JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/s12876-025-04216-z (2025)

Title: The Short-term Effect of Laparoscopic Sleeve Gastrectomy with His Angle
Reconstruction (LSG-His) on Gastroesophageal Reflux Disease
Version: 2 Date: 25 May 2025
Reviewer:  Mohamed Ibrahim
Reviewer's report:
• This study examines the effectiveness of Laparoscopic Sleeve Gastrectomy with His angle
reconstruction in comparison to conventional LSG in mitigating postoperative Gastroesophageal
Reflux Disease and enhancing weight loss. Although the subject is pertinent, several
methodological shortcomings limit the reliability and broader applicability of the results.
• GERD symptom evaluation is based solely on subjective questionnaires (RD-Q and GERD-Q),
without incorporating objective diagnostic tools such as 24-hour pH monitoring or esophageal
manometry. Relying on subjective measures introduces potential bias and may not accurately
capture the physiological changes following surgery.
• The lack of intraoperative photographs represents a significant limitation. Visual
documentation would offer clearer insights into the specific surgical steps of the LSG-His
technique, particularly regarding suture placement and the extent of angle reconstruction. In
the absence of such images, evaluating the precision and consistency of the procedure across
patients becomes challenging.
• The study notes that patients chose their surgical procedure voluntarily, which introduces
potential selection bias. Individuals opting for LSG-His may differ in their baseline
characteristics or expectations compared to those selecting standard LSG, potentially
influencing the outcomes.
• The study does not sufficiently address selection bias. Notably, GERD morbidity appears to be
the most influential factor affecting sample size, further limiting the robustness of the findings.
• Consequently, the study’s conclusions should be interpreted with caution. Future research
should involve well-designed, multi-center randomized controlled trials with objective GERD
assessments and extended follow-up periods to validate the findings.
Review for 10.1186/s12876-025-04216-z (2025)

Title: The Short-term Effect of Laparoscopic Sleeve Gastrectomy with His Angle
Reconstruction (LSG-His) on Gastroesophageal Reflux Disease
Version: 4 Date: 20 Jun 2025
Reviewer:  Komol Chaivanijchaya
Reviewer's report:
The manuscript is generally well-structured, the methodology is clearly described, and the
findings are of interest to the surgical and bariatric community.
However, several issues require clarification or further elaboration to strengthen the manuscript
Here are my comments.
1. Study Design and Clarity
The manuscript is described as a "cohort study" and “observational study,” but it would be
helpful to clarify whether the study was retrospective or prospective. While data collection
appears retrospective, the surgical procedures and follow-up seem prospective. Please clarify
the study design explicitly.
2. Patient Allocation and Selection Bias
As patients self-selected the procedure type after discussion with surgeons, this introduces
potential selection bias. Please elaborate more on how this bias was addressed or minimized
(e.g., was propensity score matching considered?).
3. Definition of GERD Outcomes
The study relies solely on subjective questionnaire scores (GERD-Q and RD-Q) for reflux
evaluation. While this is acceptable in early-phase studies, the absence of objective measures
like 24-hour pH monitoring or endoscopy for all patients limits the strength of conclusions.
Consider acknowledging this as a more prominent limitation.
4. Innovation and Clinical Relevance
The concept of angle of His reconstruction is compelling, yet the novelty should be more clearly
emphasized. Consider citing whether similar techniques have been trialed previously in bariatric
surgery, and how LSG-His is technically and conceptually distinct from fundoplication or hiatal
hernia repair.
Review for 10.1186/s12876-025-04216-z (2025)

Title: The Short-term Effect of Laparoscopic Sleeve Gastrectomy with His Angle
Reconstruction (LSG-His) on Gastroesophageal Reflux Disease
Version: 4 Date: 22 Jun 2025
Reviewer:  Bradley Schwack
Reviewer's report:
I commend you on an well thought of manuscript--from hypothesis through conclusion I think
this revised manuscript I read is well done.
The uploaded MS Word document of your manuscript (in the editing mode) has been attached to
this review.  On it are mainly (in red) syntax/grammar/style edits as well as particular comments/
suggestions of note.
1. On the upper right of your Word window choose for “Editing”-- editing or reviewing.
2. To the left of the Editing button, please click on “Comments” so my comments appear in the
right margin (associated with the comment bubble icon in the part of the text of your manuscript
to which that comment is referring).
3.  In the Word window, Click on  “Review” which will avail the editing tools—suggest selecting
“Reviewing” to summarize my edits on the R margin and select Tracking (follow all) and  “all
markup” to assure seeing my edits in red.
Should you have any issues accessing the edits or comments or have any questions contact me
(or contact the journal) and we can sort it out.
Aside form the small syntactical and grammatical changes I suggest (please see that attachment),
I do not see any need for any major things to revamp.
This angle of his modification is something that will be verynew to many of the readers--I know
what i read was a 2nd draft after inital review--and I wouldn't require it-but I think the paper
wouldbenefit froma little bit more of a discussion of the recent history of such modifications
in the recent literature (perhaps enhancing your introduction section).  But overall, paper works
and I think it's a job well done.
Thank you very much.
Good luck.
Review for 10.1186/s12876-025-04216-z (2025)

Title: The Short-term Effect of Laparoscopic Sleeve Gastrectomy with His Angle
Reconstruction (LSG-His) on Gastroesophageal Reflux Disease
Version: 7 Date: 30 Jul 2025
Reviewer's report:
thanks for inviting me to review this interesting manuscript. The manuscript discusses the
concept of His angle reconstruction during sleeve gastrectomy.
In its current form, this manuscript is very well written and suitable for publication
Review for 10.1186/s12876-025-03978-w (2025)

Title: Hypoxia-induced exosomal circNRIP1 activates cancer-associated fibroblasts to promote
esophageal squamous cell carcinoma migration and invasion
Version: 2 Date: 15 Mar 2025
Reviewer:  Mohamed H. Zidan
Reviewer's report:
Dear Authors,
Re: "Hypoxia-induced exosomal circNRIP1 activates cancer-associated fibroblasts to promote
esophageal squamous cell carcinoma progression"
I would like to commend the authors on their study exploring the role of hypoxia-induced
exosomal circNRIP1 in the activation of cancer-associated fibroblasts (CAFs) and its impact
on esophageal squamous cell carcinoma (ESCC) progression. This study provides valuable
mechanistic insights into tumor-stroma interactions and highlights a potential therapeutic target
for ESCC. The integration of in vitro experiments, molecular analyses, and bioinformatics
predictions adds depth to the findings.
the study is well-structured and methodologically sound, and i find no comments to state
Sincerely,
Review for 10.1186/s12876-025-03978-w (2025)

Title: Hypoxia-induced exosomal circNRIP1 activates cancer-associated fibroblasts to promote
esophageal squamous cell carcinoma migration and invasion
Version: 3 Date: 01 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
the responses are satisfactory
Review for 10.1186/s12876-025-04148-8 (2025)

Title: An updated systematic review and meta-analysis: Correlation between circulating
Plasminogen Activator Inhibitor-1 levels and Metabolic Dysfunction-Associated Steatotic Liver
Disease
Version: 1 Date: 01 Mar 2025
Reviewer's report:
1. Experts renamed NAFLD as ‘metabolic-associated fatty liver disease’ (MAFLD) because
it with obesity, type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) are closely
related.
If you are using the updated terminology, please also mention MASLD along with MAFLD,
which is actually, the globally accepted name and not MAFLD.
2. The authors have included patients with MAFLD. The authors must clarify what exact
proportion of these patients have history of alcohol intake. According to the MASLD definition,
there is a term called ‘MetALD’. This is important because there is a fundamental difference
between NAFLD and MAFLD/MASLD. MAFLD/MASLD include patients who consume
alcohol. There is a strong relationship between alcohol intake and PAI-1 levels (Liu, S., Xie,
X., Zhao, D. et al. Alcohol use disorder disrupts BDNF maturation via the PAI-1 pathway
which could be reversible with abstinence. Sci Rep 14, 22150 (2024). https://doi.org/10.1038/
s41598-024-73347-2). This issue must be addressed because whether PAI-1 levels are affected
by mere steatosis/steatohepatitis or by concurrent alcohol intake needs to be better investigated.
3. The authors would do well to find out any association between different categories of NAFLD
(steatosis/steatohepatitis/fibrosis/advanced CLD) and their association with PAI-1 levels. This
would provide more clarity.
4. The studies included are observational studies.  Based on this, it would be erroneous to
conclude that “PAI-1 levels were strongly related to MAFLD development.” This is because
no causal association can be established. Increased PAI-1 may be an antecedent or may be a
subsequent development of NAFLD development. There can be many confounders itself like
diabetes, metabolic syndrome, dyslipidemia which can influence the circulating PAI-1 levels.
5. The authors should mention if there were any lean subjects with NAFLD. If so, what was the
level of expression of PAI-1 in them? This would help us understand the dynamics of PAI-1
expression in NAFLD better.
Review for 10.1186/s12876-025-04148-8 (2025)

Title: An updated systematic review and meta-analysis: Correlation between circulating
Plasminogen Activator Inhibitor-1 levels and Metabolic Dysfunction-Associated Steatotic Liver
Disease
Version: 1 Date: 06 Mar 2025
Reviewer:  Bryan Adrian Priego-Parra
Reviewer's report:
Thank you for inviting me to review this manuscript, in which the authors conducted a systematic
review and meta-analysis to evaluate the correlation between plasminogen and MAFLD. They
found that plasminogen levels in MAFLD are elevated compared to control individuals.
The study is well-designed, registered with the NIH, and correctly followed the PROSPERO
protocol, the GRADE system, and PRISMA guidelines. It is an interesting, well-written article,
though I have some suggestions to consider, listed below:
General Comments:
1. Statistical notation: Use lowercase "p" for statistical p-values in both the text and figures.
2. Introduction: Before discussing plasminogen, briefly introduce the diagnosis of MAFLD.
Address the limitations of liver biopsy as the gold standard for MAFLD (e.g., invasiveness,
sampling variability, cost) to provide context for readers unfamiliar with the field. Emphasize
the need to explore new biomarkers.
Specific Edits:
• Line 153: Replace "gender" with "sex."
• Line 211: Add a space after "respectively."
• Line 294: Insert the appropriate citation immediately after "Alsharoh et al."
Discussion Section Additions:
1. Discuss sex- and ethnicity-related differences in the diagnostic performance of biomarkers
for NAFLD/MAFLD/MASLD. Consider citing:
o PMIDs: 38760802, 30924946, 38809396, 38901566, 39980852, 40035953, 40029148.
Additional Suggestions:
• Did the authors perform a sex-based analysis? If so, include it; if not, mention this as a
limitation.
Thank you again for the invitation to review this work.
Review for 10.1186/s12876-025-04208-z (2025)

Title: Efficacy and Safety of Reduced Thromboprophylaxis with Low Molecular Weight
Heparin for Hepatocellular Carcinoma after conversion therapy
Version: 1 Date: 08 Jul 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-04124-2 (2025)

Title: The Prognostic Value of Indoleamine 2,3-dioxygenase in Colorectal Cancer: A
Systematic Review and Meta-analysis
Version: 0 Date: 28 Apr 2025
Reviewer's report:
Comments to Authors
This manuscript presents a systematic review and meta-analysis evaluating the prognostic
significance of IDO expression in colorectal cancer (CRC). The topic is important and the study
is generally well-structured; however, a few areas would benefit from clarification and further
elaboration to strengthen the manuscript. We respectfully suggest addressing the following
points.
1. In the Abstract, the number of included patients is reported as 2,174, while in the Results
section (3.1) it is stated as 2,334. Additionally, Table 1 presents two studies by Julia Schollbach
with identical sample sizes and characteristics, which may suggest possible overlap. It would
be helpful if the authors could clarify the total number of participants and confirm whether any
overlapping datasets were included, to ensure transparency and avoid potential bias.
2. There appears to be some inconsistency regarding the interpretation of HR values in the
manuscript. In certain sections, HR < 1 is associated with poorer prognosis, while elsewhere,
HR > 1 is interpreted as unfavorable. We recommend clearly defining the interpretation of HRs
in the Methods section and applying this consistently throughout the text, which would enhance
clarity for readers.
3. Although significant heterogeneity (I² > 80%) was observed, only subgroup analyses were
conducted to explore its sources. The authors may wish to consider discussing why meta-
regression analysis was not pursued and whether factors such as geographic region, detection
method, or sample size might account for some of the observed variability. This additional
discussion could further strengthen the robustness of the findings.
4. In the Discussion section, the manuscript suggests that elevated IDO expression may be
associated with improved prognosis via immune modulation. However, the meta-analysis
findings indicate an association between high IDO levels and worse DFS and metastasis. It
would be helpful if the authors could more clearly reconcile these points, perhaps by discussing
potential context-dependent effects of IDO in CRC progression.
Review for 10.1186/s12876-025-04180-8 (2025)

Title: Association between gastrointestinal disorders and sleep-related problems: the mediating
effect of depression
Version: 3 Date: 05 Jun 2025
Reviewer's report:
I would like to thank the Editor for inviting me for the review of the presented study.
Generally, the punctuation in the whole manuscript is untidy.
Abstract:
The objective of the study is twice emphasized and it is not precise enough. Additionally, the
external link to the survey is not necessary.
There is a lack of explanation of which sleep disorders were studied. Or in methods there was
no indication about which sleep disorders embraced survey - more sleep-disorder breathing or
parasomnias?
PIR is not commonly known abbreviation such as DNA - please extend the PIR shortcut
It is a first impression for readers that over 19000 patients were diagnosed with gastrointestinal
disorders - but in the result section only 8% of those had gastrointestinal disorders. Please
improve it.
Introduction:
Again, there is a lack of an aim to study. And there is no explanation why this study was
conducted.
Methods:
It is a serious limitation of presented work because gastrointestinal diseases were diagnosed by
one single question - there is a possibility of bias
Again, sleep disorders were not diagnosed - it is a serious risk of bias. Maybe the term "sleep
disorder" is not suitable for this study, maybe more "sleep disturbances" or "sleep problems"
are better terms.
Forrest plot is not opening in the Word document.
Discussion:
Authors discussed the results by showing an association between particular gastrointestinal
disorders and sleep disorders, but they have not specified the above disorders in their work.
Discussion not fully addressed the main objective of this study. Discussion is short-length.
Review for 10.1186/s12876-025-04180-8 (2025)

Title: Association between gastrointestinal disorders and sleep-related problems: the mediating
effect of depression
Version: 5 Date: 07 Jul 2025
Reviewer's report:
Dear Authors,
Thank you for your thoughtful and detailed revision. I appreciate your efforts to address each
point raised in the previous review. Your updated manuscript shows substantial improvement
in clarity, statistical transparency, and methodological rigor.
Most major concerns, including the use of appropriate survey weights, mediation analysis
clarity, and avoidance of causal language, have been satisfactorily addressed. However, a few
minor issues remain that should be revised before the manuscript is ready for acceptance:
Causal Wording: While most causal expressions have been corrected, terms such as “higher
risk” or “effect” still appear in the Abstract and Discussion. To reflect the cross-sectional design,
please consistently use terms like “elevated odds” or “association” instead.
GI and Sleep Variable Limitations: The limitation of using single-item questions to capture
GI disorders and sleep disturbances should be stated more explicitly in both the Methods
and Discussion sections. For example, mention that “functional and organic GI conditions are
combined” and that sleep apnea could not be separately assessed due to data constraints.
Unmeasured Confounders: Please include a brief sentence noting that factors such as obstructive
sleep apnea, chronic pain, and hypnotic medication use could not be adjusted for due to missing
or inconsistent data in NHANES.
Table 1 Structure: Consider reorganizing Table 1 with subheadings (e.g., Demographics,
Lifestyle, Comorbidities) and moving the full version to the Supplementary Material while
presenting a concise version in the main text.
Figure Quality: Ensure that high-resolution SVG files are submitted for Figures 2 and 3. Figure
3 should include clearly visible path coefficients.
Formatting Details: Please double-check formatting consistency for statistical values (e.g., “95%
CI”), and confirm that the corresponding author’s phone number is in international format (e.g.,
“+86-…”).
These remaining revisions are minor and can be implemented without additional analyses. Once
completed, the manuscript will be suitable for publication.
Thank you again for your contributions to this important topic.
Best regards,
Review for 10.1186/s12876-025-04180-8 (2025)

Title: Association between gastrointestinal disorders and sleep-related problems: the mediating
effect of depression
Version: 6 Date: 16 Jul 2025
Reviewer's report:
Thank you for your thoughtful and comprehensive revisions. I appreciate the clear and
constructive manner in which you addressed all reviewer comments.
The modifications made to terminology—particularly the consistent use of terms like
"association" and "increased probability" to reflect the cross-sectional study design—are
appropriate and enhance the manuscript’s clarity.
The added clarifications regarding gastrointestinal and sleep variable limitations are well-
articulated and meet the expectations for transparency in methodology and discussion. The
inclusion of unmeasured confounders, such as sleep apnea and chronic pain, strengthens the
study's acknowledgment of its limitations.
The reorganization of Table 1 with subheadings and the provision of a concise version in the
main text, along with high-quality figure files, significantly improves the overall readability and
presentation.
Additionally, the adjustments to formatting consistency and contact information are
appropriately handled.
Overall, the manuscript is much improved and now meets the standards required for publication.
I commend the authors for their diligence in responding to feedback and improving the
manuscript.
No further revisions are necessary.
Review for 10.1186/s12876-025-04193-3 (2025)

Title: Gluten-Free Diet Adherence Patterns and Health Outcomes in Celiac Disease: A
Retrospective Observational Study
Version: 1 Date: 22 May 2025
Reviewer's report:
The reviewer considers it to be a very interesting topic, but thinks that the biography should be
enriched with current citations and more citations.
Review for 10.1186/s12876-025-04193-3 (2025)

Title: Gluten-Free Diet Adherence Patterns and Health Outcomes in Celiac Disease: A
Retrospective Observational Study
Version: 1 Date: 27 May 2025
Reviewer's report:
Assessment:
1. Spelling mistake in background section of abstract [thier# their].
2. In methods section of article, this sentence may be rephrased to clearly understand that two
time points were asked in the same questionnaire applied once to the patient. [The questionnaire
included a broad array of clinical and demographic questions assessed at two time points:
initially, at the time of disease diagnosis, and recently during the study.]
3. What is ‘gripes’ in the figure 2? It may be considered to merge similar meaning symptoms
which the patient might had difficulty in answering, like abdominal pain and cramps; gas feeling
and bloating.
4. The response in infertility is same with all the duration category. This requires explanation
and further literature support. This is a very good finding that even short duration can cause
marked improvement in infertility. However, fallacy is the what was the cause of infertility
at the baseline? It can be mentioned that it was not assessed if not done. The same applies to
abortion also.
5. The changes in blood parameters lacks a clear explanation. Why did Ca, MCV and Hb fall
in follow up? Were these patients not on strict GFD or were relying only on GFD for nutrients?
Can this be concluded that GFD is nutritionally depleted diet and should also require drug
supplementations?
6. Were the participants taking any medications related to comorbidities, haematinics and
calcium/ vit D supplements?
7. How was the number of comorbidities and their change assessed over time? How system
related comorbidities assessed? Were these a speculation from the blood results and symptoms?
Overall, the study has assessed an important aspect of celiac disease management, that is the
change in individual parameters with GFD adherence and time duration. Further prospective
studies can be done to assess similar parameters after overcoming confounders and limitations
of this study.
Review for 10.1186/s12876-025-04193-3 (2025)

Title: Gluten-Free Diet Adherence Patterns and Health Outcomes in Celiac Disease: A
Retrospective Observational Study
Version: 1 Date: 28 May 2025
Reviewer's report:
The whole work seems to be extremely interesting and contributes a lot to the development of
research on celiac disease and its treatment. The comments are only intended to slightly improve
the excellently prepared work.
Review for 10.1186/s12876-025-04193-3 (2025)

Title: Gluten-Free Diet Adherence Patterns and Health Outcomes in Celiac Disease: A
Retrospective Observational Study
Version: 1 Date: 05 Jun 2025
Reviewer's report:
Minor revision – The manuscript is well-structured and valuable. It merits publication after
minor language editing and refinement of phrasing in a few areas for greater clarity and academic
tone.
The manuscript is largely readable and clear, but a light language polish is needed. Some
examples:
“they generally stated that the difficulty in following the prescribed diet was the primary
reason…” # consider: “most participants cited dietary difficulty as the main barrier…”
“after a while of adhering” # consider rephrasing to “after an initial period of adherence”
Terms like “mediate” instead of “moderate” for COVID-19 severity (Table 3) should be
corrected.
Use either “GFD” or “gluten-free diet” consistently when first introduced.
Tables include some repetition in variable labeling (e.g., Table 2 – “do not adherence” # “no
adherence”).
Worthy of publication after minor revision.
The study is methodologically sound, relevant, and thoughtfully discussed. With light language
corrections and a few technical clarifications, it will be a strong contribution to literature on
celiac disease management.
Review for 10.1186/s12876-025-04193-3 (2025)

Title: Gluten-Free Diet Adherence Patterns and Health Outcomes in Celiac Disease: A
Retrospective Observational Study
Version: 2 Date: 13 Jul 2025
Reviewer's report:
As I mentioned in my previous review, the presented work provides exceptionally important
information on the impact of the duration of a gluten-free diet on patient health. Now, after
the corrections, it is clear that despite the duration of gluten-free diet use, patients experience
symptoms that may be related to celiac disease. In my opinion, the changes made to the article
are sufficient and do not require further revisions.
Review for 10.1186/s12876-025-04193-3 (2025)

Title: Gluten-Free Diet Adherence Patterns and Health Outcomes in Celiac Disease: A
Retrospective Observational Study
Version: 2 Date: 15 Jul 2025
Reviewer's report:
Thank you for addressing the comments from the previous review. I believe you have considered
all my suggestions and made modifications and additions wherever possible.
For this reason, I consider the revised manuscript to be in good shape.
Best regards,
Reviewer 1
Review for 10.1186/s12876-025-04213-2 (2025)

Title: Insights from age-stratified endoscopic detection metrics support initiating colorectal
cancer screening at age 45
Version: 3 Date: 14 Mar 2025
Reviewer's report:
This is a study that analyze adenoma detection rate between age 45-49.  This is an important
study to understand prevalence of polyps/precancerous lesions any younger population.  I have
several comments.
1) I think this can be presented as a brief report rather than a full original article.  It can
be rewritten to make it concise and appears to have redundancy.  Many sentences can be
summarized succinctly.  There appeared to his be multiple reputations.
2) Please provide the screening guidelines used in Israel.  Do patients start colonoscopy
screening/colon cancer screening by age 45?  When was this criterion changed, and provide
further details.
3) The inclusion criteria are not very clear.  It appears that more than 200,000 patients underwent
colonoscopy between the ages 45-49 between the year 2016 to 2022.  Looks like patients
with positive family history of cancer or polyps were excluded.  Who were these patients who
qualified for colonoscopy if they were not for screening or diagnostic purposes?
4) Please add recent references from cohort studies from United States that that have looked at
adenoma detection rate between age 45-49 (Aasma Shaukat's study)
5) It is unclear how the pathology of adenomas was assessed.  Where the text-based search used
or they were manually reviewed?  Page 12, last paragraph is not clear.  Where only 24% of cases
reviewed and found to have adenomas in ages 45-49 ?  If it is not done based on the text search,
unclear if we can say what was the true ADR in this cohort.
6) I would remove reference 48 as this is an abstract and not a full original article that has been
published in a peer-reviewed journal.
Review for 10.1186/s12876-025-04085-6 (2025)

Title: Mesenteric Fat Proliferation on Magnetic Resonance Enterography Is a Predictor of Long-
Term Disease Complications in Crohn’s Disease
Version: 4 Date: 19 May 2025
Reviewer's report:
Koifman et al. sought to identify if mesenteric fat proliferation on MR enterography is a
predictor of complications in Crohn’s disease, particularly hospital admissions and surgery. In a
retrospective fashion, they studied 175 patients who had undergone MRE and had GI follow up
in clinic. They found that the presence of mesenteric fat proliferation on MRE was associated
with an increase in hospitalizations and surgery on both univariate and multivariate analysis.
Strengths:
- Size of the study
- The role of mesenteric fat is of increasing interest in Crohn’s disease, and the possibility of
a radiographic finding providing added diagnostic information to make therapeutic decisions is
exciting, given MRE is less invasive than endoscopy.
Comments:
- Mesenteric fat proliferation is not a quantifiable measurement, rather a subjective assessment
of the presence of increased fibrofatty tissue around the bowel loop. This categorization, which
lies at the center of this paper’s question and results, was only performed by a single radiologist.
This major limitation of intra/inter-observer variability is not mentioned.
- Interestingly, mesenteric edema, which IS a quantifiable variable (defined as increased signal
intensity in the T2-weighted imaging of the mesenteric fat) was associated with increased risk
of hospitalization and surgery on univariate analysis but did not hold up in multivariate analysis.
The limitation of power is mentioned, but this discrepancy questions the true connection between
mesenteric fat and Crohn’s complications.
- Given the high proportion of patients who have mesenteric fatty proliferation that persists over
time, does the ongoing MFP represent a significant ongoing inflammatory process that requires
intervention or rather just a lagging of the radiographic findings?
- From this data I am not sure one can conclude that mesenteric fat plays a role in incurring
damage in Crohn’s disease. Prior work has suggested a protective effect of mesenteric/creeping
fat in creating a barrier to prevent dissemination of bacteria in areas of active inflammation.
Therefore, the presence of mesenteric fat proliferation may be a protective response that is
present in areas of active disease, but not necessarily a promoter of long-term damage in and
of itself.
Review for 10.1186/s12876-025-04085-6 (2025)

Title: Mesenteric Fat Proliferation on Magnetic Resonance Enterography Is a Predictor of Long-
Term Disease Complications in Crohn’s Disease
Version: 4 Date: 21 May 2025
Reviewer's report:
Important topic.
Questions / Suggestions:
-would be helpful to add indications for surgery - obstruction, penetrating disease, medially
refractory disease, etc...
-any difference in results between patients with and without previous IBD surgery?
- what was stricture criteria - CONSTRICT?
- was Radiologist blinded to all clinical information?
- Would make it clear that MRE findings in the study refer to the index MRE (not follow-up
imaging)
- Did all the patients on index MRE with stricture (14.3%) also have mesenteric fat proliferation?
-What percent of those with mesenteric fat proliferation on index MRE developed strictures or
penetrating complication on follow-up imaging?
Review for 10.1186/s12876-025-04085-6 (2025)

Title: Mesenteric Fat Proliferation on Magnetic Resonance Enterography Is a Predictor of Long-
Term Disease Complications in Crohn’s Disease
Version: 7 Date: 06 Jun 2025
Reviewer's report:
Thank you for your comprehensive revisions addressing all comments. The additions
—including representative imaging, longitudinal MFP data, therapy-interaction analyses,
and expanded mechanistic discussion—have strengthened the manuscript. Limitations are
appropriately acknowledged.
Review for 10.1186/s12876-025-04085-6 (2025)

Title: Mesenteric Fat Proliferation on Magnetic Resonance Enterography Is a Predictor of Long-
Term Disease Complications in Crohn’s Disease
Version: 7 Date: 06 Jun 2025
Reviewer's report:
The authors adequately addressed the editors and reviewers concerns in their response and
resulting changes to the manuscript. Acceptable for publication.
Review for 10.1186/s12876-025-04054-z (2025)

Title: Construction of a Predictive Model for Concurrent Infection in Liver Failure Patients
Based on Prognostic Nutritional Index and Inflammatory Cytokine Analysis
Version: 1 Date: 21 Mar 2025
Reviewer:  Rafael Suarez del Villar
Reviewer's report:
Dear Corresponding Author,
Thank you for submitting your manuscript. Your study presents a clinically relevant approach
by integrating inflammatory and nutritional markers to predict infection in liver failure patients.
The use of a nomogram based on CRP, sTREM-1, SIRI, PNI, and APACHE II is well justified
and statistically robust.
Below are several suggestions aimed at enhancing the clarity, reproducibility, and clinical value
of the manuscript.
> Major Revisions
1. Model Validation and Overfitting Risk:
The internal validation via ROC analysis shows excellent predictive power (AUC = 0.960).
However, there is no external validation or cross-validation method applied.
Recommendation: Please elaborate on whether any cross-validation was performed (e.g., k-fold)
to assess model robustness. If not, acknowledge this limitation more explicitly and suggest future
validation strategies.
2. Handling of Missing Data:
The retrospective nature of the study raises concerns about potential missing or incomplete data.
Recommendation: Clarify whether there were missing values in any of the predictors and how
they were handled statistically (e.g., complete case analysis, imputation).
3. Definition of Infections and Diagnostic Consistency:
The infection criteria include both culture-based and empirical (response-to-treatment)
diagnoses. This may introduce subjectivity.
Recommendation: Consider discussing the potential for misclassification bias and how it might
affect model specificity.
4. Collinearity Analysis and Predictor Selection:
Although VIF and tolerance were reported, the manuscript would benefit from a clearer
explanation of how predictors were selected and whether any stepwise or penalized regression
methods were considered.
Recommendation: Briefly discuss the predictor selection strategy and its potential implications
on model generalizability.
> Minor Revisions
1. Terminology Consistency:
Ensure consistent use of acronyms (e.g., PNI, SIRI) across the manuscript. At times, full terms
and abbreviations are interchanged inconsistently.
2. Language and Grammar:
While generally clear, the manuscript would benefit from a light English-language edit to correct
some awkward phrasing and improve flow, especially in the introduction and discussion.
3. Figures and Tables:
Improve figure resolution and ensure that axis labels and scoring interpretation on the nomogram
are clearly readable and intuitive.
4. References and Context:
Several key references are provided, but it would help to briefly contrast your model with similar
predictive tools used in liver failure or infectious complications to position your work in the
broader literature.
Best regards,
Review for 10.1186/s12876-025-04054-z (2025)

Title: Construction of a Predictive Model for Concurrent Infection in Liver Failure Patients
Based on Prognostic Nutritional Index and Inflammatory Cytokine Analysis
Version: 2 Date: 26 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
the responses are satisfactory
Review for 10.1186/s12876-025-04054-z (2025)

