Review for 10.1186/s12876-022-02245-6 (2022)

Title: PEPTIC ULCER DISEASE AMONG DYSPEPTIC PATIENTS AT ENDOSCOPY
UNIT, UNIVERSITY OF GONDAR HOSPITAL, NORTH WEST ETHIOPIA
Version: 1 Date: 26 Oct 2021
Reviewer's report:
Title
The title is expressed what the manuscript is about.
Abstract
Comments:
• While writing the microorganism name, authors should follow the scientific method of writing.
(H.pylori)
• While writing the adjusted odds ratio and confidence interval, you should indicate a 95%
confidence interval.
• It is not clear how the authors collected the associated factors-related data.
Q1 =It is not clear what clinical specimen was collected from the patients for the H. pylori test?
Authors should say something about the type of sample they collected, and it is better clearly
indicated in the method part of the abstract.
Q2 =Why do the authors want to use the consecutive sampling technique, which is a convent
sampling technique, to include study participants? This should be explained since the sample
collection lasted for about 6 months.
Background
Comments:
• The introduction part clearly summarized the current stats on the topic and the research
question at the end of the paragraph clear and appropriate. But it is very limited in discussing the
current problem with the associated factors, the H. pylori infection, and other possible diagnostic
problems.
• At the same time, the authors fail to discuss the presented topic in the available findings and
literature within the locality and country.
• The burden of PUD and H. pylori infection could be elaborated upon by the available
findings. Therefore, I highly recommend the authors include the following articles: https://
doi.org/10.1179/000349804225003190, https://doi.org/10.1186/s12876-018-0927-3, https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC6140150/ .
Methods
Comments:
• It would have been good if the authors give detailed information about the endoscopy unit at
University of Gondar hospital in the view of the average number of patients provides endoscopic
services for patients with gastrointestinal disorders per week or month or annually.
• The authors exclude those patients who have contraindication to endoscopy, this needs some
clarification and the authors should list all the contraindication to endoscopy.
• Data related to co-morbidities in the patient clinical characteristics should be listed clearly.
What are the co-morbidities?
• Sample size calculation: The sample size calculation using single population proportion formal
is good. But the proportion of PUD 15% taken by the authors may not be good, and it is not
scientifically sound.
• Sampling is clear, that authors used consecutive sampling method which is convenient
sampling. Perhaps authors should justify why they used consecutive sampling method?
• Data collection instrument and procedures, the endoscopy procedures need some detailed
information and separate subtitle “endoscopic examination” the authors should paraphrase this
part.
• The reference number 13 (Shimoyama T. Stool antigen tests for the management of
Helicobacter pylori infection. World J gastroenterol 2013; 19(5):8188-91) for the diagnosis of
H. pylori infection is not good reference. The authors should specifically write the kit they used
for the diagnosis of H. pylori infection, make reference for that rather than citing other work,
you should exactly write the type of kit, the name of the country and country of origin, and test
procedure.
• In definition of terms: no need of defining or list the endoscopy unit.
Results
Comments:
• In the results part, the authors presented findings only by percentage (%) without a number. It
is possible to include percentages in some points, but it is not always recommended. Therefore,
authors should revise accordingly.
• Is that 49% or 39.5% of dyspeptic patients used NSAIDs/ASA?
• The co-morbidity, it is not clear who many of the dyspeptic patients had cardiovascular
diseases, rheumatologic diseases, chronic airway diseases, and HIV infection? You should
clearly indicate both in number and percentage.
• The adjusted odds ratio (AOR) should be expressed with a 95% confidence interval (CI). I
really recommend the authors include the 95% CI for all AOR values.
• Generally, the way of presenting results is not in a good manner. This needs a very thorough
revision.
Discussion
Comments:
• For the comparison of H. pylori infection prevalence, you have to have the 95% CI. Without
having a 95% CI, all the discussion points will end up with the wrong interpretation. The authors
should include the 49% H. pylori infection prevalence in a 95% CI result and compare and
contrast based on the result. At that point, the authors could say it is low, high or similar.
• The discrepancy between the authors' results and those of others' gives a very broad
justification, like socio-economic status, environmental sanitation, living conditions, and
personal hygiene are not acceptable. I would like to invite the authors to give specific
justification for each of their specific studies.
• The strength and limitations of the study should be reconsidered. The prospective nature of the
study cannot be used as a strong part of the study.
• The conclusion and recommendations are not the implications of the findings for future
research.