Review for 10.1186/s12876-025-03886-z (2025)

Title: The relationship between the eradication of Helicobacter pylori and the occurrence of
stomach cancer: an updated meta-analysis and systemic review
Version: 2 Date: 20 Feb 2025
Reviewer's report:
I read with interest the study titled "The relationship between the eradication of Helicobacter
pylori and the occurrence of stomach cancer: an updated meta-analysis and systematic review."
However, I have identified several areas that require improvement:
1. Abstract:
The statement, "Helicobacter pylori has recently been shown to have a substantial correlation
with the occurrence of stomach cancer," could be misleading. The International Agency for
Research on Cancer (IARC) have classified H. pylori as a group 1 carcinogen in 1994. (IARC
Monogr. Eval. Carcinog. Risks Hum. 1994;61:1–241).
The primary outcome of the study should be clearly defined in the abstract’s objective section.
The sentence "In the subgroup analysis, 0.67 and the occurrence of stomach cancer among
healthy adults was recorded at 0.67 (RR: 0.67; 95% CI: 0.48–0.93; NNT = 476)," is unclear.
2. Terminology: "Elimination therapy of Helicobacter pylori" is not commonly used in scientific
literature. I recommend replacing it with "Helicobacter pylori eradication therapy" throughout
the text.
3. Author Citation: Use "First author et al." instead of "First author alone". For example, replace
"Li WQ" with "Li et al."
4. The inclusion and exclusion criteria would benefit from being written as a continuous text
rather than separate topics.
5. The inclusion criteria mention: "The participants in the study comprised individuals who
received a positive diagnosis for Helicobacter pylori and did not have stomach cancer at
the initial assessment. This group included both healthy individuals as well as those with
gastric tumors, such as dysplasia or early-stage stomach cancer, who had previously undergone
endoscopic mucosal resection.”
However, the study by Kim et al. (2016) assessed patients who underwent distal gastrectomy,
instead of endoscopic mucosal resection, which seems inconsistent with the stated criteria. Could
the authors explain why this study was included?
- Kim YI, Cho SJ, Lee JY, et al. Effect of Helicobacter pylori Eradication on Long-Term Survival
after Distal Gastrectomy for Stomach Cancer. Cancer Res Treat. 2016;48(3):1020–9.
6. Omitted Studies: The meta-analysis by Ford et al. (2020) included the study "Saito D, Boku
N, Fujioka T, et al. Impact of H. pylori eradication on gastric cancer prevention: endoscopic
results of the Japanese Intervention Trial (JITHP-Study)." This study was not included in the
present manuscript. Could the authors provide a reason for its exclusion?
- Ford AC, Yuan Y, Forman D, Hunt R, Moayyedi P. Helicobacter pylori eradication for the
prevention of gastric neoplasia. Cochrane Database Syst Rev. 2020;7(7):CD005583.
7. Similarly, Ford et al. (2022) included the study "Piazuelo MB, Bravo LE, Mera RM, et al. The
Colombian Chemoprevention Trial: 20-Year Follow-Up of a Cohort of Patients With Gastric
Precancerous Lesions." Why was this study not included in the present manuscript?
- Ford AC, Yuan Y, Moayyedi P. Long-Term Impact of Helicobacter pylori Eradication Therapy
on Gastric Cancer Incidence and Mortality in Healthy Infected Individuals: A Meta-Analysis
Beyond 10 Years of Follow-Up. Gastroenterology. 2022;163(3):754–756.e1.
8. The description of the study selection process alternates between future and past tense, which
can be confusing. Please maintain consistency by using past tense throughout, as the study
selection process has already occurred.
9. In the analysis of gastric cancer mortality, the authors report a fixed effects model with
RR=0.83 (95% CI: 0.69–1.01) and p=0.057. Since the p-value is greater than 0.05, the result is
not statistically significant. The authors should clearly state this in the manuscript.
10. The authors should minimize the use of passive voice, eliminate redundancy, and ensure
grammatical accuracy throughout the text.
11.   The manuscript requires substantial revisions to enhance clarity and consistency.
Several sections would benefit from simplified phrasing and improved presentation to increase
readability and scientific precision.