Reviewer ’s report  
 
Title: Effect of Helicobacter pylori Eradication on Reflux Esop hagitis and GERD Symptoms 
after Endoscopic Resection of  Gastric Neoplasm: A Single -Center Prospective Study  
 
Version: 0 Date: 23 Mar 2020  
 
Reviewer: Aurelio Mauro  
 
Reviewer's report:  
 
In this study the authors evaluated the relationship between H.pylori infection and prevalence of 
reflux esophagitis (RE) and reflux symptoms in a selected population of patients who  underwent 
to gastric neoplasm endoscopic resection.  
 
The study is well described and authors prospectively evaluated every 6 months the association 
between effect of Hp eradication and presence of RE and GERD symptoms. In the exclusion 
criteria they were aware about the use of PPi in the previous months that is know to interfere 
with presence of RE and Hp and previous Hp eradication.  
In a follow up period of 2 yrs they found that Hp eradication did not increase the incidence of 
GERD symptoms or RE.  
 
Many pr evious studies evaluated the effect of Hp eradication and presence of RE and GERD 
symptoms and their results were often discordant, although recent metanalysis suggest that Hp 
eradication do not increase the risk of RE.  
Discordant results are probably rela ted to bias in patient's selection and the retrospective nature 
of the studies. Therefore i think that the prospective nature of this study could add more evidence 
in this field of research.  
 
Here below some comments that need to be elucidated:  
 
In table 2 is not clear if there's a proportion of patients that were lost during the follow up (the 
sum of Hp pos and neg is less than the total of 173 patients that were included in the study)  
Which was the rate of eradication of first line therapy? How many patients underwent to second 
or third line regimens?  
 
Full dose of PPi was prescribed for 4 wks after endoscopic resection. How many pts continued 
PPI after this period?  
 
Was the questionnaire for symptoms evaluation validated? if not please discuss tha t this is a 
limitation  
 
English language needs to be reviewed  
 
 
 
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 comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in t he 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 comments to the editors.  
 
I am able to assess the statistics  
 
Quality of  written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or share s in an organisation t hat 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 patents  relating to the content of the 
manuscript?  
4. Have you rece ived 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 intere sts 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 yes to any, please give details below.  
 
 
I declare that I have no competing interests' below. If your reply is yes to any, please give details  
below  
 
I agree to the open pe er review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named re port 
including any attachments I upload will be posted on the website along with the auth ors' 
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 includ ed 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: Effect of Helicobacter pylori Eradication on Reflux Esop hagitis and GERD Symptoms 
after Endoscopic Resection of  Gastric Neoplasm: A Single -Center Prospective Study  
 
Version: 0 Date: 23 Mar 2020  
 
Reviewer: Aurelio Mauro  
 
Reviewer's report:  
 
In this study the authors evaluated the relationship between H.pylori infection and prevalence of 
reflux esophagitis (RE) and reflux symptoms in a selected population of patients who  underwent 
to gastric neoplasm endoscopic resection.  
 
The study is well described and authors prospectively evaluated every 6 months the association 
between effect of Hp eradication and presence of RE and GERD symptoms. In the exclusion 
criteria they were aware about the use of PPi in the previous months that is know to interfere 
with presence of RE and Hp and previous Hp eradication.  
In a follow up period of 2 yrs they found that Hp eradication did not increase the incidence of 
GERD symptoms or RE.  
 
Many pr evious studies evaluated the effect of Hp eradication and presence of RE and GERD 
symptoms and their results were often discordant, although recent metanalysis suggest that Hp 
eradication do not increase the risk of RE.  
Discordant results are probably rela ted to bias in patient's selection and the retrospective nature 
of the studies. Therefore i think that the prospective nature of this study could add more evidence 
in this field of research.  
 
Here below some comments that need to be elucidated:  
 
In table 2 is not clear if there's a proportion of patients that were lost during the follow up (the 
sum of Hp pos and neg is less than the total of 173 patients that were included in the study)  
Which was the rate of eradication of first line therapy? How many patients underwent to second 
or third line regimens?  
 
Full dose of PPi was prescribed for 4 wks after endoscopic resection. How many pts continued 
PPI after this period?  
 
Was the questionnaire for symptoms evaluation validated? if not please discuss tha t this is a 
limitation  
 
English language needs to be reviewed  
 
 
 
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 comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in t he 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 comments to the editors.  
 
I am able to assess the statistics  
 
Quality of  written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or share s in an organisation t hat 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 patents  relating to the content of the 
manuscript?  
4. Have you rece ived 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 intere sts 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 yes to any, please give details below.  
 
 
I declare that I have no competing interests' below. If your reply is yes to any, please give details  
below  
 
I agree to the open pe er review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named re port 
including any attachments I upload will be posted on the website along with the auth ors' 
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 includ ed 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: Effect of Helicobacter pylori Eradication on Reflux Esop hagitis and GERD Symptoms 
after Endoscopic Resection of  Gastric Neoplasm: A Single -Center Prospective Study  
 
Version: 0 Date: 23 Mar 2020  
 
Reviewer: Aurelio Mauro  
 
Reviewer's report:  
 
In this study the authors evaluated the relationship between H.pylori infection and prevalence of 
reflux esophagitis (RE) and reflux symptoms in a selected population of patients who  underwent 
to gastric neoplasm endoscopic resection.  
 
The study is well described and authors prospectively evaluated every 6 months the association 
between effect of Hp eradication and presence of RE and GERD symptoms. In the exclusion 
criteria they were aware about the use of PPi in the previous months that is know to interfere 
with presence of RE and Hp and previous Hp eradication.  
In a follow up period of 2 yrs they found that Hp eradication did not increase the incidence of 
GERD symptoms or RE.  
 
Many pr evious studies evaluated the effect of Hp eradication and presence of RE and GERD 
symptoms and their results were often discordant, although recent metanalysis suggest that Hp 
eradication do not increase the risk of RE.  
Discordant results are probably rela ted to bias in patient's selection and the retrospective nature 
of the studies. Therefore i think that the prospective nature of this study could add more evidence 
in this field of research.  
 
Here below some comments that need to be elucidated:  
 
In table 2 is not clear if there's a proportion of patients that were lost during the follow up (the 
sum of Hp pos and neg is less than the total of 173 patients that were included in the study)  
Which was the rate of eradication of first line therapy? How many patients underwent to second 
or third line regimens?  
 
Full dose of PPi was prescribed for 4 wks after endoscopic resection. How many pts continued 
PPI after this period?  
 
Was the questionnaire for symptoms evaluation validated? if not please discuss tha t this is a 
limitation  
 
English language needs to be reviewed  
 
 
 
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 comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in t he 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 comments to the editors.  
 
I am able to assess the statistics  
 
Quality of  written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or share s in an organisation t hat 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 patents  relating to the content of the 
manuscript?  
4. Have you rece ived 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 intere sts 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 yes to any, please give details below.  
 
 
I declare that I have no competing interests' below. If your reply is yes to any, please give details  
below  
 
I agree to the open pe er review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named re port 
including any attachments I upload will be posted on the website along with the auth ors' 
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 includ ed as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant