Title: Atrophic gastritis rather than Helicobacter pylori infection can be an independent risk
factor of colorectal polyps: a retrospective study in China
Version: 2 Date: 21 Nov 2022
Reviewer:  Thomas Wex
Reviewer's report:
Comments to authors:
Authors address a relevant clinical aspect; improving the management of screening for polyps
in context to colorectal cancer. However, study design chosen seems to be unsuitable for this
question.
Certainly, there exist several studies that suggest a higher prevalence of polyps in context to
H. pylori infection or certain type of gastritis compared to H. pylori-negative individuals   The
study design used in this manuscript remains somehow unclear. What was the underlying clinical
question for including patients who needed both gastroscopy and colonoscopy at the same time?
Surprisingly, based on Table 2, 791 of 792 patients had either atrophic or non-atrophic gastritis;
however the majority of patients were H. pylori-negative.  What are the underlying reason/cause
for the gastritis if not H. pylori?
The assessment of atrophy by the endoscopically focused Kimura-Takemoto classification
seems to be not accurate. Authors would need to implement histologic data based on
updated Sydney /OLGA/OLGIM classification system or alternatively serum-based markers
(GastroPanel including Pepsinogen I, II, Gastrin-17 and anti-H.pylori antibodies. In particular,
the serology-based approach would allow assessing previous H. pylori infection based on anti-
H. pylori-IgG.
Both the proportion of cases with gastritis and the proportion of atrophic gastritis among them
seem to be unusually high implying that a certain subgroup has been included, and therefore any
conclusion made cannot be addressed to normal population eligible for colon cancer screening
as the authors focused on.
Data from Figure 1 and 2 are completely redundant to data in tables, figures should be omitted.
Data of Table 3 (numbers of polyps) are far away from any normal distribution and should be
analyzed and presented using non-parametric tests/methodology.
The conclusion that atrophic gastritis can effectively predict colorectal polyps is not sufficiently
demonstrated by the manuscript.
Notably, authors claim that age, gender and atrophic gastritis are independent risk factors for
colorectal polyps, but the odds ratio of atrophic gastritis is 0.44 suggesting that gastric atrophy
is even a “protective factor” for the development of colorectal polyps.
Title: Atrophic gastritis rather than Helicobacter pylori infection can be an independent risk
factor of colorectal polyps: a retrospective study in China
Version: 2 Date: 21 Nov 2022
Reviewer:  Thomas Wex
Reviewer's report:
Comments to authors:
Authors address a relevant clinical aspect; improving the management of screening for polyps
in context to colorectal cancer. However, study design chosen seems to be unsuitable for this
question.
Certainly, there exist several studies that suggest a higher prevalence of polyps in context to
H. pylori infection or certain type of gastritis compared to H. pylori-negative individuals   The
study design used in this manuscript remains somehow unclear. What was the underlying clinical
question for including patients who needed both gastroscopy and colonoscopy at the same time?
Surprisingly, based on Table 2, 791 of 792 patients had either atrophic or non-atrophic gastritis;
however the majority of patients were H. pylori-negative.  What are the underlying reason/cause
for the gastritis if not H. pylori?
The assessment of atrophy by the endoscopically focused Kimura-Takemoto classification
seems to be not accurate. Authors would need to implement histologic data based on
updated Sydney /OLGA/OLGIM classification system or alternatively serum-based markers
(GastroPanel including Pepsinogen I, II, Gastrin-17 and anti-H.pylori antibodies. In particular,
the serology-based approach would allow assessing previous H. pylori infection based on anti-
H. pylori-IgG.
Both the proportion of cases with gastritis and the proportion of atrophic gastritis among them
seem to be unusually high implying that a certain subgroup has been included, and therefore any
conclusion made cannot be addressed to normal population eligible for colon cancer screening
as the authors focused on.
Data from Figure 1 and 2 are completely redundant to data in tables, figures should be omitted.
Data of Table 3 (numbers of polyps) are far away from any normal distribution and should be
analyzed and presented using non-parametric tests/methodology.
The conclusion that atrophic gastritis can effectively predict colorectal polyps is not sufficiently
demonstrated by the manuscript.
Notably, authors claim that age, gender and atrophic gastritis are independent risk factors for
colorectal polyps, but the odds ratio of atrophic gastritis is 0.44 suggesting that gastric atrophy
is even a “protective factor” for the development of colorectal polyps.
Please review this paper.
user
Title: Atrophic gastritis rather than Helicobacter pylori infection can be an independent risk
factor of colorectal polyps: a retrospective study in China
Version: 2 Date: 21 Nov 2022
Reviewer:  Thomas Wex
Reviewer's report:
Comments to authors:
Authors address a relevant clinical aspect; improving the management of screening for polyps
in context to colorectal cancer. However, study design chosen seems to be unsuitable for this
question.
Certainly, there exist several studies that suggest a higher prevalence of polyps in context to
H. pylori infection or certain type of gastritis compared to H. pylori-negative individuals   The
study design used in this manuscript remains somehow unclear. What was the underlying clinical
question for including patients who needed both gastroscopy and colonoscopy at the same time?
Surprisingly, based on Table 2, 791 of 792 patients had either atrophic or non-atrophic gastritis;
however the majority of patients were H. pylori-negative.  What are the underlying reason/cause
for the gastritis if not H. pylori?
The assessment of atrophy by the endoscopically focused Kimura-Takemoto classification
seems to be not accurate. Authors would need to implement histologic data based on
updated Sydney /OLGA/OLGIM classification system or alternatively serum-based markers
(GastroPanel including Pepsinogen I, II, Gastrin-17 and anti-H.pylori antibodies. In particular,
the serology-based approach would allow assessing previous H. pylori infection based on anti-
H. pylori-IgG.
Both the proportion of cases with gastritis and the proportion of atrophic gastritis among them
seem to be unusually high implying that a certain subgroup has been included, and therefore any
conclusion made cannot be addressed to normal population eligible for colon cancer screening
as the authors focused on.
Data from Figure 1 and 2 are completely redundant to data in tables, figures should be omitted.
Data of Table 3 (numbers of polyps) are far away from any normal distribution and should be
analyzed and presented using non-parametric tests/methodology.
The conclusion that atrophic gastritis can effectively predict colorectal polyps is not sufficiently
demonstrated by the manuscript.
Notably, authors claim that age, gender and atrophic gastritis are independent risk factors for
colorectal polyps, but the odds ratio of atrophic gastritis is 0.44 suggesting that gastric atrophy
is even a “protective factor” for the development of colorectal polyps.
assistant