Title: Effect of Saccharomyces boulardii supplementation to bismuth quadruple therapy on
Helicobacter pylori eradication
Version: 2 Date: 08 Jan 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While S. boulardii is described as resistant to antibiotics and gastric acid, its role in enhancing
eradication rates and reducing adverse effects could be explained briefly (e.g., modulation of
gut microbiota or anti-inflammatory properties).
-Clarify why earlier meta-analyses were insufficient (e.g., outdated protocols, limited subgroup
analysis) to better justify this study's necessity.
-Consider adding a brief justification for excluding multi-strain probiotics to preempt questions
about their potential effects on the outcomes.
-The process is well-described, but including examples of diagnostic methods for H. pylori (e.g.,
urea breath test, stool antigen test) would enhance clarity.
-Provide more detail on how heterogeneity was managed beyond switching between fixed
and random-effects models. Were subgroup analyses or meta-regression conducted to explore
potential sources of heterogeneity?
-Clarify how inter-rater reliability for quality assessment was managed (e.g., kappa statistic) to
ensure transparency in the review process.
-The quality assessment description is clear but can benefit from added context. For example:
Discuss the implications of having moderate-quality evidence based on the GRADE assessment.
Address how unclear the risk of bias in some studies might influence the results.
-Provide more context for the mechanisms of S. boulardii and their clinical implications.
-The discrepancy between the findings of this study and those of Zhou et al.[10] is noted.
Consider discussing other factors (e.g., differences in patient populations, eradication regimens,
or methodologies) that could explain the variability.
-Since all included studies were conducted in China, address how these findings may translate to
other regions with different dietary habits, healthcare practices, or antibiotic resistance profiles.
Title: Effect of Saccharomyces boulardii supplementation to bismuth quadruple therapy on
Helicobacter pylori eradication
Version: 2 Date: 08 Jan 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While S. boulardii is described as resistant to antibiotics and gastric acid, its role in enhancing
eradication rates and reducing adverse effects could be explained briefly (e.g., modulation of
gut microbiota or anti-inflammatory properties).
-Clarify why earlier meta-analyses were insufficient (e.g., outdated protocols, limited subgroup
analysis) to better justify this study's necessity.
-Consider adding a brief justification for excluding multi-strain probiotics to preempt questions
about their potential effects on the outcomes.
-The process is well-described, but including examples of diagnostic methods for H. pylori (e.g.,
urea breath test, stool antigen test) would enhance clarity.
-Provide more detail on how heterogeneity was managed beyond switching between fixed
and random-effects models. Were subgroup analyses or meta-regression conducted to explore
potential sources of heterogeneity?
-Clarify how inter-rater reliability for quality assessment was managed (e.g., kappa statistic) to
ensure transparency in the review process.
-The quality assessment description is clear but can benefit from added context. For example:
Discuss the implications of having moderate-quality evidence based on the GRADE assessment.
Address how unclear the risk of bias in some studies might influence the results.
-Provide more context for the mechanisms of S. boulardii and their clinical implications.
-The discrepancy between the findings of this study and those of Zhou et al.[10] is noted.
Consider discussing other factors (e.g., differences in patient populations, eradication regimens,
or methodologies) that could explain the variability.
-Since all included studies were conducted in China, address how these findings may translate to
other regions with different dietary habits, healthcare practices, or antibiotic resistance profiles.
Please review this paper.
user
Title: Effect of Saccharomyces boulardii supplementation to bismuth quadruple therapy on
Helicobacter pylori eradication
Version: 2 Date: 08 Jan 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While S. boulardii is described as resistant to antibiotics and gastric acid, its role in enhancing
eradication rates and reducing adverse effects could be explained briefly (e.g., modulation of
gut microbiota or anti-inflammatory properties).
-Clarify why earlier meta-analyses were insufficient (e.g., outdated protocols, limited subgroup
analysis) to better justify this study's necessity.
-Consider adding a brief justification for excluding multi-strain probiotics to preempt questions
about their potential effects on the outcomes.
-The process is well-described, but including examples of diagnostic methods for H. pylori (e.g.,
urea breath test, stool antigen test) would enhance clarity.
-Provide more detail on how heterogeneity was managed beyond switching between fixed
and random-effects models. Were subgroup analyses or meta-regression conducted to explore
potential sources of heterogeneity?
-Clarify how inter-rater reliability for quality assessment was managed (e.g., kappa statistic) to
ensure transparency in the review process.
-The quality assessment description is clear but can benefit from added context. For example:
Discuss the implications of having moderate-quality evidence based on the GRADE assessment.
Address how unclear the risk of bias in some studies might influence the results.
-Provide more context for the mechanisms of S. boulardii and their clinical implications.
-The discrepancy between the findings of this study and those of Zhou et al.[10] is noted.
Consider discussing other factors (e.g., differences in patient populations, eradication regimens,
or methodologies) that could explain the variability.
-Since all included studies were conducted in China, address how these findings may translate to
other regions with different dietary habits, healthcare practices, or antibiotic resistance profiles.
assistant