JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/s12876-021-01824-3 (2021)

Title: Waist-to-height ratio and non-alcoholic fatty liver disease in adults
Version: 1 Date: 22 Mar 2021
Reviewer:  Mattias Ekstedt
Reviewer's report:
In this manuscript by Sheng and co-workers, data from 14 125 individuals included in the
“human dock” are presented. The main result is that the waist-to-height ratio is strongly
associated with the prevalence of NAFLD. The main strengths of this study are the large sample
size and that the diagnosis of NAFLD is based on ultrasound (a biopsy study of more than 14
000 is unethical).
I have only minor comments:
Why were individuals with diabetes excluded? I would suggest adding individuals with diabetes
and investigate if there is the same association between WHtR and NAFLD in individuals with
and without diabetes.
Table 1, add unit for smoking and drinking. I would suggest using grams/week for alcohol since
that is easier to relate to the exclusion criterion.
There are generally to many decimals for many variables.
-Page 16, row 339, typo.
-Page 9, row 184-187, rephrase as this sentence is unclear.
-Page 6, row 112, is there another font in this row?
-Page 5, row 92, is it correct that height, weight, and WC was self-assessed. If not, describe how
these measurements were performed.
-Page 5, row 89, I do not think that you excluded everyone > 18 years… Obviously a typo.
-Page 2, row 34, should be prevalence, not incidence.
-Page 4, row 76-79, this sentence is unclear to me.
Review for 10.1186/s12876-021-01821-6 (2021)

Title: Endoscopic mucosal resection: still a reliable therapeutic option for gastrointestinal
neuroendocrine tumors
Version: 4 Date: 29 Apr 2021
Reviewer:  Davide Ravizza
Reviewer's report:
The aim of the study is not stated in an easily understandable way.
“… This study was designed to address the debate on the long-term follow-up of EMR for
localized NETs in the rectum and upper gastrointestinal (GI) tract. …”
The T stage of the treated NETs is reported in confusing way.
In PATIENTS AND METHOD it is still reported that T2 NETs were excluded although NETs
with a size > mm 10, which should be classified as T2, are included in the study.
“… Patients with advanced tumors unfit for endoscopic removal (larger than 2 cm in size,
higher than T1 stage on endoscopic ultrasound [EUS], and/or poorly differentiated lesions) were
excluded …”
A few lines below it is reported that T2 lesions were included.
“… In other words, we included T1, T2 lesions with N0 M0 and excluded lesions with N1 and
above and M1 and T3 lesions …”
In DISCUSSION it is reported that EMR was used for NETs below T1
“… In this study, we performed EMR as the only available technique for resection of GI NETs
smaller than 2 cm in diameter and below T1 on EUS. In fact, we did not excluded cases with
size up to 2 cm if there was no lymph node metastasis or invasion to muscularis propria (MP)
based on pre resection endosonography findings. In other words, we included T1, T2 lesions
with N0 M0 and excluded lesions with N1 and above and M1 and T3 lesions. …”
DISCUSSION
I do not understand very well the following sentences. What is the evidence to support them?
“… Our proposal is that with current definition of T2 and stage II in gastric and duodenal NET
there would be a heterogeneous group of cases with NETs. …”
“… It may be more appropriate to use the framework used for T staging in rectum for upper
gastrointestinal tract as well, at least in patients with G1 grade. …”
How does the experience of the Authors can expand the use of EMR for NETs up to mm 20
in size?
“… We believe our finding could expand the indications of the EMR in NET up to 2 cm if there
is no node or invasion to MP. …”
I do not understand very well the following sentence.
“… In our study, only 4 patients were treated with modified EMR and all of them had no
resection margin involvement.  We implemented the simple EMR technique with a submucosal
saline injection for the rest of individuals, which is why we could only achieve a 40% complete
resection rate. …”
The Author stated that “… conventional EMR could not be considered as a curable and
decisive procedure for gastrointestinal NETs smaller than 20 mm and limited to the mucosa
or sub mucosa due to its low chance of R0 (complete resection) achievement. …”. But, if “…
incomplete resection of the lesion is not relevant for the prognosis of these patients and tumor
recurrence, …“ why EMR should not be considered curative also in the case of R1 resection?
Review for 10.1186/s12876-021-01820-7 (2021)

Title: SOMATIZATION IN PATIENTS WITH PREDOMINANT DIARRHEA IRRITABLE
BOWEL SYNDROME: THE ROLE OF THE INTESTINAL BARRIER FUNCTION AND
INTEGRITY
Version: 1 Date: 10 Apr 2021
Reviewer's report:
This is a very interesting paper dealing with the complex interplay between GI and  psychological
symptoms, changes of mucosal barrier and dysbiosis in IBS-D patients
The aim of the study and methods are clearly described.
The statistical analysis appears to have been carried out correctly
The results are clearly shown and widely discussed
BACKGROUND
The reference 1 should be changed because it refers to  Rome III criteria. Conversely the
classification, correctly reported by the authors, is available in:
“BE. Lacy, F. Mearin, L. Chang, WD Chey, AJ Lembo, M Simren, and R Spiller.  Bowel
Disorders. Gastroenterology 2016…”.
(Rome IV criteria)
METHODS
Line 105: Insert the reference Lacy BE…. about Rome IV criteria
RESULTS
-Were IBS mean age (42.8 ± 10.3 yrs.); and HC mean age (32.5 ± 14.1 yrs) significantly
different? If so the authors should briefly discuss this issue
-“Faecal zonulin concentrations were significantly higher in the HS group than the LS one”.
Were serum zonulin levels increased, too? The authors should briefly discuss this topic
DISCUSSION
Lines 320-335: the authors could profitably use to enlarge this interesting topic some papers
coming  from the same country cases to find out similarities and/or  differences  i.e.
-Soncini M et al. IBS clinical management in Italy…”. DLD 2018
-Stasi C et al. The complex interplay between gastrointestinal and psychiatric symptoms in
irritable bowel syndrome…” JGH 2018
The authors used non-invasive, “indirect” methods ( urinary indole and skatole) for gut dysbiosis
evaluation.  Could a direct assessment  of the microbiome and metabolome have provided further
(different) information?
What’s their opinion? Could be another point of weakness?
Review for 10.1186/s12876-021-01820-7 (2021)

Title: SOMATIZATION IN PATIENTS WITH PREDOMINANT DIARRHEA IRRITABLE
BOWEL SYNDROME: THE ROLE OF THE INTESTINAL BARRIER FUNCTION AND
INTEGRITY
Version: 1 Date: 26 Apr 2021
Reviewer's report:
This is a nice study on a topic investigated by other teams. Trying to look for somatization in
IBS is common, but trying to correlate this with intestinal peremability is useful.
Permeability measurement is correct but dysbiosis is not assessed by evaluating microbiota. This
limitation should be commented.
Authors should explain why permeability is  influencing somatization, while most of the
symptoms are not statistically difefrent between low and high somatizers.
Discussion are not well explaining the findings.
Conclusions: first sentence is conceptually wrong.
Review for 10.1186/s12876-021-01819-0 (2021)

Title: Endoscopic resection combined with the Cryoballoon focal ablation system in the porcine
normal esophagus: A preclinical study
Version: 2 Date: 14 Feb 2021
Reviewer's report:
The authors describe the technical feasibility and tissue damage of combination therapy with
ER and CbFAS. This study is generally well written. Some points to consider are below.
1. The data in Table 1 is insufficient. ''Procedure success rate'' of EMR is 2/2 in Table 1, but the
authors performed EMR for 8 lesions (#1,2,3,4,5,6,11,12). 'Procedure success rate'' of CbFAS
is 2/2 in Table 1, but the authors performed CbFAS for 4 lesions (#7,8,9,10). These results are
confusing. The authors should clarify the data in more detail by describing the lesion numbers
in the ''RESULTS'' paragraph.
2. The data in pig C should be described in Table 2. Tissue damage after ER is important
information.
3. The lesion number should be described in Figures 2, 3, 4, or figure legends.
4. Which strategy is more useful, ''EMR+CbFAS'' or ''CbFAS for EMR scar''? Although it may
depend on the clinical situation, a more detailed discussion is desirable.
Review for 10.1186/s12876-021-01819-0 (2021)

