Reviewer ’s report  
 
Title:  Perceived stress as a risk factor for peptic ulcers: A register -based cohort study  
 
Version: 0 Date: 11 Aug 2016 
 
Reviewer:  Rupa  Banerjee  
 
Reviewer’s report:  
 
The present study addresses the key issue of the role of unknown determinants in the 
pathogenesis of idiopathic peptic ulcers. The contribution of stress  and other psychosocial factors 
like depression and anxiety in the development of peptic ulcers has been a long debated topic 
with some studies supporting and others refuting their role. In this context, the authors' efforts to 
find the causal relationship  between perceived everyday stress and peptic ulcers is commendable.  
 
However, the major limitation of the study appears to be the administration of triple treatment to 
patients as the outcome measure without testing for H. pylori infection. More evidence is 
required to conclude that H. pylorus modifies the effect of stress on risk of peptic ulcer.  
 
The authors need to isolate cases who have been tested negative for H. pylori and diagnosed to 
have peptic ulcers and correlate with stress levels. A subgroup a nalysis of such patients would 
significantly increase the reliability of the study.  
 
Are the methods appropriate and well described?  
If not, please spec ify 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.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistic s 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 manuscript:  
 
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 now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manusc ript? 
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to 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 interests' 
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 manuscript 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 an y 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:  Perceived stress as a risk factor for peptic ulcers: A register -based cohort study  
 
Version: 0 Date: 11 Aug 2016 
 
Reviewer:  Rupa  Banerjee  
 
Reviewer’s report:  
 
The present study addresses the key issue of the role of unknown determinants in the 
pathogenesis of idiopathic peptic ulcers. The contribution of stress  and other psychosocial factors 
like depression and anxiety in the development of peptic ulcers has been a long debated topic 
with some studies supporting and others refuting their role. In this context, the authors' efforts to 
find the causal relationship  between perceived everyday stress and peptic ulcers is commendable.  
 
However, the major limitation of the study appears to be the administration of triple treatment to 
patients as the outcome measure without testing for H. pylori infection. More evidence is 
required to conclude that H. pylorus modifies the effect of stress on risk of peptic ulcer.  
 
The authors need to isolate cases who have been tested negative for H. pylori and diagnosed to 
have peptic ulcers and correlate with stress levels. A subgroup a nalysis of such patients would 
significantly increase the reliability of the study.  
 
Are the methods appropriate and well described?  
If not, please spec ify 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.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistic s 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 manuscript:  
 
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 now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manusc ript? 
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to 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 interests' 
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 manuscript 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 an y 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:  Perceived stress as a risk factor for peptic ulcers: A register -based cohort study  
 
Version: 0 Date: 11 Aug 2016 
 
Reviewer:  Rupa  Banerjee  
 
Reviewer’s report:  
 
The present study addresses the key issue of the role of unknown determinants in the 
pathogenesis of idiopathic peptic ulcers. The contribution of stress  and other psychosocial factors 
like depression and anxiety in the development of peptic ulcers has been a long debated topic 
with some studies supporting and others refuting their role. In this context, the authors' efforts to 
find the causal relationship  between perceived everyday stress and peptic ulcers is commendable.  
 
However, the major limitation of the study appears to be the administration of triple treatment to 
patients as the outcome measure without testing for H. pylori infection. More evidence is 
required to conclude that H. pylorus modifies the effect of stress on risk of peptic ulcer.  
 
The authors need to isolate cases who have been tested negative for H. pylori and diagnosed to 
have peptic ulcers and correlate with stress levels. A subgroup a nalysis of such patients would 
significantly increase the reliability of the study.  
 
Are the methods appropriate and well described?  
If not, please spec ify 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.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistic s 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 manuscript:  
 
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 now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manusc ript? 
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to 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 interests' 
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 manuscript 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 an y 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