Title: Construction of a Predictive Model for Concurrent Infection in Liver Failure Patients
Based on Prognostic Nutritional Index and Inflammatory Cytokine Analysis
Version: 2 Date: 28 May 2025
Reviewer:  Rafael Suarez del Villar
Reviewer's report:
Dear Corresponding Author,
Thank you for your thorough and thoughtful responses to the previous review. The revised
manuscript demonstrates clear improvements and addresses all major concerns appropriately.
You have clarified the diagnostic criteria and expanded the discussion regarding the clinical
utility of the predictive model, as well as acknowledged the limitations of not having external
validation. The methodology, particularly the treatment of missing data and the statistical
analysis, is now better detailed and justified. Additionally, your explanation of the relevance
and interpretation of the included biomarkers enhances the scientific rigor of the study.
Overall, the manuscript is now clearly presented, methodologically sound, and clinically
meaningful. Thank you for your diligent revisions.
Best regards,
Review for 10.1186/s12876-025-04129-x (2025)

Title: Serrated Polyps in Colorectal Cancer Prevention: Prevalence, Characteristics, and Clinical
Insights from a Large Retrospective Cohort Study
Version: 1 Date: 09 Jun 2025
Reviewer's report:
Firstly, the WHO definition of SSP changed during study period in this article. Please specify
what definition was used in your study and what was done to address this issue. Pathologic
diagnosis was also not mentioned whether central review was used, which may have a
misclassification SSP as HP. For serrated polyps and hyperplastic polyps (no-serrated) in the
draft, a definition section suggested to be added to clarify the terminology in detail and most
of SPs described in the manuscript are more likely to be SSL specified by WHO according the
results.
Secondly, the manuscript did not describe withdrawal time as a key quality indicator, which has
an impact on SPPs detection rate. When following the guideline, a withdrawal time > 6 min is a
basic requirement for standard colonoscopy and restrictions for this in the study are not yet clear.
These deficiencies in method section need to be further refined and described in the manuscript.
Thirdly, we recommend the authors carefully interpret critical results. According to the
description in context, the SPs mentioned refers to SSPs. The results showed a lower SP
detection rate (2.98%) and a higher HGD rate in SPs (21.3%) compared with previous studies.
ACG/ASGE Quality Task Force’ recommended minimum threshold of 6% about SSLDR and
this result is also notably lower than the prevalence of 4.6% reported in a systematic review of
global studies. Meanwhile, SSLDs are not frequently found, occurring in approximately 0.5%
of average-risk patients (approximately 4-8% of all SSLs) according to other studies. Failure
to perform uniform pathology center reading may be one of the causes. The manuscript should
more critically in explaining the limitations of the results and data.
Fourthly, references require consolidation and to add key citations. The reference list contains
duplicate citations as ref 8 and 13, and the authors should to recheck it. Meanwhile the
manuscript lacks foundational supporting references. For instance, IJspeert et al. (2017) should
be cited for defining endoscopic features for SSLs (e.g., cloud-like surface, mucus cap) and the
2019 WHO classification of tumors of the digestive system should also be cited.
Finally, the language of manuscript is slightly imprecise and graphical presentation need to be
optimized. Additional information be included in the manuscript for the undefined size and shape
of the polyps in Table 1. Similarly, description of polyp size has some errors in Fig. 2.
Review for 10.1186/s12876-025-04129-x (2025)

Title: Serrated Polyps in Colorectal Cancer Prevention: Prevalence, Characteristics, and Clinical
Insights from a Large Retrospective Cohort Study
Version: 2 Date: 27 Jun 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-04129-x (2025)

Title: Serrated Polyps in Colorectal Cancer Prevention: Prevalence, Characteristics, and Clinical
Insights from a Large Retrospective Cohort Study
Version: 2 Date: 30 Jun 2025
Reviewer's report:
I am pleased to confirm that the authors have adequately addressed all my concerns through
their thorough revisions. The manuscript has been significantly improved and is now suitable
for acceptance.
Review for 10.1186/s12876-025-04225-y (2025)

Title: A Real-world Study of Balloon dilation vs. Self-Expandable Metal Stents for Benign
Gastric Outlet Obstruction
Version: 1 Date: 28 Jul 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-04189-z (2025)

