Several aspects in study design need further consideration

We read with interest the work by Cheung et al1 describing that patients with prior Helicobacter pylori eradication therapy receiving long-term proton pump inhibitors (PPIs) therapy are still at enhanced risk of gastric cancer development, particularly for non-cardia cancer. As the current consensus report stated, long-term treatment with PPIs in H. pylori-positive patients accelerates the process of loss of specialised glands, leading to atrophic gastritis. Hence, it is recommended that eradication of H. pylori heals gastritis in patients receiving long-term PPIs.2–4 Nonetheless, in this article, the authors drew a relatively contrary conclusion. One hundred and fifty-three (0.24%) subjects included in the cohort developed gastric cancer after H. pylori eradication during the median follow-up of 7.6 years.1 We are curious about the initial gastric condition of these patients with cancer. Detailed data such as the number of subjects with chronic non-atrophic gastritis, atrophic gastritis...

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