Title: An extended 36-week oral esomeprazole improved long-term recurrent peptic ulcer
bleeding in patients at high risk of rebleeding
Version: 2 Date: 15 Aug 2022
Reviewer:  Tianyu Chi
Reviewer's report:
Comments to the Author
I reviewed with great interest the manuscript entitled “An extended 36-week oral esomeprazole
improved long-term recurrent peptic ulcer bleeding in patients at high risk of rebleeding” in
BMC Gastroenterology.
The aim of this study is important. However, I found various issues, which are described below.
Major points:
1. A large part of the references in this paper are from before 2013. It is suggested to add
references in recent 5 years to understand the latest progress of relevant research and improve
the scientific nature of this paper. DOI number should be added to each reference.
2. In subgroup analysis of secondary outcomes in this paper, the sample size of one subgroup is
not enough to meet the needs of statistical analysis, so it is suggested to explain in the limitation
to improve the reliability of this paper.
3. The efficacy of PPI is related to CYP2C19. Was Esomeprazole used according to the test
results of CYP2C19 before enrollment in this study? If not, how to ensure that PPI efficacy is
consistent in each group?
4. Whether esomeprazole was used at the same time as other gastric mucosal protective agents
during follow-up is one of the key factors affecting the primary and secondary outcomes. Please
include an analysis and discussion of whether to use gastric mucosal protective agents.
5. H.pylori infection are important issues in peptic ulcer bleeding. Are the results influenced by
H.pylori infection during follow-up? Please elaborate in the discussion.
6. During the follow-up, was the bleeding site of the patients with rebleeding the original
bleeding site, or were there other new bleeding sites?
Minor points
1. On page 15, line 13 of the DISCUSSION, “However, because of the small sample size,
this study did not show a significant difference in terms of risk reduction between twice- and
once-daily esomeprazole.” Please consider whether the theoretical basis for this conclusion is
sufficient in this paper according to your analysis.
2. On page 17, line 11 of the CONCLUSIONS, “However, the protective effect of reducing
recurrent peptic ulcer bleeding was diminished after shifting to on-demand or discontinuing the
use of PPIs.” Please consider whether the theoretical basis for this conclusion is sufficient in
this paper according to your analysis.
Title: An extended 36-week oral esomeprazole improved long-term recurrent peptic ulcer
bleeding in patients at high risk of rebleeding
Version: 2 Date: 15 Aug 2022
Reviewer:  Tianyu Chi
Reviewer's report:
Comments to the Author
I reviewed with great interest the manuscript entitled “An extended 36-week oral esomeprazole
improved long-term recurrent peptic ulcer bleeding in patients at high risk of rebleeding” in
BMC Gastroenterology.
The aim of this study is important. However, I found various issues, which are described below.
Major points:
1. A large part of the references in this paper are from before 2013. It is suggested to add
references in recent 5 years to understand the latest progress of relevant research and improve
the scientific nature of this paper. DOI number should be added to each reference.
2. In subgroup analysis of secondary outcomes in this paper, the sample size of one subgroup is
not enough to meet the needs of statistical analysis, so it is suggested to explain in the limitation
to improve the reliability of this paper.
3. The efficacy of PPI is related to CYP2C19. Was Esomeprazole used according to the test
results of CYP2C19 before enrollment in this study? If not, how to ensure that PPI efficacy is
consistent in each group?
4. Whether esomeprazole was used at the same time as other gastric mucosal protective agents
during follow-up is one of the key factors affecting the primary and secondary outcomes. Please
include an analysis and discussion of whether to use gastric mucosal protective agents.
5. H.pylori infection are important issues in peptic ulcer bleeding. Are the results influenced by
H.pylori infection during follow-up? Please elaborate in the discussion.
6. During the follow-up, was the bleeding site of the patients with rebleeding the original
bleeding site, or were there other new bleeding sites?
Minor points
1. On page 15, line 13 of the DISCUSSION, “However, because of the small sample size,
this study did not show a significant difference in terms of risk reduction between twice- and
once-daily esomeprazole.” Please consider whether the theoretical basis for this conclusion is
sufficient in this paper according to your analysis.
2. On page 17, line 11 of the CONCLUSIONS, “However, the protective effect of reducing
recurrent peptic ulcer bleeding was diminished after shifting to on-demand or discontinuing the
use of PPIs.” Please consider whether the theoretical basis for this conclusion is sufficient in
this paper according to your analysis.
Please review this paper.
user
Title: An extended 36-week oral esomeprazole improved long-term recurrent peptic ulcer
bleeding in patients at high risk of rebleeding
Version: 2 Date: 15 Aug 2022
Reviewer:  Tianyu Chi
Reviewer's report:
Comments to the Author
I reviewed with great interest the manuscript entitled “An extended 36-week oral esomeprazole
improved long-term recurrent peptic ulcer bleeding in patients at high risk of rebleeding” in
BMC Gastroenterology.
The aim of this study is important. However, I found various issues, which are described below.
Major points:
1. A large part of the references in this paper are from before 2013. It is suggested to add
references in recent 5 years to understand the latest progress of relevant research and improve
the scientific nature of this paper. DOI number should be added to each reference.
2. In subgroup analysis of secondary outcomes in this paper, the sample size of one subgroup is
not enough to meet the needs of statistical analysis, so it is suggested to explain in the limitation
to improve the reliability of this paper.
3. The efficacy of PPI is related to CYP2C19. Was Esomeprazole used according to the test
results of CYP2C19 before enrollment in this study? If not, how to ensure that PPI efficacy is
consistent in each group?
4. Whether esomeprazole was used at the same time as other gastric mucosal protective agents
during follow-up is one of the key factors affecting the primary and secondary outcomes. Please
include an analysis and discussion of whether to use gastric mucosal protective agents.
5. H.pylori infection are important issues in peptic ulcer bleeding. Are the results influenced by
H.pylori infection during follow-up? Please elaborate in the discussion.
6. During the follow-up, was the bleeding site of the patients with rebleeding the original
bleeding site, or were there other new bleeding sites?
Minor points
1. On page 15, line 13 of the DISCUSSION, “However, because of the small sample size,
this study did not show a significant difference in terms of risk reduction between twice- and
once-daily esomeprazole.” Please consider whether the theoretical basis for this conclusion is
sufficient in this paper according to your analysis.
2. On page 17, line 11 of the CONCLUSIONS, “However, the protective effect of reducing
recurrent peptic ulcer bleeding was diminished after shifting to on-demand or discontinuing the
use of PPIs.” Please consider whether the theoretical basis for this conclusion is sufficient in
this paper according to your analysis.
assistant