Title: Mobile Health Technologies in Inflammatory Bowel Disease: A Narrative Review
Version: 0 Date: 26 Apr 2025
Reviewer's report:
Dear Author,
I am writing regarding your manuscript titled "Mobile Health Technologies in Inflammatory
Bowel Disease: A Narrative Review" submitted to the BMC Gastroenterology for my
consideration as an Invited Reviewer. This is a well-organized, timely, and highly relevant
review considering the increasing integration of digital health solutions in the management of
IBD. The manuscript offers a thorough overview of mobile apps and wearable technologies,
demonstrating a good understanding of the current landscape. I have carefully reviewed your
article and would like to highlight some specific areas for improvement.
Please consider the following points:
1. While the review extensively covers symptom-tracking apps and remote monitoring, the role
of telenutrition is not discussed, despite its growing importance in IBD management.
I recommend including recent advances in telenutrition as a complementary digital health
strategy, particularly focusing on dietary interventions and gut health. I suggest citing the
following paper to support this point:
• Co#kun MG, Kolay E, Basaranoglu M. Telenutrition for the management of inflammatory
bowel disease: Benefits, limits, and future perspectives. World Journal of Clinical Cases
2023;11(2):308.
• Elamin, S., & Cohen, J. (2021). Telenutrition for inflammatory bowel disease: a tipping point
for dietary wellness. Crohn's & Colitis 360, 3(2), otab017.
• Gupta, A., Singh, N., Madan, D., Farooqui, M., Singh, N., Thomas, D. M., ... & Ahuja, V.
(2022). Development and validation of a smartphone application for telenutrition in patients
with inflammatory bowel disease. Diagnostics, 12(10), 2482.
• Gupta, A., Singh, N., Kante, B., Madan, D., Farooqui, M., Singh, N., ... & Ahuja, V. (2022).
Development and validation of a digital health platform (IBD NutriCare) for telenutrition in
patients with Inflammatory bowel disease.
2. Add references for applications on “Table 1: List of mobile apps for IBD management and
their target disease population, features, and availability to patients.”
3. The discussion could benefit from a clearer acknowledgment of the limitations of mobile
apps, such as user adherence challenges, digital literacy barriers, insurance coverage variability,
and disparities in access across different populations.
4. The future outlook is generally well articulated; however, a small section highlighting the need
for interdisciplinary digital platforms (integrating gastroenterologists, dietitians, psychologists,
and exercise physiologists into one app) would be visionary and align well with the holistic
management needs of IBD patients.
Thank you for your valuable contribution to the field. I appreciate the effort you have put into
this manuscript, and I look forward to reviewing it after the suggested revisions.
Yours sincerely,
Review for 10.1186/s12876-025-04189-z (2025)

Title: Mobile Health Technologies in Inflammatory Bowel Disease: A Narrative Review
Version: 0 Date: 10 Jun 2025
Reviewer's report:
The manuscript is informative, clinically relevant, and well-suited for a gastroenterology or
digital health audience
- In the pathogenesis section during introduction one can mention genetic contributions towards
the development of IBD.
- What about the cost of such apps? Though cost is mentioned the review fails to address cost
effectiveness and long term outcomes of such apps.
- Highlight that studies regarding HRV as still exploratory and in small scale.
- In the method section please add date ranges of data collection
Review for 10.1186/s12876-025-04189-z (2025)

Title: Mobile Health Technologies in Inflammatory Bowel Disease: A Narrative Review
Version: 1 Date: 30 Jun 2025
Reviewer's report:
To the Authors,
Thank you for your thoughtful responses and the effort invested in revising the manuscript.
While I understand your decision to focus primarily on symptom-tracking apps and remote
monitoring, I would still encourage you to briefly acknowledge the emerging role of telenutrition
in IBD management. Given the growing interest in integrating dietary interventions into digital
care strategies, even a short mention of validated platforms such as IBD NutriCare, or the
increasing evidence on telenutrition’s role in supporting dietary adherence and gut health, would
add value to your discussion and future directions. This addition would not shift the scope of
your paper but rather enrich it by recognizing a complementary area that is gaining prominence
in digital health for IBD.
Kind regards,
Review for 10.1186/s12876-025-04189-z (2025)

Title: Mobile Health Technologies in Inflammatory Bowel Disease: A Narrative Review
Version: 1 Date: 06 Jul 2025
Reviewer's report:
I have re-reviewed this manuscript
I appreciate that the authors have thoughtfully addressed my previous comments:
The pathogenesis section now appropriately mentions genetic contributions to IBD
development, which better contextualizes the review.
The cost considerations have been expanded to discuss cost-effectiveness and long-term
outcomes, improving the review’s practical relevance.
The discussion on HRV monitoring now correctly clarifies that available studies remain
exploratory and small-scale.
The Methods section now clearly states the date range of the literature search, ensuring
transparency and reproducibility.
Review for 10.1186/s12876-025-04189-z (2025)

Title: Mobile Health Technologies in Inflammatory Bowel Disease: A Narrative Review
Version: 1 Date: 11 Jul 2025
Reviewer's report:
The authors have addressed the requested edits. A few small edits are suggested on this revised
manuscript:
In line 56, “due to abnormal immune response” should be “due to an abnormal immune
response”.
In line 139, “QoL of life” should be “QoL”.
In lines 160 – 161, the authors comment “although it should be noted that research is often easier
to execute when tied to academic centers, given the increased resources and emphasis on clinical
validation.” Many would disagree that research is easy in academics. Further, this statement
suggests that clinical validation is not a focus of research in the private sector. I recommend
removing this statement.
In line 175-176, please provide a reference for the AGA Quality of Care indicator checklist.
In line 182, “useful to assess efficacy” should be “useful to assess the efficacy”.
In line 208-209, the authors only report the outcomes for 2 study arms (TECCU group vs control
group), however the 3 cohorts described are the TECCU group, nurse-assisted telephone care
and standard of care. Which is the control group? Please clarify these findings.
In line 283, “further research into efficacy” should be “further research into the efficacy”.
In line 317, “they found significant interaction” should be “they found a significant interaction”.
Review for 10.1186/s12876-025-04189-z (2025)

Title: Mobile Health Technologies in Inflammatory Bowel Disease: A Narrative Review
Version: 2 Date: 21 Jul 2025
Reviewer's report:
Thank you for the opportunity to review this manuscript. I confirm that all necessary changes
have been addressed satisfactorily, and I have no further comments. The manuscript is now
ready for publication in its current form.