gastroenterol 2014;49:381 -2; Kountouras J, et al. Am J Gastroenterol 
2013;108:625 -6). 
 
3. The authors could reinforce their findings by comparing them to a similar study which also 
found an association between H. pylori and colorectal polyps/cancer (Kapetanakis N, et al. 
Immunogastroenterology 2013;2:47 -56.). This study included 50 colorectal cancer (CRC) 
patients, 25 patients with colorectal adenomas (CRA) and 10 controls, and showed a 
significantly hig her presence of H. pylori infection in the CRA (68%) and CRC (84%) 
groups compared with controls (30%).  
 
4. The Figure is not high -quality, and the Figure legend does not explain the various 
pathophysiological mechanisms, which are also not explained in the  Discussion. I would 
recommend that the mechanisms are mentioned in the Discussion and more shortly in the 
Figure legend.  
 
5. The references are not checked for consistency.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comme nts to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comm ents to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declar ation of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscrip t, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any p atents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is y es to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publicat ion, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/ 4.0/). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant