Review for 10.1186/1471-230X-14-57 (2014)

Reviewer's report
Title:Diagnostic yield of endoscopy in patients with abdominal complaints:
Incremental value of fecal calprotectin on guidelines of appropriateness
Version:1Date:25 December 2013
Reviewer: Petr Ricanek
Reviewer's report:
- In the paper “Diagnostic yield of endoscopy in patients with abdominal
complaints: Incremental value of fecal calprotectin on guidelines of
appropriateness”, the authors want to “investigate if the use of fecal calprotectin
testing in combination with guidelines of appropriateness would improve the
diagnostic yield of endoscopic procedures.”
- The question posed by the authors is important, well defined, and is answered
in the conclusions of the abstract of the paper. The methods used are
appropriate and validated. Alltogether, the paper is well written in a clear
language with well documented results, and no doubt, demonstrates the benefit
of adding fecal calprotectin as a marker, when selecting patients for endoscopy.
There are, however, some issues regarding upper gastrointestinal disease and
fecal calprotectin, that should be addressed.
- Major Compulsory Revisions:
1. In Background, fifth paragraph, the authors refer to a previous paper, which
includes the same cohort of patients, which they describe in the current paper, to
argue that calprotectin in feces “has proven highly useful…for distinguishing
between organic and functional disorders of the…upper intestinal tract”. Has this
been documented by other authors?
2. At the end of the discussion, the authors point out several potential limitations
of the study. The second potential limitation mentioned is selection bias. Could
this be the reason for the high number of EGDs with clinically-significant findings
and the high number of study subjects with a fecal calprotectin value >50 mg/kg?
Could the authors comment on this?
3. When it comes to lower gastrointestinal disease, the use of fecal calprotectin,
is much better documented, and, especially in younger patients, a helpful aid
when selecting for colonoscopy. Being a clinician, I have my doubts towards
using fecal calprotectin in everyday clinical practice as a diagnostic tool in upper
gastrointestinal disease. Is it feasible to measure in all patients with upper
gastrointestinal complaints? How big is the clinical value?
4. In the paper, the authors define clinically-significant findings as reflux
esophagitis, erosive gastritis, gastric ulcer and stomach cancer. Could the
authors speculate on, or document, the association between fecal calprotectin
and other upper gastrointestinal diseases, such as for instance eosinophilic
esophagitis and gastritis, as well as celiac disease?
-Minor Essential Revisions:
1. Are figure 3A and figure 3B incorrectly marked as figure 3 and 4?
Discretionary Revisions:
1. Abstract, Methods: Here, for reasons of clarity, the authors should consider to
write 298 patients or 298 of 575 (51,8%) patients in stead of 298 (51,8%).
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.