Reviewer's report 
 Role of rapid urease test and histopathology in the diagnosis of Helicobacter pylori infection in Title: 
a developing country 
 1  28 June 2005 Version: Date: 
 B J Marshall Reviewer: 
Reviewer's report: 
General 
1. Is the question posed by the authors new and well defined? 
The accuracy of the urease test in patients taking PPI is assumed to be less since the urea breath 
test and histology are known to be less accurate in this setting of PPI usage. The question posed is 
slightly new, in that the urease test studied here is not as well known as some others. 
2. Are the methods appropriate and well described, and are sufficient details provided to replicate 
the work? 
There were two biopsies for histology and these were the reference method when stained by Giemsa if the H&E section gave a doubtful result. This leaves room for some error since 
contaminating bacteria may appear to be H.pylori in some patients thus causing spurious “false 
negative” urease test results. This inaccuracy might account for a few percent error in the results. 
3. Are the data sound and well controlled? 
Not controlled – but comparative. The methods are appropriate to local clinical practice. 
4. Does the manuscript adhere to the relevant standards for reporting and data deposition? 
Yes 
5. Are the discussion and conclusions well balanced and adequately supported by the data? 
a. The authors state that biopsies should be taken from other parts of the stomach if PPI are used. 
They do not have data to back this up because they did not take biopsies from the corpus. They have referred to work of others. At least they do recommend that more biopsies be taken when PPI 
is used. However, the histology appears superior to Urease tests here. The authors might suggest 
that a negative diagnosis on PPI might be backed up with a serological test which should not be affected by PPI. 
b. The terminology in page 6 lines 10-11 I confusing. This needs to be clarified (at least to me). I 
don’t see where these numbers come from. ” The likelihood of a positive urease test with and without PPI was 3.18 and 3.59 and negative urease test with and without PPI was 0.65 and 0.35.” 
6. Do the title and abstract accurately convey what has been found? 
Yes 
7. Is the writing acceptable? 
Quite well done 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
see item 5 above 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Acceptable Quality of written English: 
 Yes Statistical review: 
Declaration of competing interests: 
I have a medical company which sells a competing test in Australia. I have reviewed many papers on 
urease tests in the past. 
Reviewer's report 
 Role of rapid urease test and histopathology in the diagnosis of Helicobacter pylori infection in Title: 
a developing country 
 1  28 June 2005 Version: Date: 
 B J Marshall Reviewer: 
Reviewer's report: 
General 
1. Is the question posed by the authors new and well defined? 
The accuracy of the urease test in patients taking PPI is assumed to be less since the urea breath 
test and histology are known to be less accurate in this setting of PPI usage. The question posed is 
slightly new, in that the urease test studied here is not as well known as some others. 
2. Are the methods appropriate and well described, and are sufficient details provided to replicate 
the work? 
There were two biopsies for histology and these were the reference method when stained by Giemsa if the H&E section gave a doubtful result. This leaves room for some error since 
contaminating bacteria may appear to be H.pylori in some patients thus causing spurious “false 
negative” urease test results. This inaccuracy might account for a few percent error in the results. 
3. Are the data sound and well controlled? 
Not controlled – but comparative. The methods are appropriate to local clinical practice. 
4. Does the manuscript adhere to the relevant standards for reporting and data deposition? 
Yes 
5. Are the discussion and conclusions well balanced and adequately supported by the data? 
a. The authors state that biopsies should be taken from other parts of the stomach if PPI are used. 
They do not have data to back this up because they did not take biopsies from the corpus. They have referred to work of others. At least they do recommend that more biopsies be taken when PPI 
is used. However, the histology appears superior to Urease tests here. The authors might suggest 
that a negative diagnosis on PPI might be backed up with a serological test which should not be affected by PPI. 
b. The terminology in page 6 lines 10-11 I confusing. This needs to be clarified (at least to me). I 
don’t see where these numbers come from. ” The likelihood of a positive urease test with and without PPI was 3.18 and 3.59 and negative urease test with and without PPI was 0.65 and 0.35.” 
6. Do the title and abstract accurately convey what has been found? 
Yes 
7. Is the writing acceptable? 
Quite well done 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
see item 5 above 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Acceptable Quality of written English: 
 Yes Statistical review: 
Declaration of competing interests: 
I have a medical company which sells a competing test in Australia. I have reviewed many papers on 
urease tests in the past. 
Please review this paper.
user
Reviewer's report 
 Role of rapid urease test and histopathology in the diagnosis of Helicobacter pylori infection in Title: 
a developing country 
 1  28 June 2005 Version: Date: 
 B J Marshall Reviewer: 
Reviewer's report: 
General 
1. Is the question posed by the authors new and well defined? 
The accuracy of the urease test in patients taking PPI is assumed to be less since the urea breath 
test and histology are known to be less accurate in this setting of PPI usage. The question posed is 
slightly new, in that the urease test studied here is not as well known as some others. 
2. Are the methods appropriate and well described, and are sufficient details provided to replicate 
the work? 
There were two biopsies for histology and these were the reference method when stained by Giemsa if the H&E section gave a doubtful result. This leaves room for some error since 
contaminating bacteria may appear to be H.pylori in some patients thus causing spurious “false 
negative” urease test results. This inaccuracy might account for a few percent error in the results. 
3. Are the data sound and well controlled? 
Not controlled – but comparative. The methods are appropriate to local clinical practice. 
4. Does the manuscript adhere to the relevant standards for reporting and data deposition? 
Yes 
5. Are the discussion and conclusions well balanced and adequately supported by the data? 
a. The authors state that biopsies should be taken from other parts of the stomach if PPI are used. 
They do not have data to back this up because they did not take biopsies from the corpus. They have referred to work of others. At least they do recommend that more biopsies be taken when PPI 
is used. However, the histology appears superior to Urease tests here. The authors might suggest 
that a negative diagnosis on PPI might be backed up with a serological test which should not be affected by PPI. 
b. The terminology in page 6 lines 10-11 I confusing. This needs to be clarified (at least to me). I 
don’t see where these numbers come from. ” The likelihood of a positive urease test with and without PPI was 3.18 and 3.59 and negative urease test with and without PPI was 0.65 and 0.35.” 
6. Do the title and abstract accurately convey what has been found? 
Yes 
7. Is the writing acceptable? 
Quite well done 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
see item 5 above 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Acceptable Quality of written English: 
 Yes Statistical review: 
Declaration of competing interests: 
I have a medical company which sells a competing test in Australia. I have reviewed many papers on 
urease tests in the past. 
assistant