Review for 10.1186/1471-230X-14-50 (2014)

Reviewer's report
Title:A retrospective study showing Maintenance treatment options for paediatric
CD in the first year following diagnosis after induction of remission with EEN:
supplemental enteral nutrition is better than nothing!
Version:2Date:5 November 2013
Reviewer: Andrew S. Day
Reviewer's report:
COMMENT FOR THE AUTHORS
The manuscript authored by Duncan and colleagues considers the impact of
ongoing supplementary enteral nutrition after a course of EEN in children with
Crohn disease
Overall Comment
This work provides further data supporting the practice of recommending
supplementary enteral nutrition as an ongoing intervention in children with CD.
The work is, however, limited by the numbers (n=15) that were taking these
ongoing supplements and the report’s retrospective nature
Specific Comments:
1. The Abstract and parts of the Manuscript contain several sentences that
commence with numbers (e.g. 15) rather than words (e.g. fifteen).
2. The Abstract reports that all of the 48 children were in remission at the end of
the 8 weeks course of EEN. Subsequently in the Results section, it is stated that
all of the 48 had either clinical response or in remission. This feature should be
consistent.
3. Further, did those who were in remission at 8 weeks have better outcomes
than those who just had improvements?
4. In providing the details of those who were in remission at 12 months, it is not
clear if these children had entered remission with initial therapy and then
remained in remission for the whole of the subsequent period, or if they had
achieved remission at some time point (e.g. 12 weeks) and then remained in
remission at 12 months or if they were simply in remission at 12 months
(regardless of initial response and any intervening relapses)
5. The Introduction comments about a lack of Classic Symptoms (which are
accepted as pain, diarrhoea and weight loss), and then goes on to describe
these being present. This should be revised to be more clear.
6. The Introduction comments about diagnostic delay: the final part of this section
implies that diagnostic delay is only important in adolescents. This could be
revised also
7. The Methods comments about “physicians global assessment” (the overall
assessment of an experienced paediatric gastroenterologist). This should be
referenced appropriately to an earlier description of PGA. This is not the method
utilised, then an alternative term should be used with appropriate reference also
applied.
8. The children who received ongoing supplements had these feeds for a
variable length of time (from 4 to 12 months). It would seem feasible that the
length of continuing feeds is important in longer term outcomes. Were the
authors able to define this?
9. Also, it appears that the assessment of outcome at 12 months is considered
regardless of the duration of supplementation. It may be helpful to consider a
formal review of this analysis by a statistician.
10. How were the authors able to confirm that the children were compliant with
the supplementary feeds? And that the volume reported was accurate?
11. NG and n-g are both used: one abbreviation should be used consistently
12. The Discussion would benefit from revision and attention to detail. Presently
it is a little disjointed. For example, the detail about adult studies of
supplementary feeds are separated by a paragraph discussing a different topic.
13. Also, the adult studies included patients who entered remission by different
routes (not all of them were treated with EEN first). This may of relevance to the
impact of this intervention
14. In addition to the outcome presented (remission), did the groups differ
otherwise? (such as growth outcomes, surgical outcomes etc)
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
'I declare that I have no competing interests'