I read with a great interest the recently published article by Shiota et al. The article is well designed and has important outcomes on the relationship between H. pylori status and endoscopic findings in dyspeptic patients [1]. However, I think that this study has two limitations. The first is related to the lack of data on family history for the study population. In H. pylori infection, polymorphisms involving IL-1 are reported to be linked with duodenal ulcer disease in Japan [2]. The second limitation is related to the absence of the serological CagA status of the patients. The disease risk in CagA+ subjects may be different from the disease risk in CagA− ones. Accordingly, the CagA+ virulent strain may protect against the development of severe esophagitis [3, 4]. CagA serology is easy to perform, and may replace serology against H. pylori whole antigens in the future.