Title: Chronic atrophic gastritis in different ages in South China: a 10-year retrospective analysis
Version: 2 Date: 18 Dec 2022
Reviewer:  Tran Tien Dao
Reviewer's report:
COMMENT SHEET
Article name: Chronic atrophic gastritis in different ages in South China: a 10-year retrospective
analysis
I .  INFORMATION ABOUT REVIEWERS
Full name: Dao Tran Tien
Specialty: Gastroenterologist
Organize: Department of Gastroenterology and Hepatology, Tam Anh Hospital, Ha Noi, Viet
Nam
Email: tiendt1511@yahoo.com/ daotrantien1982@gmail.com
Orcid ID: 0000-0002-4787-6144
II. CRITICAL COMMENTARY
Atrophic chronic gastritis (ACG) is one of the common problems that is associated with the
risk of developing stomach cancer. Therefore, research to identify factors related to atrophic
chronic gastritis such as autoimmune diseases, and H. pylori infection, especially in Asians, has
scientific significance, topical help to predict and have prophylactic methods.
For the research method, the retrospective study had a very large sample size with 24,084 patients
with ACG. However, there is some information that the author should make clear. Firstly,
the author needs to make clear the criteria for the diagnosis of atrophic gastritis in research.
If the diagnosis is based on the OLGA staging system, you should describe the number of
biopsies you take. It is an important factor because it affects the accuracy as well as reliability
of the diagnosis of atrophy gastritis. Although ACG is considered a risk of gastric cancer,
many studies in Japan indicate severe ACG (OGLA grade III, IV) has a high risk of stomach
cancer. So, you need to give detail for this information. Secondly, for patients diagnosed with
autoimmune gastric mucosal atrophy due to pepsinogen reduction or positive intrinsic factor
antibody findings, positive parietal cell antibody findings should be analyzed. We found that
cutoff values of pepsinogen I reduction, or PGI/PGII ratio was different in other studies as well
as race or countries.  Japan takes PGI #70 ng/ml and PGI/PGII # 3 as criteria of ACG, but is
this value consistent with research in China? Thirdly, the criteria for diagnosing and excluding
H. pylori infection only by urease test are not accurate because the sensitivity and specificity
of this method is only about 60-70% and the accuracy of the method is greatly reduced if the
number of biopsy samples is not enough (e.g. 1 biopsy in antrum or body). In addition, urease
testing is also affected by factors such as using antibiotics and PPI drugs. Can the author rule
out these factors? Finally, if stomach cancer is seen in young people < 40 years of age, familial
factors should be evaluated, or it may be that disseminated stomach cancer is hereditary. These
patients need to investigate the factors involved in gene mutations
In conclusion, the research has a large sample size, so the result could influence the population,
however, the author should be made information in the article.
Title: Chronic atrophic gastritis in different ages in South China: a 10-year retrospective analysis
Version: 2 Date: 18 Dec 2022
Reviewer:  Tran Tien Dao
Reviewer's report:
COMMENT SHEET
Article name: Chronic atrophic gastritis in different ages in South China: a 10-year retrospective
analysis
I .  INFORMATION ABOUT REVIEWERS
Full name: Dao Tran Tien
Specialty: Gastroenterologist
Organize: Department of Gastroenterology and Hepatology, Tam Anh Hospital, Ha Noi, Viet
Nam
Email: tiendt1511@yahoo.com/ daotrantien1982@gmail.com
Orcid ID: 0000-0002-4787-6144
II. CRITICAL COMMENTARY
Atrophic chronic gastritis (ACG) is one of the common problems that is associated with the
risk of developing stomach cancer. Therefore, research to identify factors related to atrophic
chronic gastritis such as autoimmune diseases, and H. pylori infection, especially in Asians, has
scientific significance, topical help to predict and have prophylactic methods.
For the research method, the retrospective study had a very large sample size with 24,084 patients
with ACG. However, there is some information that the author should make clear. Firstly,
the author needs to make clear the criteria for the diagnosis of atrophic gastritis in research.
