Review for 10.1186/s12876-020-01549-9 (2020)

Reviewer’s report
Title: 
Assessment of a novel method to detect clarithromycin-resistant
Helicobacter pylori using a stool antigen test reagent
Version: 
1 
Date: 
23 Jun 2020
Reviewer's report:
Kakiuchi and colleagues have performed a study which assessed a novel method
to detect clarithromycin-resistant H. pylori. The authors reported that this
method could be useful for non-invasively detecting CAM-R mutations in H.
pylori by using residual solution of stool antigen test, particularly for children
who receive heavy burden by conventional(using the strains that are cultured
from gastric biopsy tissue) method.
This novel method doesn't need to perform esophagogastroduodenoscopy and
may be useful in the high CAM-R rate area, like Japan. In this report, the authors
confirmed the clinical usefulness of novel Nested PCR-QP method that used
stool specimens comparing conventional method. After that, the authors
investigated the clinical usefulness for children using stool specimens without
EGD and performed eradication therapy. 
This manuscript provides new data regarding new non-invasive method to detect
CAM-R H. pylori. Nevertheless, the work suffers from several minor weakness:
this new method can detect only CAM-R, so discussions about the usefulness in
several situations (e.g. the area where a CAM-R rate is low or high, the area
where other drug resistance is high) and the reasons why there was no significant
difference in the success rate between those with and without a CAM-R
mutation (e.g. number of cases, vonoprazan ) are needed.
These and other specific points for the authors' consideration are listed below.
1) (p4, line7-11) It's needed to describe the information of where.
2) (p8, line5-7) It's needed to describe the breakpoint values. 
3) (p11, line16-17) The authors describe "No CAM resistance mutation was
detected in Nested PCR-QP for two adults with a negative stool H. pylori
antigen test result.", but in Table 3 Nested PCR-QP, statement is "Not tested",
Were Nested PCR-QP tested for these 2 samples?
4) Table3: What is the meaning of the number 1,2 in sex field and 3+, 2+ in
Result field? 
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No
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
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authors.
Yes
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Yes
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I am able to assess the statistics
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Acceptable
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