Review for 10.1186/s12876-023-03033-6 (2023)

Title: Histopathological features of glandular atrophy of the lamina propria of the gastric mucosa
during its occurrence and development
Version: 0 Date: 17 Sep 2023
Reviewer's report:
The authors aimed to explore the histopathological features of glandular atrophy of the lamina
proprio of gastric mucosa during its occurrence and development. The study is well conceived
and the iconography is supportive of the findings. However, some details worthy of clarification
should be noted.
1) Introduction, lines 74 to 78: Although the distinction between the degrees of chronic atrophic
gastritis reflects that reported in the most widely accepted classifications, OLGA and OLGIM,
I believe it would be correct to refer to the two types mentioned because the results are more
easily comparable between different researchers in different parts of the world. Notably, the
cited references, 11-15, refer to these classifications.
2) Results, 2 Clinical characteristics: It would have been appropriate for the reported results to
highlight the differences at least between the antrum and the fundus (see comment below, point
4). Can the authors report such data?
3) Discussion, line 204: A distinction must be made regarding autoimmune gastritis: Recent
publications in authoritative journals have shown that naïve, Helicobacter-free autoimmune
gastritis does not represent precancerous lesions (Rugge M, Bricca L, Guzzinati S, Sacchi D,
Pizzi M, Savarino E, Farinati F, Zorzi M, Fassan M, Dei Tos AP, Malfertheiner P, Genta RM,
Graham DY. Autoimmune gastritis: long-term natural history in naïve Helicobacter pylori-
negative patients. Gut. 2023 Jan;72(1):30-38. doi: 10.1136/gutjnl-2022-327827. Epub 2022 Jun
30. PMID: 35772926.
Rugge M, Genta RM, Malfertheiner P, Graham DY. Gastric cancer risk in autoimmune
gastritis: evidence versus opinion. Gut. 2023 Feb 27:gutjnl-2023-329618. doi: 10.1136/
gutjnl-2023-329618. Epub ahead of print. PMID: 36849227.
Genta RM, Turner KO, Robiou C, Singhal A, Rugge M. Incomplete Intestinal Metaplasia Is
Rare in Autoimmune Gastritis. Dig Dis. 2023;41(3):369-376. doi: 10.1159/000527479. Epub
2023 Feb 3. PMID: 36739859.
Rugge M, Genta RM, Bricca L, Savarino E. Not All Autoimmune Gastritis Are Created the
Same. Gastroenterology Res. 2021 Dec;14(6):348-349. doi: 10.14740/gr1443. Epub 2021 Nov
5. PMID: 35059069; PMCID: PMC8734497.)
4) Discussion, line 210: It would be appropriate to specify that from a histological point of view
there are differences between the pyloric, corpus-fundic and cardial areas. These differences,
also taken into consideration in Sidney's classification scheme, make it difficult to evaluate
the disappearance of the glandular elements in the different gastric districts. The structure and
function of the glandular layer, in fact, vary depending on the different areas of the stomach. The
foveolae are larger in the areas of the cardial and pyloric mucosa than elsewhere. The foveolae
occupy approximately half the thickness of the mucosa in the cardial and pyloric areas. The
foveolae in the mucosa of the oxyntic gland constitute only about one-fifth of the thickness of the
mucosa. The glands are straight rather than coiled and are tightly packed relative to the cardial
and pyloric mucosa (Stacey Mills Ed. Histology for Pathologist, Chapter 23). As for point 2,
can the authors report any differences found?