Title: Endoscopic resection combined with the Cryoballoon focal ablation system in the porcine
normal esophagus: A preclinical study
Version: 2 Date: 15 Feb 2021
Reviewer's report:
This  study describes about combination treatment with ER and CbFAS.
Histologically properly evaluated, it is a practical research content for future treatment.
However, the number of cases is too small, and the primary endpoint "success of the procedure"
is a subjective endpoint. How did you decide on the sample size?
There is no state in the manuscript regarding the extent of circumferential resected by EMR. I
don't think that stenosis occur in post EMR cases.
Review for 10.1186/s12876-021-01818-1 (2021)

Title: Low preoperative prealbumin predicts the prevalence of complications following liver
transplantation
Version: 2 Date: 03 Apr 2021
Reviewer's report:
Dear Authors,
I have reviewed with pleasure a the  manuscript titled "Low preoperative prealbumin predicts the
prevalence of complications following liver transplantation" . The paper evaluates associations
between preoperative serum prealbumin and post-LT complications. I have made some
considerations in order to  improve the quality of evidence provided by the manuscript:
1. Introduction section
- Line 77: when the authors mentioned "nutrition" and post-LT complications: Do they use the
word "nutrition" with the meaning of "nutritional status"? If it is the case, maybe it would be
interesting to consider the idea of using "nutritional status" instead. In order to make it clearer
for the readers.
- Line 83: as a negative acute phase protein it is questionable wether prealbumin is a good
nutritional status marker.
- Line 92: Is it acceptable to state the conclusion at the end of the Introduction section?
2. Results section
- Line 143: It is explained the patiets were categorised according the cut-off points of prealbumin.
Should not this explanation be at the Methods section?
- Lines 167,168: same comment as mentioned above.
3. Discussion section:
- Prealbumin is a negative acute phase protein, and it was briefly stated at the limitation
considerations. Maybe it would be interesting to describe its role at the methods section.
4. Tables:
- Table 1 there are two groups: low x normal prealbumin. On Table 3 the same groups are called:
low x high prealbumin. Maybe it would be interesting to standardise it.
- Table 1: It would be interesting to see prealbumin values on Table 1.
With Regards,
Reviewer
Review for 10.1186/s12876-021-01818-1 (2021)

Title: Low preoperative prealbumin predicts the prevalence of complications following liver
transplantation
Version: 2 Date: 13 Apr 2021
Reviewer's report:
Liver transplantation is currently the single most efficient and definitive treatment option in
patients with end-stage liver disease. Survival rates after surgery are over 80%, depending
on the post-transplant time. The number of post-transplant complications is directly related to
the nutritional status of this patient. Therefore, methods that assess the association between
pre-operative nutritional status indicators and postoperative complications in these patients are
essential to reduce negative clinical outcomes after transplantation. Among the biochemical
markers of the state is prealbumin, which, due to its short half-life, is more sensitive and specific
in response to nutritional reserves.
The authors aimed to verify whether prealbumin levels before transplantation are associated
with postoperative complications. However, some points need to be revised.
The authors had more than one objective, it may be necessary to expand, as I signaled at least
three:
1. Assess the association between preoperative prealbumin and postoperative complications.
2. Assess the correlation between preoperative albumin and prealbumin.
3. Assess the association between preoperative prealbumin levels and disease severity using
MELD.
In the methods, the inclusion and exclusion criteria were not included. In the limitations, it is
pointed out that prealbumin can be influenced by acute inflammation, hyperthyroidism, and
nephrotic syndrome, were these patients excluded?
The cutoff point for MELD was 15, which criterion was used to determine this value?
A discussion that should have been further investigated is why prealbumin in these patients may
be low.
An in-depth discussion needs to be made as to why there was an association between low levels
of prealbumin and a greater number of complications only in MELDs under 15.
An important finding was not discussed, the high mortality rate in patients with low prealbumin
in individuals with low MELD (Table 3).
On line 114, wouldn't it be creatinine?
In Table 4, in the header, high prealbumin or normal prealbumin?
What is the average postoperative time that complications were evaluated? Do the authors think
that shorter or longer time could interfere in the prevalence of complications? Similarly, what
is the average length of stay, could this data also interfere with the results?
What were the other indications for liver transplantation? 80.6% of patients had HBV infection,
could the indication interfere with prealbumin results and complications?
One suggestion: Prealbumin levels could be measured in conjunction with C-reactive protein as
it is an inflammation marker and therefore could help to distinguish between secondary decrease
due to acute inflammatory diseases or malnutrition.
Review for 10.1186/s12876-021-01811-8 (2021)

Title: Immunohistochemical Staining for IMP3 in Patients with Duodenal Papilla Tumors:
Assessment of the Potential for Diagnosing Endoscopic Resectability and Predicting Prognosis
Version: 5 Date: 25 Mar 2021
Reviewer's report:
Thank you for the revised edition of your manuscript. I think the revisions have greatly improved
the quality of the manuscript, and the storyline and conclusions are easy to follow. However, I
have two important comments that need to be adressed:
1) The quality of the histological images in figure 3 is not sufficient for publication. The images
appear blurred with an unadjusted whitebalance. If it is impossible to obtain high quality images
using a camera mounted on a microscope, could you perhaps use a digital slide scanner instead?
2) Figure 1 depicting a flowchart of the included patients is very informative. However, all text
and patient-numbers should be included inside boxes to improve the visual impression of the
flowchart, even though some of the text would be repeated in seperate boxes (ie. #No evidence
of(...)", "Adenoma or carcinoma (...)","adenoma", "Tis and T1", "T2", and "T3"). Furthermore,
I would relabel the "Analysis"-box to "Patients included in study" or something similar.
Good luck with the publication.
Review for 10.1186/s12876-021-01811-8 (2021)

Title: Immunohistochemical Staining for IMP3 in Patients with Duodenal Papilla Tumors:
Assessment of the Potential for Diagnosing Endoscopic Resectability and Predicting Prognosis
Version: 5 Date: 07 Apr 2021
Reviewer's report:
Thank you to the authors for addressing all comments from both reviewers and revising the
manuscript accordingly improving clarity.
Further comments on revised manuscript:
The revised method sections still leaves some uncertainty regarding patient selection and
pathological assessment of IPM3 immunohistochemistry:
1. What were the exact criteria for sufficient data that lead to only 25 out of 151 patients to be
included? Is it possible to include this into the flowchart?
2. Was percentage of IPM3 positive cells semiquantatively estimated by the two researchers or
was another method used?
Minor suggestions:
Abstract: Would it be worth specifying ‘no method’ in the second sentence as ‘However, there is
currently no reliable pre-operative method to diagnose the infiltration in the sphincter of Oddi.’?
Would it be best to replace ‘each carcinoma’ with something more appropriate such as ‘many’
or ‘several carcinoma types’?
Introduction: Might it be best to remove the word ‘level’ after T-stage? Is it worth specifying PD
as ‘a major invasive surgical procedure’ as strictly speaking an endoscopic papillectomy might
also be regarded as an invasive surgical procedure.
Results: What is meant by ‘degree of malignancy of the background tissue’ in the sentence: ‘The
distribution of IMP3-positive cells was relatively homogeneous within the tumor, regardless of
the degree of malignancy of the background tissue.’?
Review for 10.1186/s12876-021-01811-8 (2021)

Title: Immunohistochemical Staining for IMP3 in Patients with Duodenal Papilla Tumors:
Assessment of the Potential for Diagnosing Endoscopic Resectability and Predicting Prognosis
Version: 6 Date: 02 May 2021
Reviewer's report:
Thank you for the revised manuscript. I have no further input, and I think the manuscript is
ready for publication.
Review for 10.1186/s12876-021-01811-8 (2021)

Title: Immunohistochemical Staining for IMP3 in Patients with Duodenal Papilla Tumors:
Assessment of the Potential for Diagnosing Endoscopic Resectability and Predicting Prognosis
Version: 6 Date: 04 May 2021
Reviewer's report:
Thank you to the authors for responding to all the reviewers’ comments and amending the
manuscript accordingly. The manuscript has been improved by clarifying the study as a
preliminary/pilot study. The flowchart is now also explanatory in itself.
Review for 10.1186/s12876-021-01809-2 (2021)

Title: Clinical characteristics and longitudinal changes of patients with non-alcoholic fatty liver
disease in two decades: the NAGALA study
Version: 2 Date: 01 Jan 2021
Reviewer's report:
Takuro Okamura et al. investigated the clinical characteristics and longitudinal changes of
NAFLD patients in two decades. This manuscript has a lot of data and is very interesting.
However, there are some problems described below.
1. The authors should list the clinical characteristics of study participants excluding intermediate
alcohol consumption group and alcoholic group at baseline examination.
2. Same as above, the authors should list the clinical characteristics of study participants without
obesity at baseline examination if they mention about non-obese NAFLD.
3. In discussion session, the manuscript states the following “The prevalence of metabolic
abnormalities, such as obesity and hyperglycemia in NAFLD patients significantly increased
through these two decades in men.” and “The prevalence of obesity in the current cohort
significantly increased for both genders, which might induce an increased prevalence of
NAFLD.”. However, in table 3, the prevalence of obesity in NAFLD patients did not increase
through two decades in men. In addition, in table 1, the prevalence of obesity in the current
cohort did not increased in women.
Review for 10.1186/s12876-021-01809-2 (2021)

Title: Clinical characteristics and longitudinal changes of patients with non-alcoholic fatty liver
disease in two decades: the NAGALA study
Version: 2 Date: 02 Jan 2021
Reviewer's report:
- Introduction section: i suggest to report the data of global NAFLD pandemic, with regards
to the japanese status. I also suggest to report the metabolic, genetic and evironmental factors
linked with the onset and progression of NAFLD with references (i.e. 33349658; 27610012)
- Methods section: is important to report the tool used for the US diagnosis of liver steatosis. I
suggest to use, if is possible, the ultrasound parameters or scores like Hamaguchi socre
- Results section: the high number of non obese pts with NAFLD is related to the genetic profile
of the studied population
- Discussion section: is importnat to underline the fact that the global rise of NAFLD is related
to lifestile changes and in particular with high caloric diet
Review for 10.1186/s12876-021-01809-2 (2021)

Title: Clinical characteristics and longitudinal changes of patients with non-alcoholic fatty liver
disease in two decades: the NAGALA study
Version: 2 Date: 02 Jan 2021
Reviewer's report:
An interesting and well-detailed analysis of the prevalence of NAFLD in a Japanese population,
with associations to components of MetSyn and lifestyle (alcohol, physical activity and
smoking) in two cohorts, the first in the mid ’90, the second 20 years ahead. Data show
considerable differences in the prevalence of NAFLD and other variables, including physical
activity, and obesity as leading factors associated with NAFLD (although also lean NAFLD
increased systematically), with gender differences. There are several unexpected findings that
I found difficult to reconcile:
1. Apparently, the leading factor is the increase in obesity rates, despite a minimum, but highly
significant increase in BMI. This was accompanied by a dramatic increase in fasting glucose
(doubled in 20 years), that fits with increased obesity rates in males (not with decreased obesity
rates in females). How was that triglycerides were reduced in males and HDL cholesterol were
increased in the presence of diabetes? The increased prevalence of exercise seems too small to
justify these changes.
2. The authors argue that altered metabolic factors in females are driven by reduced physical
activity. If this is the case, why was BMI decreased? The lack of data on calorie intake is a
severe limit for the assessment of lifestyle. Any evidence from the literature that calorie intake
was reduced in the 20-year span of the two observations?
3. And in males, the prevalence of NAFLD in non-obese current cohort was higher, in spite of
increased exercise? How it comes? Any evidence frojm the literature that body shape (waist
circumference) in Japan population has changed during the past 20 years?
4. In the last sentence of “Study Population and Design” chapter the authors say that longitudinal
data of individuals who participated in health check-ups more than twice were analyzed. What
do they mean? Where are longitudinal data in paired samples?
5. Considering that data are continuously retrieved in the Gifu area, it would have been much
more solid a study analyzing trajectories on disease prevalence based un multiple cohorts instead
of two cohorts taken some 20 years apart.
6. Table 3 might be omitted. Data are already present in Table 2, and the P for comparison should
be added to Table 2.
Review for 10.1186/s12876-021-01809-2 (2021)

