Review for 10.1186/s12876-015-0366-3 (2015)

Reviewer's report
Title:Chronic constipation in the elderly: a Primer for the Gastroenterologist
Version:2Date:22 June 2015
Reviewer: Zubin Arora
Reviewer's report:
Major Compulsory revisions:
None
Minor essential revisions:
1. Needs several corrections to the general English of the paper. There are
multiple punctuation errors, spelling errors and grammatical errors which need to
be addressed to improve the flow of text as well as to convey the correct
meaning intended. E.g.
- Page 2 Line 37 should read: “gastroenterologists’ clinic workload” instead of
“gastroenterologist clinic workload”
- Page 3 Line 48: there is an additional period prior in “affected. [3,4].”
- Page 3 Line 54 should read: “who often have” instead of “which often have”
- Page 4 Line 71: “Faced with a lower prevalence in Eastern areas (around 8
.75% of the population), in Western countries constipation may affect up to 30%
of the general population [1,2].” I believe the authors are trying to bring out the
contrast in prevalence between the eastern and western population, but the
sentence is poorly constructed and does not convey the right meaning.
- Page 4 Line 75 should read: “are using laxatives” instead of “is using laxatives”
- Page 4 Line 80 should read: “a health care professional” instead of “an health
care professional”
- Page 11 Line 241-242: “The diagnosis of constipation, as with other functional
disorders, was primarily based on a differential diagnosis.” Not entirely clear what
the authors are trying to covey by this. Suggest rephrasing this to clarify the
meaning.
There are several more such areas in the paper which need corrections and
improvements.
2. Page 16 Line 397: Lactobacillus acidophilus NCFM is a scientific name and
should be italicized.
3. Page 20 Line 491 should read “prucalopride” instead of “rucalopride”
4. Please provide references for the following:
- Page 4 Line 70: Please provide reference to data for prevalence of constipation
more common in females with ratio 1:2-3.
- Page 10 Line 230-232: Please provide reference for data showing “elderly
patients often live a sedentary lifestyle, reduce water intake, resulting in
dehydration, and eat less fibre in their diet”.
- Page 16 Line 383: Please provide reference for ‘most common’ and safety data
for “Lactulose, lactitol and macrogol are the most commonly and safest
compounds used in the elderly.”
Discretionary revisions:
- Page 12, Line 277: In addition to radio-opaque markers and manometry, colonic
transit time can now also be measured using the wireless motility capsule which
not only provides data for colonic transit, but simultaneously gives transit time
information about the stomach and small bowel as well. It does not involve
radiation (unlike radio-opaque markers) and is much less invasive than
manometry. This becomes particularly relevant when patients have multi regional
dysmotility and invasive therapeutic procedures like colectomy are being
considered, which the authors rightfully suggest should not be offered without
first assessing the motility of both the anorectum and the small bowel. The
wireless motility capsule offers a much less invasive way of assessing that as
compared to manometry as suggested by the authors. There is recent data
looking at the same which is relevant to the current review and is suggested to
be incorporated in the current paper (Dig Dis Sci. 2015 May;60(5):1350-7. doi:
10.1007/s10620-014-3431-9)
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
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.