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: 23 Feb 2025
Reviewer's report:
I read with great interest the study by Wu et al. In this updated meta-analysis, the authors attempt
to use the latest evidence to reveal the relationship between Helicobacter pylori eradication and
the occurrence of gastric cancer. My comments are as follows:
1. First, the language and wording of this paper are disastrous, which significantly hampers the
reviewer’s reading experience. I recommend that the authors thoroughly review the language
of the manuscript and, if necessary, seek professional services for editing. I noticed some very
obvious traces of AI-assisted editing; I suggest the authors reflect on this issue and disclose it
accordingly in the study.
2. Methods section: (1) The authors describe various methods for obtaining literature data,
including the search for conference abstracts, inclusion of gray literature, and requesting
additional data from original authors. While this approach is indeed rigorous, it should be
noted that in the Results section, there is no description of whether any additional data was
actually obtained through these methods. (2) I am not clear why the authors considered including
populations who had previously undergone endoscopic resection for early gastrointestinal cancer
and treated them as equivalent to the general population. The cancer risk in this group is not
the same as in healthy individuals. (3) This is not a meta-analysis based on individual data,
so I do not understand how the authors excluded so-called "individuals" who did not meet the
criteria during the data collection process. (4) The Cochrane Risk of Bias tool is outdated; I
would recommend considering ROB2 instead. (5) In the statistical methods section, I would like
the authors to be more careful when using the term "heterogeneity." It is a specialized term and
should not be replaced by other words. I would also like to remind the authors to describe the
way of reporting heterogeneity. Meta-analysis focuses more on explaining heterogeneity, rather
than merely using different methods to judge its presence or not. Typically, Q tests and I2 are
sufficient for this purpose.
3. Results section: (1) The statement "Risk of bias graphs are not presented in the article due to
space constraints but can be provided if required by the editor" is meaningless. The risk of bias
assessment for each included study MUST be presented to the readers. (2) I recommend that the
authors use the online GRADE tool to generate the table. The current table is not aesthetically
pleasing. (3) Please provide the results of the sensitivity analysis. This can easily be generated
using Stata or R software. Such graphs can be included in the supplementary materials. (4) Please
provide detailed results of the meta-regression to help readers understand how different factors
may influence heterogeneity. These can be presented in a table format, and also included in the
supplementary materials. Please provide the R² value for the factors tested. (5) The authors may
consider conducting further subgroup analyses based on factors such as the study region, follow-
up duration, and other relevant variables. (6) I do not believe the description of the funnel plot
for gastric cancer incidence as " notable symmetry " is correct. The P-value from the Egger test
also supports this.
4. Discussion section: (1) The first paragraph contains a significant amount of repetition from the
introduction. The first paragraph should focus on summarizing the results of the current study
and whether it contributes new insights compared to previous research. (2) The authors should
explore the reasons behind the meta-analysis results for the different outcomes and examine the
differences between the included studies to explain the current study’s findings. (3) The authors
should discuss the differences in results across the various subgroups (as described in the Results
section) in this part of the manuscript.