Title: Clinical characteristics and longitudinal changes of patients with non-alcoholic fatty liver
disease in two decades: the NAGALA study
Version: 2 Date: 03 Jan 2021
Reviewer's report:
Thank you for submitting this paper. I here list a number of comments regarding the methods
of the study.
It is not clarified whether the study population could be considered as a primary or secondary
care population.
How were patients invited for the health chech-up? were they apparently healthy subjects and
was there any selection based on age? Where all consecutive patients invited to take part to the
study?
A diagnosis of liver disease was based on medical history or full liver screen blood tests?
How was the population distributed statistically.
Regarding the results of the study:
As fibrosis is the clinically significant feature on NAFLD, was there any result of non invasive
markers of fibrosis (even those based on blood tests?), if not, it should be listed among the
limitations of the study
It would be interesting to build a predisctive model for NAFLD using binary logistic regression.
This could be derived in the first (derivation) cohort and then tested in the second (validation)
cohort. This could allow  could compare the predictive value of risk factors in the 2 different
cohorts
Review for 10.1186/s12876-021-01809-2 (2021)

Title: Clinical characteristics and longitudinal changes of patients with non-alcoholic fatty liver
disease in two decades: the NAGALA study
Version: 3 Date: 20 Feb 2021
Reviewer's report:
The following sentence has been repeated twice in the discussion, and one should be removed:
Per capita food consumption has increased significantly in the world, from an average of 2360
kcal/person/day in the mid-1960s to 2800 kcal/person/day today, according to a study by the
Food and Agriculture Organization of the United Nations.
Review for 10.1186/s12876-021-01810-9 (2021)

Title: The Influence of the Interval between Percutaneous Transhepatic Gallbladder Drainage
and Cholecystectomy on Perioperative Outcomes: A Retrospective Study
Version: 3 Date: 03 May 2021
Reviewer's report:
1. In Figure 1, the numbers of conservative treatment (n = 159) and PTGBD (n = 28) did not
match the sum of their subdivisions.
2. In the abstract, the method is too short and not well described. Some descriptions in the
result should be mentioned in the method. For example, “We examined perioperative factors
between patients with an interval of #7 days between PTGBD and cholecystectomy (#7-day
group; n = 12) and those with an interval of #8 days (#8-day group; n = 10).” “We also
examined perioperative factors between patients with an interval of #14 days from PTGBD to
cholecystectomy (#14-day group; n = 14) and those with an interval of #15 days (#15-day group;
n = 8).”
3. The first paragraph in the discussion is not related to the authors’ result. This paragraph should
be moved to the introduction.
Review for 10.1186/s12876-021-01806-5 (2021)

Title: Prevalence of constipation in adults with obesity class II and III and associated factors
Version: 2 Date: 16 Nov 2020
Reviewer:  Vera Lucia Conceicao De Gouveia Santos
Reviewer's report:
The paper contains all necessary items of a scientific paper although there are some issues to be
revised by the authors. Besides the methodological comments, the authors will find additional
comments as following:
- Background: its content is well written based on a specialized and updated literature, although
it lacks in a better justification. I would like to suggest the authors start this chapter with bowel
constipation content as this is the dependent variable instead of obesity. Include constipation
definition as this appears only in Methods section. Besides the authors must improve the
relationship between the two conditions also to justify the manuscript in a more consistent way
(as it is based on a previous RCT database).
- Aims: “…to evaluate the prevalence of constipation and its risk factors in adults with class II
and III obesity and to describe their intestinal habits profile.” It is not possible to find risk factors
in prevalence studies but just associated factors (risk factors are observed just in prospective
studies such as cohort ones). Maybe intestinal habits profile is included in the main objective (?)
- Results: Table 1: why the authors categorized the bowel movements frequence just in two
categories for statistical analysis: 1 to 4 times per week may be related to a normal or to an
abnormal bowel habit! To facilitate statistical analysis, maybe the authors could stratify the stool
forms referring the categories to the presence or absence of constipation.
- Discussion: it is based in a broad and update literature including those mentioned in
background. Anyway, there are other epidemiological studies about constipation in Brazilian
population which could be mentioned.
- Limitations: According to the previous comment, the inclusion criterium related to the sample´s
age range can be one of the study limitations as constipation is frequently associated to elderlies.
Review for 10.1186/s12876-021-01806-5 (2021)

Title: Prevalence of constipation in adults with obesity class II and III and associated factors
Version: 4 Date: 05 Jan 2021
Reviewer:  Vera Lucia Conceicao De Gouveia Santos
Reviewer's report:
The authors replied almost all questions but there are still some of them without satisfactory
reply:
1. The authors did not reply about two instruments for data collection:
- Food Frequency Questionnaire (FFQ): maybe it is recognizable by dietitians but not necessarily
for other health professionals. My previous demand was related to the need of reference about
the original instrument and also the culturally adapted and validated for Brazilians) or even just
translated).
- Bristol Stool Form Scale: as the manuscript will be published in an international Journal, it is
important to clarify that the authors applied the original version of this instrument instead of the
culturally adapted and validated for Brazilians (Martinez AP, Azevedo GR. Rev. Latino-Am.
Enfermagem May/June 2012;20(3). https://doi.org/10.1590/S0104-11692012000300021.)
2. Related to the authors´ reply about the bowel movements cathegorization, it was not
satisfactory as the range 3-4 and/or 1-4 times/ week includes both normal and abnormal
frequencies.
3. References: as the authors changed the sequence of Background content and included some
other references, it will be necessary to revise the references numbers according to their
insertions in the text.
Review for 10.1186/s12876-021-01806-5 (2021)

Title: Prevalence of constipation in adults with obesity class II and III and associated factors
Version: 4 Date: 08 Mar 2021
Reviewer's report:
Prevalence of constipation in adults with obesity class II and III and associated factors
Overall the study has important scientific merit and there is room for improvements on the
manuscript to increase the clarity. Congratulations on the write-up and research.
The followings are comments according to sections of the manuscript.
Abstract:
•       Well written, no further comment. PR or adjustedPR ? Which one are you referring to
in your manuscript ?
Methodology
•       Line 126: Terminology used; super obesity: Where is your reference from ?
Currently obesity class I, obesity class II and obesity class III which is according to WHO
standard classification.
• Line 127: DASS questionnaire should used to measure depression, anxiety level. These
questionnaires are validated questionnaires for screening mental health status.
• Line 138: Polypharmacy; type of medications is need to specified. It is possible if the person is
thin and on polypharmacy to be constipation or not necessarily be obese and on polypharmacy
to be constipated.
Discussion
•      Is there any research conducted for Latin America Region to support your research?
Most of your references are quoted from other research and not many from Latin America
Region.
• Is there any research done on obesity class 1 and constipation ? you might want to compare
between obese class 1 and your current research to add on more information in your discussion
section.
Overall, a good attempt to investigate the association between obesity and constipation. Good
luck and all the best for your manuscript publication. Congrats once again.
Review for 10.1186/s12876-021-01806-5 (2021)

Title: Prevalence of constipation in adults with obesity class II and III and associated factors
Version: 4 Date: 11 Mar 2021
Reviewer:  Alberto De Vitta
Reviewer's report:
In the introduction, the authors could mention the prevalence of constipation in the Brazilian
population.
In Poison's regression analysis, what criteria were used to introduce the variables?
Review for 10.1186/s12876-021-01806-5 (2021)

Title: Prevalence of constipation in adults with obesity class II and III and associated factors
Version: 5 Date: 06 Apr 2021
Reviewer:  Vera Lucia Conceicao De Gouveia Santos
Reviewer's report:
The paper improved a lot with all the changes performed by authors. It is really an interesting
paper with a very relevant issue. Congratulations for that.
Just one final comment: as the research was developed with a Brazilian sample, it is necessary all
international tools be culturally adapted and validated for the target population, even the clinical
ones. Please, remember that in other studies.
Review for 10.1186/s12876-021-01787-5 (2021)

