Review for 10.1186/s12876-020-01564-w (2020)

Reviewer’s report
Title: 
More fuel to the fire: Some patients with non-celiac self-reported wheat
sensitivity exhibit adaptive immunological responses in duodenal mucosa.
Version: 
0 
Date: 
31 Jul 2020
Reviewer's report:
The manuscript "More fuel to the fire: some patients with non-celiac gluten
sensitivity exhibit adaptive immunological response in duodenal mucosa" is a
research paper about histological feature of a still undefined clinical condition; it
is generally well written, the topic is relevant, but I have the following addressed
concerns.
Major:
My main concern in the manuscript is the definition of NCGS patients; as stated
by the authors these patients should be better defined as "self reporting wheat
intolerance", since no blinded gluten challenge has been performed. I agree with
authors that in clinical setting a double blind placebo controlled challenge is not
required, but in a research setting I think it is mandatory, especially when
histological features of this condition are addressed. My suggestion is to refer to
these patients not as NCGS patients, but as SRWI patients (Self-reporting wheat
intolerance). This suggestion should be applied in the title, abstract and text.
Minor:
Introduction section:
- Salerno Experts Criteria should be cited when reporting diagnosis of NCGS (in
the text the reference is in the discussion section);
- In the introduction more data about studies on histological feature of gluten
related disorders should be d presented (for example Zanini et al, Virchows Arch
2018, Kirmizi et al Virchow Arch 2018)
Methods Section:
- Please specify the time of the enrolment (at least months and years)
- For CD diagnosis please provide the commercial kit of serology test and their
range of normality or upper normal limit
- For diagnosis of NCGS (or better SRWI) please specify that duodenal biopsies
must be performed during gluten containing diet
- The six weeks challenge was performed in both CD patients and NCGS
patients: please clarify
- Brain fog: I suggest "foggy mind"
- Define how clinical data about extra-intestinal symptoms were collected (Y/N
questionnaire, Likert scale score?)
- If you declare that you did not perfor a DBPC challenge, you should better
specify why
- Patients with FD wee on a restrictive diet or not?
- In the section about histologic preparation, each procedure must be referenced
- In Statistics, some consideration about sample size should be provided.
Results section
- I prefer to avoid through this section any word that could be perceived as a
comment (while, noteworthy, however, ...)
- In 2 patients levels of AGA was >ULN; please report ULN
Discussion section
The section is well written and referenced
Conclusion section:
- The second sentence of this section is not in line with results and discussion
sections, I think that the authors should focus on histologic findings.
Table 2
- In the columns after the number of patients the rates in brackets are missing
(but in the title are mentioned)
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Declaration of competing interests
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes