Your findings show that gastric atrophy depletes microbial diversity even as H. pylori dominance persists. Should gastroenterologists consider atrophy stage when selecting eradication regimens? Could probiotics administered alongside or after eradication help restore beneficial diversity in patients with advanced atrophy?

Dr. Miftahussurur: A few studies have found that atrophy depletes H. pylori and makes room for other taxa to flourish, but in our dataset what happens is in reverse. This could be due to differences in the population dataset. Hence, if the H. pylori test is positive, eradication still needs to be carried out despite the atrophy stage. Probiotics have been known to improve eradication outcomes and ameliorate carcinogenesis signaling (https://doi.org/10.1186/s12929-025-01149-3, https://doi.org/10.1038/s41598-024-59399-4).

Your data revealed that Helicobacter correlates positively only with Veillonella, while Streptococcus correlates with multiple gastric taxa. Given Indonesia's paradoxically low gastric cancer rates despite high H. pylori prevalence, could specific co-colonizing bacteria serve as additional biomarkers for risk stratification alongside traditional virulence factors like CagA?

Dr. Miftahussurur: Yes, probably, but we would need more samples to confirm this biomarker possibility.

Prof. Muhammad Miftahussurur, MD, PhD
Universitas Airlangga Institute of Tropical Disease, Surabaya, Indonesia