Reviewer's report
Title:Additional corpus biopsy enhances the detection of Helicobacter pylori
infection in a backdrop of atrophic gastritis
Version: 1Date:24 July 2012
Reviewer: Michael Vieth
Reviewer's report:
Major Compulsory Revisions
I completely agree that the current recommendations concerning the location of
gastric biopsy sampling are not perfect to detect atrophy, intestinal metaplasia
and even the morphological proof of Helicobacter colonisation depend a lot on
the site of the biopsy due to the patchy nature of changes within the stomach.
In the literature there is a continous mix of autoimmune gastritis and gastritis with
atrophy. I would like to suggest to change terminology in the present manuscript
from "atrophic gastritis" (which can be mixed up with autoimmune gastritis or
features of autoimmune gastritis) into "gastritis with atrophy" throughout the
manuscript.
The discrepant cases where Helicobacter was not detected morphologically: I
would like to recommend in these cases to mention the degree of inflammation
(at least the acivitiy of the gastritis) which can be an indirect sign of Helicobacter
gastritis even if the bacteria can't be detected morphologically and relate this to
other positive tests. This can be added to table 1.
In contrary to the authors' statement that there are no recommendations for the
location of taking a biposy (personally I think that they are not optimal but they do
exist!): the Sydney System (ref 18) has an enourmous background of statistical
analysis to ensure that with a minimum of biopsies from defined areas the correct
histological diagnosis can be made. Also, an incisura biposy was once suggested
within the Sydney System. Please mention the exact number of biopsies and
exact proposed location of the biopsy site of the Sydney System. It is not "one
biposy from antrum and corpus" ! I would like to suggest to change this / add this
information throughout the manuscript.
I would also like to suggest to emphazise that grading of antrum atrophy is most
difficult for pathologists since kappa values are very low. Please mention also,
that you graded the atrophy like proposed in the Sydney System (please, with
reference 18).
Minor Essential Revisions
instead of backdrop may be background is a better term ?
ref 7... there is a new Masstricht IV/Florence report available from 2011
Table 4: "ca" in front of "Degree" ?
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Reviewer's report
Title:Additional corpus biopsy enhances the detection of Helicobacter pylori
infection in a backdrop of atrophic gastritis
Version: 1Date:24 July 2012
Reviewer: Michael Vieth
Reviewer's report:
Major Compulsory Revisions
I completely agree that the current recommendations concerning the location of
gastric biopsy sampling are not perfect to detect atrophy, intestinal metaplasia
and even the morphological proof of Helicobacter colonisation depend a lot on
the site of the biopsy due to the patchy nature of changes within the stomach.
In the literature there is a continous mix of autoimmune gastritis and gastritis with
atrophy. I would like to suggest to change terminology in the present manuscript
from "atrophic gastritis" (which can be mixed up with autoimmune gastritis or
features of autoimmune gastritis) into "gastritis with atrophy" throughout the
manuscript.
The discrepant cases where Helicobacter was not detected morphologically: I
would like to recommend in these cases to mention the degree of inflammation
(at least the acivitiy of the gastritis) which can be an indirect sign of Helicobacter
gastritis even if the bacteria can't be detected morphologically and relate this to
other positive tests. This can be added to table 1.
In contrary to the authors' statement that there are no recommendations for the
location of taking a biposy (personally I think that they are not optimal but they do
exist!): the Sydney System (ref 18) has an enourmous background of statistical
analysis to ensure that with a minimum of biopsies from defined areas the correct
histological diagnosis can be made. Also, an incisura biposy was once suggested
within the Sydney System. Please mention the exact number of biopsies and
exact proposed location of the biopsy site of the Sydney System. It is not "one
biposy from antrum and corpus" ! I would like to suggest to change this / add this
information throughout the manuscript.
I would also like to suggest to emphazise that grading of antrum atrophy is most
difficult for pathologists since kappa values are very low. Please mention also,
that you graded the atrophy like proposed in the Sydney System (please, with
reference 18).
Minor Essential Revisions
instead of backdrop may be background is a better term ?
ref 7... there is a new Masstricht IV/Florence report available from 2011
Table 4: "ca" in front of "Degree" ?
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:Additional corpus biopsy enhances the detection of Helicobacter pylori
infection in a backdrop of atrophic gastritis
Version: 1Date:24 July 2012
Reviewer: Michael Vieth
Reviewer's report:
Major Compulsory Revisions
I completely agree that the current recommendations concerning the location of
gastric biopsy sampling are not perfect to detect atrophy, intestinal metaplasia
and even the morphological proof of Helicobacter colonisation depend a lot on
the site of the biopsy due to the patchy nature of changes within the stomach.
In the literature there is a continous mix of autoimmune gastritis and gastritis with
atrophy. I would like to suggest to change terminology in the present manuscript
from "atrophic gastritis" (which can be mixed up with autoimmune gastritis or
features of autoimmune gastritis) into "gastritis with atrophy" throughout the
manuscript.
The discrepant cases where Helicobacter was not detected morphologically: I
would like to recommend in these cases to mention the degree of inflammation
(at least the acivitiy of the gastritis) which can be an indirect sign of Helicobacter
gastritis even if the bacteria can't be detected morphologically and relate this to
other positive tests. This can be added to table 1.
In contrary to the authors' statement that there are no recommendations for the
location of taking a biposy (personally I think that they are not optimal but they do
exist!): the Sydney System (ref 18) has an enourmous background of statistical
analysis to ensure that with a minimum of biopsies from defined areas the correct
histological diagnosis can be made. Also, an incisura biposy was once suggested
within the Sydney System. Please mention the exact number of biopsies and
exact proposed location of the biopsy site of the Sydney System. It is not "one
biposy from antrum and corpus" ! I would like to suggest to change this / add this
information throughout the manuscript.
I would also like to suggest to emphazise that grading of antrum atrophy is most
difficult for pathologists since kappa values are very low. Please mention also,
that you graded the atrophy like proposed in the Sydney System (please, with
reference 18).
Minor Essential Revisions
instead of backdrop may be background is a better term ?
ref 7... there is a new Masstricht IV/Florence report available from 2011
Table 4: "ca" in front of "Degree" ?
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
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