Review for 10.1186/s12876-025-04095-4 (2025)

Title: Long-term Quality of Life After Acute Pancreatitis: A Systematic Review and Meta-
Analysis
Version: 3 Date: 09 Jun 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
1. Heterogeneity Across Studies
There was substantial heterogeneity in the pooled QoL outcomes, possibly due to differences
in study populations, methodologies, and time frames. Despite addressing this in the
discussion, heterogeneity undermines the interpretability of results. Consider adding a more
thorough explanation of how heterogeneity might influence specific findings. Additionally,
recommendations for future studies to standardize methodology or study design could enhance
the overall consistency of the results.
2. Lack of Subgroup Analyses
The absence of subgroup analyses limits the ability to explore the impact of variables such as
etiology, disease severity, or follow-up duration on QoL outcomes. This also prevents a deeper
understanding of how different patient characteristics may affect long-term QoL.
While subgroup analysis was not feasible due to insufficient data, future studies should aim to
collect more detailed and varied data to allow for stratification based on relevant clinical factors
like disease severity and comorbidities.
3. Study Design Limitations (Cross-sectional Nature)
Most of the included studies utilized cross-sectional designs, which may introduce selection bias
and limit the ability to determine causality between AP and QoL outcomes.
The manuscript should emphasize the need for longitudinal studies to better capture the
progression of QoL outcomes and the impact of ongoing interventions.
4. Inadequate Reporting of Clinical Variables
Incomplete reporting of important clinical variables, such as disease etiology, severity, and
treatment interventions, limits the ability to conduct meaningful stratified analyses.
Highlight the importance of comprehensive reporting of these variables in future studies
to enable more in-depth analysis. Providing recommendations for standardized reporting
guidelines could improve data consistency.
5. Potential Bias Due to Geographic Differences
Geographic differences between studies (e.g., healthcare systems and support structures) were
noted as a potential contributor to heterogeneity. This raises concerns about the generalizability
of the results across different regions.
Acknowledge these geographic differences in greater detail and propose that future studies
consider cross-cultural comparisons to assess whether the impact of AP on QoL differs
significantly between regions with varying healthcare models.
6. Insufficient Focus on Pancreatitis-Specific QoL Measures
The manuscript points out that existing QoL measures (e.g., SF-36, SF-12) do not adequately
capture pancreatitis-specific issues such as exocrine/endocrine insufficiency or structural
complications. However, it doesn't fully elaborate on the need for new, disease-specific QoL
tools.
More emphasis should be placed on the necessity for developing validated, disease-specific QoL
instruments tailored for AP survivors. Providing a more detailed discussion of current gaps and
the potential methodologies for creating these tools would improve the manuscript.
7. Potential Confounding Factors Not Addressed
The manuscript does not address potential confounding factors that could influence long-term
QoL, such as pre-existing conditions (e.g., diabetes, obesity) or sociodemographic factors (e.g.,
education, socioeconomic status).
Future studies could explore the role of these confounding variables. Additionally, the
manuscript could briefly mention these confounders and suggest that future research should
control for them in order to refine the understanding of the relationship between AP and QoL.
8. Follow-up Duration Variability
The manuscript notes variability in follow-up duration across studies, which complicates the
interpretation of time-dependent QoL changes.
Clarify how follow-up durations may influence QoL outcomes and suggest standardization of
follow-up periods in future studies to enhance consistency. The manuscript could also discuss
whether QoL recovery rates plateau after a certain period post-discharge.
9. Implications for Clinical Management
While the manuscript highlights clinical implications, the discussion could be expanded to
include specific, actionable recommendations for clinical practice.
Provide concrete guidance for clinicians on how to address the QoL issues identified in the study.
This could include recommendations for early screening of endocrine/exocrine insufficiency, as
well as more structured, long-term follow-up for AP survivors.