Reviewer’s report
Title: 
The global, regional and national burden of peptic ulcer disease from 1990
to 2019: a population-based study
Version: 
0 
Date: 
27 Oct 2021
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
No - there are major issues
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
The main objective of the study is to understand the trends and patterns of peptic
ulcer disease (PUD) burden across 204 countries. The data were drawn from the
Global Burden of Disease, Injuries and Risk factors study and the estimates
covering the period from 1990-2019. Though this is an important study, the
analysis is descriptive and has little analytical rigor. 
The authors have simply describing the numbers without going into explaining
the reasons for the trends, and patterns and variations across regions/countries.
The discussions were only drawn from different studies as speculations and did
not come from the analysis of the data.
The authors could have done a modelling to identify the factors (Socioeconomic,
demographic, biological, environmental, 
behavioral including diet and smoking
etc. ) contributing for morbidity, mortality and DALY of PUD. In addition, how
the changes in these factors contributed to the changes in the morbidity,
mortality including on DALY over the period between 1990-2019 could have
enhanced the value of the paper.
The paper used the data from GBD study and did not make any significant
contribution to the analysis to bring any unravel findings on the PUD problem.
Further, the paper is lacking scientific rigor in terms of interpretation and
discussion.
REQUESTED REVISIONS: 
The objective is very simple. There is no analytical research question or
hypothesis for the study. 
The design is descriptive. However, scientific approach of analyzing and
interpreting the trends and patterns are lacking.
The paper used generalized linear model for estimating the annual percentage
change. Though this is ok but the study did not discuss about how the
improvement in data quality over time would affect the annual percentage
change. Similarly differences in the quality of data on PUD across the countries
would also affect the understanding on trends and patterns of PUD. 
The interpretation and discussion of the results needs analytical rigor. For
example, Figure 5 reveals that there is high heterogeneity in the age standardized
prevalence of PUD among the countries of high SDI whereas the variation is low
among the countries of low SDI. Why this type of patterns presents and what
factors contributing to it? This type of analysis could be interesting and
appealing.
ADDITIONAL REQUESTS/SUGGESTIONS: 
NO
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
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, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, 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 patents 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 yes to any, please give details below.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
The global, regional and national burden of peptic ulcer disease from 1990
to 2019: a population-based study
Version: 
0 
Date: 
27 Oct 2021
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
No - there are major issues
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
The main objective of the study is to understand the trends and patterns of peptic
ulcer disease (PUD) burden across 204 countries. The data were drawn from the
Global Burden of Disease, Injuries and Risk factors study and the estimates
covering the period from 1990-2019. Though this is an important study, the
analysis is descriptive and has little analytical rigor. 
The authors have simply describing the numbers without going into explaining
the reasons for the trends, and patterns and variations across regions/countries.
The discussions were only drawn from different studies as speculations and did
not come from the analysis of the data.
The authors could have done a modelling to identify the factors (Socioeconomic,
demographic, biological, environmental, 
behavioral including diet and smoking
etc. ) contributing for morbidity, mortality and DALY of PUD. In addition, how
the changes in these factors contributed to the changes in the morbidity,
mortality including on DALY over the period between 1990-2019 could have
enhanced the value of the paper.
The paper used the data from GBD study and did not make any significant
contribution to the analysis to bring any unravel findings on the PUD problem.
Further, the paper is lacking scientific rigor in terms of interpretation and
discussion.
REQUESTED REVISIONS: 
The objective is very simple. There is no analytical research question or
hypothesis for the study. 
The design is descriptive. However, scientific approach of analyzing and
interpreting the trends and patterns are lacking.
The paper used generalized linear model for estimating the annual percentage
change. Though this is ok but the study did not discuss about how the
improvement in data quality over time would affect the annual percentage
change. Similarly differences in the quality of data on PUD across the countries
would also affect the understanding on trends and patterns of PUD. 
The interpretation and discussion of the results needs analytical rigor. For
example, Figure 5 reveals that there is high heterogeneity in the age standardized
prevalence of PUD among the countries of high SDI whereas the variation is low
among the countries of low SDI. Why this type of patterns presents and what
factors contributing to it? This type of analysis could be interesting and
appealing.
ADDITIONAL REQUESTS/SUGGESTIONS: 
NO
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
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, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, 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 patents 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 yes to any, please give details below.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
The global, regional and national burden of peptic ulcer disease from 1990
to 2019: a population-based study
Version: 
0 
Date: 
27 Oct 2021
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
No - there are major issues
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
The main objective of the study is to understand the trends and patterns of peptic
ulcer disease (PUD) burden across 204 countries. The data were drawn from the
Global Burden of Disease, Injuries and Risk factors study and the estimates
covering the period from 1990-2019. Though this is an important study, the
analysis is descriptive and has little analytical rigor. 
The authors have simply describing the numbers without going into explaining
the reasons for the trends, and patterns and variations across regions/countries.
The discussions were only drawn from different studies as speculations and did
not come from the analysis of the data.
The authors could have done a modelling to identify the factors (Socioeconomic,
demographic, biological, environmental, 
behavioral including diet and smoking
etc. ) contributing for morbidity, mortality and DALY of PUD. In addition, how
the changes in these factors contributed to the changes in the morbidity,
mortality including on DALY over the period between 1990-2019 could have
enhanced the value of the paper.
The paper used the data from GBD study and did not make any significant
contribution to the analysis to bring any unravel findings on the PUD problem.
Further, the paper is lacking scientific rigor in terms of interpretation and
discussion.
REQUESTED REVISIONS: 
The objective is very simple. There is no analytical research question or
hypothesis for the study. 
The design is descriptive. However, scientific approach of analyzing and
interpreting the trends and patterns are lacking.
The paper used generalized linear model for estimating the annual percentage
change. Though this is ok but the study did not discuss about how the
improvement in data quality over time would affect the annual percentage
change. Similarly differences in the quality of data on PUD across the countries
would also affect the understanding on trends and patterns of PUD. 
The interpretation and discussion of the results needs analytical rigor. For
example, Figure 5 reveals that there is high heterogeneity in the age standardized
prevalence of PUD among the countries of high SDI whereas the variation is low
among the countries of low SDI. Why this type of patterns presents and what
factors contributing to it? This type of analysis could be interesting and
appealing.
ADDITIONAL REQUESTS/SUGGESTIONS: 
NO
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
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, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, 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 patents 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 yes to any, please give details below.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant