Review for 10.1186/s12876-025-03806-1 (2025)

Title: Epidemiological Status of Family-Based Helicobacter pylori Infection in Yunnan
Province, China
Version: 2 Date: 28 Jan 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the introduction highlights the significance of H. pylori infection in China, a deeper
dive into the specific socio-cultural and environmental factors of Yunnan Province that could
influence transmission would be beneficial. For example, the region's dietary habits, sanitation
practices, and healthcare access could play a critical role in the transmission dynamics of H.
pylori.
-A brief explanation of why Yunnan was chosen, aside from its geographic and ethnic diversity,
would help readers understand its relevance to the broader national context.
The methodology mentions "convenience sampling" as a potential source of bias. While this
is acknowledged, it would be helpful to explain what steps were taken to minimize bias or if
any adjustments were made to compensate for this limitation. Given that convenience sampling
can lead to skewed results, elaborating on how this was handled could increase the credibility
of the study.
-The introduction of two different types of H. pylori tests (urea [14C] and [13C] breath tests)
is informative, but the methodology could clarify whether these two tests are being used for
different purposes (e.g., one for confirmation and the other for initial screening). If both tests
were used for the same purpose, some justification of why both were included could be provided.
-The study mentions the use of logistic regression to assess risk factors, but there is no discussion
on potential confounders. Given the wide range of variables (e.g., demographic, socioeconomic,
and behavioral factors), it would be valuable to briefly mention how potential confounding
variables (e.g., underlying health conditions or variations in healthcare access) are controlled
for in the analysis.
-While the study mentions that families with higher socio-economic status have lower H.
pylori infection rates, this point could be explored more deeply. For instance, how do income,
education, and living conditions interact to affect infection rates? Do higher education and
better living conditions directly translate into improved health behaviors (e.g., hygiene practices,
seeking medical attention)? A more nuanced discussion of how socio-economic factors impact
infection rates could provide a richer understanding of the data.
-There are a few instances where findings from this study seem to contradict previous studies.
For example, the discussion mentions that previous studies have found eating out to be a
risk factor for H. pylori infection, but this study found the opposite—those who ate out more
frequently had a lower infection rate. This discrepancy is intriguing and should be discussed
further. Is this due to changes in restaurant hygiene practices, improved sterilization techniques,
or a different cultural understanding of "eating out" in Yunnan? It would be helpful to explore
why the results deviate from expectations, especially if the findings might have public health
implications.
-The discussion briefly touches on the role of hygiene practices (e.g., the use of communal
chopsticks and utensils), but it could benefit from a more in-depth exploration of how specific
hygiene behaviors contribute to infection rates. For example, do families with more rigorous
hygiene practices (e.g., washing hands more frequently, sterilizing utensils) show significantly
lower infection rates? Are there regional differences in how these practices are implemented,
and how might public health campaigns better address these behaviors?