06142489

October 21, 2021, 06:23

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We read with great interest in the recent published article “Impact of Helicobacter pylori infection on gut microbiota” written by Iino et al [1]. In this minireview, the authors systematically summarized the effect of both Helicobacter pylori (Hp) infection and its targeted eradication therapy on gut microbiota according to existing researches so far. In additional, mechanism underlying Hp infection-induced gut microbiota alterations were also elucidated. From these researches, the authors concluded the variety of gut microbiota structure in the patients with Hp infection. In general, Anaerobes and Clostridia were mostly found to be decreased in the Hp infected population, while Lactobacillus acidophilus, Proteobacteria as well as the families of Succinivibrionaceae, Coriobacteriaceae, Enterococcaceae and Rikenellaceae were increased [2-7]. It’s well known that composition of gut microbiota may be affected by multiple factors such as age, body mass index, sex and so on. However, most existing researches till today failed to match the comparing population in these factors. The authors innovatively excluded the interference of these factors using propensity score matching, and found increased abundance of Haemophilusu, Streptococcus, Gemella and Actinomyces in Hp positive patients [8]. Therefore, the authors suggested it was crucial to adjust for biases to accurately evaluate the composition of the gut microbiota. We believed this adjustment would be a kind and useful reminder for the following studies. On the other hand, the relationship between Hp eradication therapy and gut microbiota has gained more attention in recent years. The authors also summarized the gut microbiota alterations after Hp eradication, and found the abundance of Proteobacteria, Enterobacteriaceae and Enterococcus was increased, while the Lactobacillus was decreased. This altered tendencies of gut microbiota were contrary to those of Hp positive patients. Specially, the authors emphasized this Hp eradication-induced microbial variation was temporary and could be maintained for a short time about half to two years. At some point, the composition of gut microbiota could be restored to baseline status [5,6]. Although gut microbiota merely changed transiently during the period of Hp eradication, the gut microbiota imbalance might be associated with successful eradication or side effects produced by eradicating therapy. We learned that some researchers supplied probiotics during Hp eradication and discovered it was helpful to reduce the side effects and improve the therapeutic efficacy [9]. Furthermore, the authors explored the mechanisms underlying Hp infection-induced gut microbiota alteration. The virulence factors of Hp, cytotoxin-associated gene A (CagA) and Vacuolating cytotoxin A (VacA), play an important role in changing gastric microbiota. Additionally, these factors were able to induced different immune phenotypes as well as the acidity in the stomach, and making a difference to the gut microbiota. In terms of Hp eradication, PPIs administration also changed acidity of stomach and antibiotics prescription was directly influential to the gut bacteria. We achieved a better understanding about the impact of Hp infection on gut microbiota after reading this review. With the help of the authors, composition variations of gut microbiota in the Hp infected patients were systematically summarized and the underlying mechanisms were also explored. Despite numerous studies have been conducted till today, most of them accompanied with bias and more convincing research results were required. References 1. Iino C, Shimoyama T. Impact of Helicobacter pylori infection on gut microbiota. World J Gastroenterol 2021; 27: 6224-6230 [DOI: 10.3748/wjg.v27.i37.6224] 2. Iino C, Shimoyama T, Chinda D, Arai T, Chiba D, Nakaji S, Fukuda S. Infection of Helicobacter pylori and Atrophic Gastritis Influence Lactobacillus in Gut Microbiota in a Japanese Population. Front Immunol 2018; 9: 712 [PMID: 29681906 DOI: 10.3389/fimmu.2018.00712] 3. Bühling A, Radun D, Müller WA, Malfertheiner P. Influence of anti-Helicobacter triple-therapy with metronidazole, omeprazole and clarithromycin on intestinal microflora. Aliment Pharmacol Ther 2001; 15: 1445-1452 [PMID: 11552917 DOI: 10.1046/j.1365-2036.2001.01033.x] 4. Myllyluoma E, Ahlroos T, Veijola L, Rautelin H, Tynkkynen S, Korpela R. Effects of anti- Helicobacter pylori treatment and probiotic supplementation on intestinal microbiota. Int J Antimicrob Agents 2007; 29: 66-72 [PMID: 17141481 DOI: 10.1016/j.ijantimicag.2006.08.034] 5. Chen L, Xu W, Lee A, He J, Huang B, Zheng W, Su T, Lai S, Long Y, Chu H, Chen Y, Wang L, Wang K, Si J, Chen S. The impact of Helicobacter pylori infection, eradication therapy and probiotic supplementation on gut microenvironment homeostasis: An open-label, randomized clinical trial. EBioMedicine 2018; 35: 87-96 [PMID: 30145102 DOI: 10.1016/j.ebiom.2018.08.028] 6. He C, Peng C, Wang H, Ouyang Y, Zhu Z, Shu X, Zhu Y, Lu N. The eradication of Helicobacter pylori restores rather than disturbs the gastrointestinal microbiota in asymptomatic young adults. Helicobacter 2019; 24: e12590 [PMID: 31124220 DOI: 10.1111/hel.12590] 7. Dash NR, Khoder G, Nada AM, Al Bataineh MT. Exploring the impact of Helicobacter pylori on gut microbiome composition. PLoS One 2019; 14: e0218274 [PMID: 31211818 DOI: 10.1371/journal.pone.0218274] 8. Iino C, Shimoyama T, Chinda D, Sakuraba H, Fukuda S, Nakaji S. Influence of Helicobacter pylori Infection and Atrophic Gastritis on the Gut Microbiota in a Japanese Population. Digestion 2020; 101: 422-432 [PMID: 31394526 DOI: 10.1159/000500634] 9. Shi X, Zhang J, Mo L, Shi J, Qin M, Huang X. Efficacy and safety of probiotics in eradicating Helicobacter pylori: A network meta-analysis. Medicine (Baltimore). 2019; 98: e 15180 [PMID: 30985706 DOI: 10.1097/MD.0000000000015180]

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03725277

October 17, 2021, 13:11

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The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories

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This is a good review.Infection with Helicobacter pylori(HP) alters the the abundance of gut microbiota. This paper mainly involves three aspects of changes, Hp negative, Hp positive, eradication of Hp after the short-term and long term changes in the gut microbiota. The mechanism of HP infection on gut microbiota is too simple and the mechanism research is not thorough enough. It would be nice to add pictures of chances in microbial diversity.

Thank you very much for your comments.