Review for 10.1186/s12876-022-02370-2 (2022)

Reviewer’s report
Title: 
Severe Small Intestinal Bacterial Overgrowth Syndrome After Jejunal
Feeding Requiring Surgical Intervention: A Case Report and Review of the
Literature
Version: 
0 
Date: 
14 Apr 2022
Reviewer's report:
Very interesting case that is well detailed in your submission. 
I have a number of
minor comments detailed below. 
You must change the comments on breath
testing and antibiotic therapy for SIBO as some of what you have written is
incorrect as detailed by me below. 
I would strongly recommend including
postoperative ileus as I have suggested.
1. In Background section of the abstract. 
Bloating is the most common symptom,
so if you are going to report a single symptom associated with SIBO, I would use
only bloating. 
Your statement should instead be the following: 
…resulting in
vague gastrointestinal symptoms with bloating being most commonly reported
(as reported in the clinical guideline by the ACG (your second reference))
Background section:
1. Line 42. 
Change "where" to "in which" 
2. Line 44. 
If you are going to list the symptoms of SIBO, include nausea,
abdominal distention and constipation in this list
3. Lines 50-51. 
It is not lactose. It is glucose or lactulose. 
Also, breath testing is
an accepted testing modality for SIBO. 
It does have weaknesses with limited
sensitivity and specificity compared to small bowel aspirate and culture (which
by the way, has its own weaknesses as a test for SIBO). 
A better way to make
your statement is: Breath testing using carbohydrate substrate such as glucose or
lactulose provides an accepted alternative non-invasive testing for SIBO. 
I would
replace the sentence in line 50-51 with this sentence.
4. Line 53. 
Rifaximin is not the only antibiotic for the treatment of SIBO and the
optimal duration of therapy has also not been determined. 
Clinicians use 7-14
days of therapy. 
This reviewer uses 2 weeks of therapy. 
A more accurate
statement at line 52 should be: …when diagnosed, the cornerstone of treatment
consists of a course of antibiotic therapy directed at aerobic and anaerobic
enteric pathogens as SIBO is frequently due to a polymicrobial overgrowth.
Recommended antibiotics can include amoxicillin-clavulanic acid,
chlortetracycline, ciprofloxacin, doxycycline, metronidazole, neomycin,
norfloxacin, rifaximin, tetracycline, and trimethoprim-sulfamethoxazole. 
This
can replace the text from line 52-56 beginning with "when diagnosed" and
ending with "metronidazole". 
Discussion:
Line 128. 
I would also strongly suggest adding: 
"and/or a post-operative ileus"
after the words "gastric outlet obstruction" 
as it very possible that the patient
developed a post-operative ileus following instrumentation of her small bowel.
Conclusion:
Line 169. 
Replace conglomerate with a "variety of"
Line 170: 
"treatment" should be "treated"
Line 171 I would add and/or postoperative ileus after the word "obstruction"
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