Reviewer ’s report  
 
Title: The potential value of serum pepsinogen for the diagnosis of atrophic gastritis among the 
health check -up populations in China: a diagnostic clinical research  
 
Version: 0 Date: 12 Dec 2016  
 
Reviewer: Irene Coati  
 
Reviewer's report:  
 
The aim of the article is interesting but its topic is to much wide to evaluate real istic the 
conclusions.  
The following points are the main revisions.  
- The cut -off of PGI and PGR always show low speficity and low positive predictive value; 
these values suggest that false positive cases are to many high. And these results seems to be 
better olny for severe atrophy.  
 
- The authors say the serum pepsinogen could be useful to find severe gastric atrophy, dividing 
Hp-positive and Hp -negative group.  
But, it is necessary to underline the small number of cases of this category is absolutely not 
sufficient to obtain significative conclusions.  
The article has a good number of cases from the asymptomatic health population. And the 
number of discovered severe gastric atrophy (n.13; 1.3%)is quite realist, since this lesion is often 
symptomatic.  
Until now and with  these present results, this article shows the serum pepsinogen is not a good 
and reliable  marker to detect atrophy gastritis, because of its statistic analysis.  
The authors could extend and screen their health -population, in order the enforce  their results, 
especially  in severe atrophy. But it is important to underline that severe atrophy - or gastric 
atrophy generally - is often symptomatic, so the study could become very expensive and without 
results.  
This article proves one more time the endo scopy and biopsy are the gold standard to "screen", to 
diagnose and to follow -up, and the serum pespinogen is an useful but not unique marker to 
screen gastric atrophy.  
Are the methods  appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the concl usions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscr ipt: 
 
Acceptable  
 
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 n ow 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 t o 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 int erests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the m anuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. 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/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: The potential value of serum pepsinogen for the diagnosis of atrophic gastritis among the 
health check -up populations in China: a diagnostic clinical research  
 
Version: 0 Date: 12 Dec 2016  
 
Reviewer: Irene Coati  
 
Reviewer's report:  
 
The aim of the article is interesting but its topic is to much wide to evaluate real istic the 
conclusions.  
The following points are the main revisions.  
- The cut -off of PGI and PGR always show low speficity and low positive predictive value; 
these values suggest that false positive cases are to many high. And these results seems to be 
better olny for severe atrophy.  
 
- The authors say the serum pepsinogen could be useful to find severe gastric atrophy, dividing 
Hp-positive and Hp -negative group.  
But, it is necessary to underline the small number of cases of this category is absolutely not 
sufficient to obtain significative conclusions.  
The article has a good number of cases from the asymptomatic health population. And the 
number of discovered severe gastric atrophy (n.13; 1.3%)is quite realist, since this lesion is often 
symptomatic.  
Until now and with  these present results, this article shows the serum pepsinogen is not a good 
and reliable  marker to detect atrophy gastritis, because of its statistic analysis.  
The authors could extend and screen their health -population, in order the enforce  their results, 
especially  in severe atrophy. But it is important to underline that severe atrophy - or gastric 
atrophy generally - is often symptomatic, so the study could become very expensive and without 
results.  
This article proves one more time the endo scopy and biopsy are the gold standard to "screen", to 
diagnose and to follow -up, and the serum pespinogen is an useful but not unique marker to 
screen gastric atrophy.  
Are the methods  appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the concl usions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscr ipt: 
 
Acceptable  
 
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 n ow 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 t o 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 int erests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the m anuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. 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/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: The potential value of serum pepsinogen for the diagnosis of atrophic gastritis among the 
health check -up populations in China: a diagnostic clinical research  
 
Version: 0 Date: 12 Dec 2016  
 
Reviewer: Irene Coati  
 
Reviewer's report:  
 
The aim of the article is interesting but its topic is to much wide to evaluate real istic the 
conclusions.  
The following points are the main revisions.  
- The cut -off of PGI and PGR always show low speficity and low positive predictive value; 
these values suggest that false positive cases are to many high. And these results seems to be 
better olny for severe atrophy.  
 
- The authors say the serum pepsinogen could be useful to find severe gastric atrophy, dividing 
Hp-positive and Hp -negative group.  
But, it is necessary to underline the small number of cases of this category is absolutely not 
sufficient to obtain significative conclusions.  
The article has a good number of cases from the asymptomatic health population. And the 
number of discovered severe gastric atrophy (n.13; 1.3%)is quite realist, since this lesion is often 
symptomatic.  
Until now and with  these present results, this article shows the serum pepsinogen is not a good 
and reliable  marker to detect atrophy gastritis, because of its statistic analysis.  
The authors could extend and screen their health -population, in order the enforce  their results, 
especially  in severe atrophy. But it is important to underline that severe atrophy - or gastric 
atrophy generally - is often symptomatic, so the study could become very expensive and without 
results.  
This article proves one more time the endo scopy and biopsy are the gold standard to "screen", to 
diagnose and to follow -up, and the serum pespinogen is an useful but not unique marker to 
screen gastric atrophy.  
Are the methods  appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the concl usions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscr ipt: 
 
Acceptable  
 
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 n ow 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 t o 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 int erests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the m anuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. 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/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant