We appreciate your insightful comments and thank you for sharing your recent publication in BMJ Open. This is an important addition to the literature, which demonstrated a decreasing trend in the prevalence of Helicobacter pylori in Japan in more recent years.1 In our systematic review, because of the inclusion of a large number of papers we have divided them into 2 time periods (1970-1999 and 2000-2016), which provided us with approximately one-half of all the papers in each time frame. It was challenging to provide more granular data by pooling prevalence over multiple shorter time periods owing to an insufficient number of publications for all the included countries.