Review for 10.1186/s12876-021-01680-1 (2021)

Reviewer’s report
Title: 
Ten-day bismuth-containing quadruple therapy versus 7-day proton pump
inhibitor-clarithromycin containing triple therapy as first-line empirical therapy
for the Helicobacter pylori infection in Korea: A randomized open-label trial
Version: 
0 
Date: 
05 Jul 2020
Reviewer's report:
Kim et al. reported an original article in title "Ten-day bismuth-containing
quadruple therapy versus 7-day proton pump inhibitor-clarithromycin containing
triple therapy as first-line empirical therapy for the Helicobacter pylori infection
in Korea: A randomized open-label trial". They concluded that ten-day BQT had
higher eradication rates compared to that of the 7-day STT as an empirical first-
line treatment for H. pylori eradication in Korea.
The topic is a high originality but less novelty. Some criticizes and suggestion
are list below.
The major comments
1. According to the consensuses after 2017 of Maastricht V/Florence, Taiwan,
and Toronto, optimal treatment of H pylori infection requires local antibiotic
resistance data and PPI based triple therapy needs a 14-day therapy (Gut
2017;66(1):6-30; Helicobacter 2017;22:e12368; Gastroenterology
2016;151(1):51-69.e14.). Therefore, the control group using a 7-day triple
therapy seems to be inappropriate. Do the majority of clinicians using a 7-day
PPI based triple therapy for H. pylori eradication in Korea?
2. Bismuth-containing quadruple therapy usually used for the 2nd line therapy
for H. pylori eradication. The idea for changing it to the first line reagent is
novel. However, based on the result of ITT (74.3%) and high adverse (23.1%) of
BQT, it seems to be hard to accept for the first line therapy.
3. The limitation of this study is lack of antimicrobial susceptibility data. As in
the sample size calculation, you assume the clarithromycin-resistant rate was
20% (may be from local data). BQT could be an alternative choice for the first
line therapy in Korea.
The minor comments
1. Page 11, lines 1-3: "Thus, 134 participants from the STT group and 143 from
the BQT group were included in the modified ITT analysis for the overall
eradication rate." It is not clear.
2. Also in Page 11, lines 4-7: "Overall eradication rates were not significantly
different between the groups (97.8% [131/134 participants] for the STT group
and 98.6% [141/143 participants] for the BQT group; p= 0.676; Table 2)." Do
you mean that to combine the BQT and STT, the eradication rate is equal in
either choosing BQT (98.6%) or STT (97.8%) for the first line therapy? Do you
find the 2nd line therapy (both BQT and STT) had a higher eradication rate that
the first line therapy? Theoretically, it is very rare.
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Are the methods appropriate and well described?
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Yes
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authors.
Yes
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Yes
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Acceptable
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