Review for 10.1186/s12876-024-03137-7 (2024)

Title: Peptic ulcer characteristics in oral opium and non-opium user patients with upper
gastrointestinal bleeding
Version: 1 Date: 19 Jun 2023
Reviewer:  Panagiotis Tsibouris
Reviewer's report:
In the introductory section authors should concentrate on ulcer bleeding as this is their main
point of interest. Moreover they should differentiate between opium and opiates like morfine
mentioned in the refference mentioned. The authors should have received approval from the
ethics commitee of their institution and their study  should be in accordance to the Helsinki
Declaration. This should be stated The number of patients presented in each group during the
study period should be stated. Bibliographic assumptions to calculate the power of  the study
should be provided otherwise a control study for this calculation should be mentioned. Exclusion
of patients receiving PPIs could have influenced the final result Thus the two groups should be
balanced on this parameter and these numbers should be provided. Using CLO-test to identify
H. pylori infection could have missed  some patients with H. pylori infection Moreover some
patients could have had false positive result due to the acute fase of bleeding and this should
be stated It is not clear if biopsies had been taken to exclude malignancy and If so why the
authors have selected CLO-test instead of histology, unless CLO-test was additional method for
H. pylori identification.  Because drug addicts usually suffer from chronic liver diseases usually
viral hepatitis I cannot see why non cirrhotic patients with viral hepatititis should be excluded.
How patients have verified NSAIDs/aspirin use because it is an exclusion criterion. After all
it would be interesting to know how NSAIDs interact with opiodes Alcohol is not mentioned
in the study; I suppose that it is illegal in the authors country but that does not exclude its use
Nevertheless smoking is a know risk factor for peptic ulcers and GERD Thus smoking habits
should be reported and smoking is usually more frequent between drug addicts. Ischemic heart
disease and medication causing ischemia are not mention They can affect mucosa vulnerability
to noxious factors. Because study groups are not balanced a logistic regression analysis or other
mutivariate analysis is needed p values should provided in Tables for each row of the table. It
is better to provided 2X2 tables to better highlighted differences. Actually Chi-square is mainly
made for those tables Nevertheless it could be appried in 2X3 tables but then p calculation is
more difficult. In the text only the mai findings should be repeated.  Anxiety and depression
are usually more frequent among drug users But in case of study patients it is not clear if their
psychological profil is different. Actually anxienty can increase mucosa vulnerability  The only
site were actually ulcers were more frequent was the esophagus It is noteworthy to localise them
since the authors mention that opiodes exacerbate GERD In the discussion they should explain
why ulcers were not more probable in the stomach and the duodenum There it should be useful
to sum up all gastric ulcers Discussion about NSAIDs-opioids interpaly is irrelevant because
those patients have been excluded Opiod effect on hormonal profil of the stomach should be
supported otherwise this part of discussion should be omitted The authors should explain why
although ulcers in the stomach and duodenum are not more frequent they tend to be larger There
the reference about pain suppresion has its place