Review for 10.1186/s12876-025-04074-9 (2025)

Title: Prevalence and Associated Risk Factors of Helicobacter pylori Infection among Medical
Students at Shendi University, Sudan
Version: 0 Date: 12 May 2025
Reviewer's report:
General comments:
The prevalence of H. pylori infection has wide variations worldwide. Africa has been indicated
to be the continent with the highest rate of this infection, presenting a prevalence of about 70%.
Moreover, it is a well-documented fact that the risk of infection increases with age, and the
prevalence increases in older individuals. However, most of the studies during the last decades
underlined a descending trend of H. pylori prevalence across geographical areas worldwide.
A possible explanation for this decrease might be related to the worldwide improvements
in socioeconomic status, but also to environmental and living conditions resulting in better
sanitation and decreased transmission over time. One of the main challenges related to H. pylori
prevalence is to diagnose the infection with high accuracy. Therefore, the differences in terms of
diagnostic tools might be responsible for the differences in H. pylori prevalence among different
areas of the world. In the present study, the authors investigated the prevalence of H. pylori
infection among 50 medical students at the Microbiology Lab, Faculty of Medical Laboratory
Sciences at Shendi University, Sudan, identify associated risk factors, and provide insights to
improve awareness and prevention strategies. To somewhat, the subject of this study fall within
the scope of the journal, however, there are several criticisms that hamper the publication of
the study.
Specific comments:
Abstract:
In subsection Material and Methods: What does the authors mean by "This is cross-sectional
study conducted during the period from January to May 2025". and "The higher rate of infected
showed in age group 22-23". The age and gender of medical students should be indicated. The
final conclusions did not include the risk factors associated with high prevalence of H. pylori
among medical students. Keywords are not appropriate and should include students and Sudan.
Introduction:
The information presented under this section is satisfactory, however, it lakes information on
the current burden of H. pylori infection in Sudan.
Materials and Methods:
The information presented under this section is ill described and should be clarified and rewritten
as paragraphs with special reference to detailed demographic data of study students and history
of H. pylori infection among study students under this section. The source address of kits should
be completely indicated. The study ethical approval code should be indicated.
Results:
The legends and quality of all tables are poor and should be improved. Moreover, Tables 3-11
could be merged in one table. How the authors determine the correlations between risk factors
and infection i.e. what was the statistical technique used to measure the degree of relationship
(Spearman or Pearson). The authors should also indicate whether obtained P values were one-
tailed or tow-tailed. Further statistical analyses of study data are required to improve and confirm
the study results.
Discussion:
The identification of major risk factors, might represent the cornerstone for effective and long-
term eradication of H. pylori infection. The authors tried to discuss their obtained data in the
light of some studies from different populations, however, they failed to discuss the lack of
association between H. pylori and some investigated risk factors. The authors diagnosed H.
pylori infection using the stool antigen test which is not reliable diagnostic test of H. pylori
infection. The current recommendations state that diagnosing active H. pylori infection should be
confirmed by at least two non-invasive tests e.g. serology, stool antigen immunoassay and PCR
taking into account the previous treatment for H. pylori infection. The authors should clarify how
they calculated the sample size of the study to evaluate the prevalence of H. pylori infection. The
lake of association between most of investigated risk factors and infection may due the small
sample size and homogeneity in age range of study sample.
References
The references are adequate and on the journal style except no. 11 and 14.
Minor Essential Revisions:
1. Some typos needs correction e.g. H. pylori should be written in italic along the whole text
of the manuscript.
2. The manuscript needs some revision of the English.