Title: Gastric cancer risk after Helicobacter pylori eradication in gastritis and peptic ulcer: a
retrospective cohort study in Japan
Version: 1 Date: 20 Feb 2025
Reviewer's report:
This is a large-sized retrospective study on gastric cancer (GC) risk after Helicobacter pylori
(Hp) eradication in gastritis and peptic ulcer patients. Although it is well analyzed, several
concerns were raised as follow:
1. Conclusion, Abstract “Endoscopic examination is required after successful eradication of H.
pylori in patients with severe baseline gastric atrophy.” – Consider revising this sentence because
there is no data on atrophy score in the results.
2. Introduction - The study aim was to determine the difference in GC development between the
four groups (Hp gastritis, GU, DU, and synchronous GU with DU patients). Nonetheless, final
conclusions stick to gastric atrophy. Then, why is the GC incidence of the synchronous GU and
DU group low as sole DU group? Please mention about different characteristics between the
GU group and the synchronous GU/DU group  from the beginning.
3. Methods – In the patient demographics, data on alcohol drinking history, antithrombotics
other than aspirin, and nonsteroidal anti-inflammatory drug (NSAID) are missing. NSAID is the
most common drug that may induce peptic ulcer disease, and is more dangerous than low-dose
aspirin. So please consider adding data on the use of NSAID.
4. Results – If the authors want to mention about atrophy in the conclusions, add data on the
severity of atrophy. This is important because not all Hp-induced GU patients show permanent
atrophy after Hp eradication.
5. Discussion – Discuss about the low incidence of GC found in DU and synchronous GU and
DU patients found in this study. Mention more about the primary outcome of this study instead
of describing about other issues.
6. Discussion - If the degree of gastric atrophy is greater in patients with chronic gastritis and
GU compared with patients with DU [7, 8, 18, 19], why is the GC incidence of the synchronous
GU and DU group low? Please explain.
Title: Gastric cancer risk after Helicobacter pylori eradication in gastritis and peptic ulcer: a
retrospective cohort study in Japan
Version: 1 Date: 20 Feb 2025
Reviewer's report:
This is a large-sized retrospective study on gastric cancer (GC) risk after Helicobacter pylori
(Hp) eradication in gastritis and peptic ulcer patients. Although it is well analyzed, several
concerns were raised as follow:
1. Conclusion, Abstract “Endoscopic examination is required after successful eradication of H.
pylori in patients with severe baseline gastric atrophy.” – Consider revising this sentence because
there is no data on atrophy score in the results.
2. Introduction - The study aim was to determine the difference in GC development between the
four groups (Hp gastritis, GU, DU, and synchronous GU with DU patients). Nonetheless, final
conclusions stick to gastric atrophy. Then, why is the GC incidence of the synchronous GU and
DU group low as sole DU group? Please mention about different characteristics between the
GU group and the synchronous GU/DU group  from the beginning.
3. Methods – In the patient demographics, data on alcohol drinking history, antithrombotics
other than aspirin, and nonsteroidal anti-inflammatory drug (NSAID) are missing. NSAID is the
most common drug that may induce peptic ulcer disease, and is more dangerous than low-dose
aspirin. So please consider adding data on the use of NSAID.
4. Results – If the authors want to mention about atrophy in the conclusions, add data on the
severity of atrophy. This is important because not all Hp-induced GU patients show permanent
atrophy after Hp eradication.
5. Discussion – Discuss about the low incidence of GC found in DU and synchronous GU and
DU patients found in this study. Mention more about the primary outcome of this study instead
of describing about other issues.
6. Discussion - If the degree of gastric atrophy is greater in patients with chronic gastritis and
GU compared with patients with DU [7, 8, 18, 19], why is the GC incidence of the synchronous
GU and DU group low? Please explain.
Please review this paper.
user
Title: Gastric cancer risk after Helicobacter pylori eradication in gastritis and peptic ulcer: a
retrospective cohort study in Japan
Version: 1 Date: 20 Feb 2025
Reviewer's report:
This is a large-sized retrospective study on gastric cancer (GC) risk after Helicobacter pylori
(Hp) eradication in gastritis and peptic ulcer patients. Although it is well analyzed, several
concerns were raised as follow:
1. Conclusion, Abstract “Endoscopic examination is required after successful eradication of H.
pylori in patients with severe baseline gastric atrophy.” – Consider revising this sentence because
there is no data on atrophy score in the results.
2. Introduction - The study aim was to determine the difference in GC development between the
four groups (Hp gastritis, GU, DU, and synchronous GU with DU patients). Nonetheless, final
conclusions stick to gastric atrophy. Then, why is the GC incidence of the synchronous GU and
DU group low as sole DU group? Please mention about different characteristics between the
GU group and the synchronous GU/DU group  from the beginning.
3. Methods – In the patient demographics, data on alcohol drinking history, antithrombotics
other than aspirin, and nonsteroidal anti-inflammatory drug (NSAID) are missing. NSAID is the
most common drug that may induce peptic ulcer disease, and is more dangerous than low-dose
aspirin. So please consider adding data on the use of NSAID.
4. Results – If the authors want to mention about atrophy in the conclusions, add data on the
severity of atrophy. This is important because not all Hp-induced GU patients show permanent
atrophy after Hp eradication.
5. Discussion – Discuss about the low incidence of GC found in DU and synchronous GU and
DU patients found in this study. Mention more about the primary outcome of this study instead
of describing about other issues.
6. Discussion - If the degree of gastric atrophy is greater in patients with chronic gastritis and
GU compared with patients with DU [7, 8, 18, 19], why is the GC incidence of the synchronous
GU and DU group low? Please explain.
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