If the diagnosis is based on the OLGA staging system, you should describe the number of
biopsies you take. It is an important factor because it affects the accuracy as well as reliability
of the diagnosis of atrophy gastritis. Although ACG is considered a risk of gastric cancer,
many studies in Japan indicate severe ACG (OGLA grade III, IV) has a high risk of stomach
cancer. So, you need to give detail for this information. Secondly, for patients diagnosed with
autoimmune gastric mucosal atrophy due to pepsinogen reduction or positive intrinsic factor
antibody findings, positive parietal cell antibody findings should be analyzed. We found that
cutoff values of pepsinogen I reduction, or PGI/PGII ratio was different in other studies as well
as race or countries.  Japan takes PGI #70 ng/ml and PGI/PGII # 3 as criteria of ACG, but is
this value consistent with research in China? Thirdly, the criteria for diagnosing and excluding
H. pylori infection only by urease test are not accurate because the sensitivity and specificity
of this method is only about 60-70% and the accuracy of the method is greatly reduced if the
number of biopsy samples is not enough (e.g. 1 biopsy in antrum or body). In addition, urease
testing is also affected by factors such as using antibiotics and PPI drugs. Can the author rule
out these factors? Finally, if stomach cancer is seen in young people < 40 years of age, familial
factors should be evaluated, or it may be that disseminated stomach cancer is hereditary. These
patients need to investigate the factors involved in gene mutations
In conclusion, the research has a large sample size, so the result could influence the population,
however, the author should be made information in the article.
Please review this paper.
user
Title: Chronic atrophic gastritis in different ages in South China: a 10-year retrospective analysis
Version: 2 Date: 18 Dec 2022
Reviewer:  Tran Tien Dao
Reviewer's report:
COMMENT SHEET
Article name: Chronic atrophic gastritis in different ages in South China: a 10-year retrospective
analysis
I .  INFORMATION ABOUT REVIEWERS
Full name: Dao Tran Tien
Specialty: Gastroenterologist
Organize: Department of Gastroenterology and Hepatology, Tam Anh Hospital, Ha Noi, Viet
Nam
Email: tiendt1511@yahoo.com/ daotrantien1982@gmail.com
Orcid ID: 0000-0002-4787-6144
II. CRITICAL COMMENTARY
Atrophic chronic gastritis (ACG) is one of the common problems that is associated with the
risk of developing stomach cancer. Therefore, research to identify factors related to atrophic
chronic gastritis such as autoimmune diseases, and H. pylori infection, especially in Asians, has
scientific significance, topical help to predict and have prophylactic methods.
For the research method, the retrospective study had a very large sample size with 24,084 patients
with ACG. However, there is some information that the author should make clear. Firstly,
the author needs to make clear the criteria for the diagnosis of atrophic gastritis in research.
If the diagnosis is based on the OLGA staging system, you should describe the number of
biopsies you take. It is an important factor because it affects the accuracy as well as reliability
of the diagnosis of atrophy gastritis. Although ACG is considered a risk of gastric cancer,
many studies in Japan indicate severe ACG (OGLA grade III, IV) has a high risk of stomach
cancer. So, you need to give detail for this information. Secondly, for patients diagnosed with
autoimmune gastric mucosal atrophy due to pepsinogen reduction or positive intrinsic factor
antibody findings, positive parietal cell antibody findings should be analyzed. We found that
cutoff values of pepsinogen I reduction, or PGI/PGII ratio was different in other studies as well
as race or countries.  Japan takes PGI #70 ng/ml and PGI/PGII # 3 as criteria of ACG, but is
this value consistent with research in China? Thirdly, the criteria for diagnosing and excluding
H. pylori infection only by urease test are not accurate because the sensitivity and specificity
of this method is only about 60-70% and the accuracy of the method is greatly reduced if the
number of biopsy samples is not enough (e.g. 1 biopsy in antrum or body). In addition, urease
testing is also affected by factors such as using antibiotics and PPI drugs. Can the author rule
out these factors? Finally, if stomach cancer is seen in young people < 40 years of age, familial
factors should be evaluated, or it may be that disseminated stomach cancer is hereditary. These
patients need to investigate the factors involved in gene mutations
In conclusion, the research has a large sample size, so the result could influence the population,
however, the author should be made information in the article.
assistant