Title: Long-Term Assessment of Helicobacter pylori cagA EPIYA Motif Changes and
Pathology Outcomes in Gastric Biopsies of Dyspeptic Patients: 10-year Follow-up
Version: 1 Date: 05 Aug 2024
Reviewer's report:
Ghadersoltani et al. have designed and executed a good study. It is also well written. The 10-
year follow-up study is a good addition to the field and shows how cagA genotypes change over
the course of an infection. This has implications in disease progression and surveillance.
However, I have concerns over the ethical approval for this project. It is not clear if the patients
were treated for H. pylori infection on initial detection of the bacteria. Please may the authors
provide clarification over these points and make it clearer how the study was designed in this
regard.
Tables have no legend – please add legends to all tables and figures.
Please may the authors add a discussion point around how cagA changes are occurring when
it is thought most patients are infected with a single strain that has diversified over time (i.e.
recombination changes in cagA are therefore unlikely in this condition). Do the authors believe
mixed infections could be driving genotype changes. Have the authors identified any patients
with a mixed strain infection (such as isolates with multiple genotypes or selecting multiple
single colony isolates to screen per patient).
Title: Long-Term Assessment of Helicobacter pylori cagA EPIYA Motif Changes and
Pathology Outcomes in Gastric Biopsies of Dyspeptic Patients: 10-year Follow-up
Version: 1 Date: 05 Aug 2024
Reviewer's report:
Ghadersoltani et al. have designed and executed a good study. It is also well written. The 10-
year follow-up study is a good addition to the field and shows how cagA genotypes change over
the course of an infection. This has implications in disease progression and surveillance.
However, I have concerns over the ethical approval for this project. It is not clear if the patients
were treated for H. pylori infection on initial detection of the bacteria. Please may the authors
provide clarification over these points and make it clearer how the study was designed in this
regard.
Tables have no legend – please add legends to all tables and figures.
Please may the authors add a discussion point around how cagA changes are occurring when
it is thought most patients are infected with a single strain that has diversified over time (i.e.
recombination changes in cagA are therefore unlikely in this condition). Do the authors believe
mixed infections could be driving genotype changes. Have the authors identified any patients
with a mixed strain infection (such as isolates with multiple genotypes or selecting multiple
single colony isolates to screen per patient).
Please review this paper.
user
Title: Long-Term Assessment of Helicobacter pylori cagA EPIYA Motif Changes and
Pathology Outcomes in Gastric Biopsies of Dyspeptic Patients: 10-year Follow-up
Version: 1 Date: 05 Aug 2024
Reviewer's report:
Ghadersoltani et al. have designed and executed a good study. It is also well written. The 10-
year follow-up study is a good addition to the field and shows how cagA genotypes change over
the course of an infection. This has implications in disease progression and surveillance.
However, I have concerns over the ethical approval for this project. It is not clear if the patients
were treated for H. pylori infection on initial detection of the bacteria. Please may the authors
provide clarification over these points and make it clearer how the study was designed in this
regard.
Tables have no legend – please add legends to all tables and figures.
Please may the authors add a discussion point around how cagA changes are occurring when
it is thought most patients are infected with a single strain that has diversified over time (i.e.
recombination changes in cagA are therefore unlikely in this condition). Do the authors believe
mixed infections could be driving genotype changes. Have the authors identified any patients
with a mixed strain infection (such as isolates with multiple genotypes or selecting multiple
single colony isolates to screen per patient).
assistant