Review for 10.1186/s12876-022-02125-z (2022)

Title: Factors affecting the use of herbal products in patients with Irritable Bowel Syndrome
and their results; case-control study
Version: 3 Date: 20 Mar 2021
Reviewer:  Ernst Fredericks
Reviewer's report:
Thank you for the opportunity to review this manuscript titled: Factors affecting the use of herbal
products in patients with Irritable Bowel Syndrome and their results; case-control study
General comments:
1. Cannot recommend the publication of this manuscript without significant corrections.
2. The language use in this manuscript is generally poor and some meaning is lost through this.
3. There is a poor correlation between the aims and objectives of the study and the discussion
of the results.
4. It should be made clear that only 40% of patients seeks herbal remedies as a source for
symptom relief and only <10% of these uses it regularly.
5. The conclusion is incongruent to the findings (results) discussed in the study.
Specific comments:
Abstract:
Methods:
‘We asked the patients survey questions…’ This can be reworked to include following
categories: demographic detail, social and educational standing, socioeconomic status etc.
It will be useful to list the herbal products (main ingredient), the intended purpose of their use
and whether they brought relief, in addition to who recommended them.
Results:
Clarify from the outset that only 40% of total population used herbal products.
‘While the use of herbal herbs and oils…’ The difference between herbal herbs and oils vs
traditional treatments and mixtures is not clear. Please clarify.
‘It was determined that those who received herbal treatments mostly lived in city centers…’ It
is not clear whether these patients constituted the OTC group or the GP prescription group.
Conclusion:
The notion that more education should target the GP group is erroneous and incongruent with
results shown that patients visiting their GP receive correct advice.
Manuscript:
Introduction:
‘The disease is 2 times more common…’ Easier to state: The disease is twice as common in
women than men…
Next sentence should probably read: High socioeconomic status and modern living…
Sentence starting with ‘Patients frequently use alternative and complimentary treatments…
should be amended ….chronic nature of symptoms, inadequate treatment response and
medication side-effects.
Materials and Methods:
In the first sentence starting with: In this study…’ remove the words ‘training and research’ and
replace with hospital name or tertiary referral.
The next sentence starting with: ‘Among these patients, whose complaints…’is longwinded and
confusing. Remove 248 and add ‘who fulfilled ROME IV criteria. Can leave rest out.
Add statistical analysis as separate sub-heading.
Results:
Again, make clear that only 40% used herbal remedies and majority and 87% used it
infrequently.
The sentence: ‘It was found that IBS was significantly more common in women with low
education than men’. This implies all men or a certain group – please make clear.
Again, it will be useful to categorize patients into reason for herbal use and symptom relief
obtained, if at all. For instance, for constipation or bloating etc, what herbal remedy they used
and whether they obtained relief.
Not entire sure what this sentence means: ‘There was no relationship between the men and
women in terms of the use of herbal therapy’. Please clarify.
What does the following sentence imply? ‘Patients who received medical treatment used herbal
therapy more than the others’. The results showed patients who consult their family doctor are
less likely to use herbal remedies.
‘In the current study, patients who received medical treatment, lived in city centers, and had a
relatively high socioeconomic and cultural level tended to receive herbal therapy. Contradictory,
more women with low socioeconomic status.
‘As in the world, most of the patients participating in the study herein tended to use herbs and
traditional methods’. Only 40%.
The next sentence starting: ‘It was also seen herein that many factors, ….affected the benefit
obtained by herbal products.  Was the benefit positive or negative?
Conclusion:
The conclusion is incongruent with the body of the manuscript and the stated results.
Table 2: Bowel habit is listed as  Diarrhoea    85
Constipation   157
Constipation and Diarrhoea 58
Total    300
However, only 248 patients in total!
Tables 5 and 6: the numeric value and % is not distinct creating confusion. Please put (%).