Title: Discovery and Validation of Novel Protein Markers in Mucosa of Portal Hypertensive
Gastropathy
Version: 1 Date: 14 Feb 2021
Reviewer's report:
I think it is excellent that the gastric mucosa was actually collected and evaluated and identified
proteins that significantly elevated in the gastric mucosa of PHG patients.
Review for 10.1186/s12876-021-01787-5 (2021)

Title: Discovery and Validation of Novel Protein Markers in Mucosa of Portal Hypertensive
Gastropathy
Version: 3 Date: 21 Apr 2021
Reviewer:  Oleksandr Petrenko
Reviewer's report:
Dear authors,
I would like to thank you for the provided clarifications and modifications to the text and figures.
The ethical aspects, materials section, and the reasoning behind non-discussed pathways are
now clear. Your decision to provide the supplementary dataset is indeed appreciated and will be
helpful for researchers to test new hypotheses or re-analyze to confirm their findings.
I have no additional remarks regarding the experimental results and the narration itself. I
recommend proofreading the final submitted version to correct typos and punctuation.
Review for 10.1186/s12876-021-01796-4 (2021)

Title: The Role of Endoscopy and Findings in COVID-19 patients, an early North American
Cohort
Version: 1 Date: 14 Mar 2021
Reviewer's report:
This is a well written and thorough description of endoscopic findings in US hospitalized patients
with COVID-19.
Although the final message is that endoscopy is somehow marginal in COVID-19 patients
(nearly 1% of endoscopies performed in the population despite high prevalence of GI symptoms)
it provides a complete picture of its use in a large multicentric cohort.
Review for 10.1186/s12876-021-01796-4 (2021)

Title: The Role of Endoscopy and Findings in COVID-19 patients, an early North American
Cohort
Version: 1 Date: 01 Apr 2021
Reviewer's report:
1992 patients hospitalized with COVID-19 at 36 medical centers in the USA and Canada were
collected to explore the role of endoscopy in this patient population, It turned out that only
24 (1.2%) underwent 27 endoscopic procedures despite a high prevalence of gastrointestinal
manifestations. According this paper, my comments are as follows:
1.The indications of endoscopy need to be discussed. Endoscopy does not have to operate until
serious symptoms appear, such as overt bleeding, because the symptoms caused by some viruses
are asymptomatic and easy to be ignored, such as peptic ulcers. So, from my point of view, the
research results cannot achieve the aim of the research.
2.Compared with the many other similar research, the results of this study do not have much
advantage.
Review for 10.1186/s12876-021-01796-4 (2021)

Title: The Role of Endoscopy and Findings in COVID-19 patients, an early North American
Cohort
Version: 3 Date: 19 Apr 2021
Reviewer's report:
The paper explored the need for endoscopic procedures in North America through  a large
multicentric cohort, the revised article is more complete and the outcomes may help guide
resource allocation in the event of ongoing and future surges.
Review for 10.1186/s12876-021-01805-6 (2021)

Title: Efficacy and safety of selective internal radiation therapy with yttrium-90 for the treatment
of unresectable hepatocellular carcinoma
Version: 2 Date: 27 Feb 2021
Reviewer:  Andrea Chierici
Reviewer's report:
Dear author,
I really appreciate your manuscript that deals with a topic which is of central importance in the
treatment of non-surgical HCC. I think the topic is really interesting, and the contents of the paper
are pretty well structured. Nevertheless, some points of the study deserve further clarification
as I pointed out in the dedicated revision area. Moreover, I would be happy if the authors could
discuss the following concerns:
- although it is quite clear at first sight, the limitations of this manuscript should be presented,
with particular attention to the retrospective nature of the study and the quite limited follow-up
- the presence of a high percentage of patients for whom the tumor response could not be
evaluated is another limitation for the results of the study. Moreover, I found it not clear what
expressed in lines 17-18-19: are those 31 patients part of the "more than 6 months follow-up"
group or not?;
- in the discussion, I suggest citing the meta-analysis from Rognoni et al. [1] and from
Facciorusso et al. [2] which represent some very effective publications on this topic, in line with
your results on radiation therapy and its comparison with TACE.
1.  Rognoni C, Ciani O, Sommariva S, et al. Trans-arterial radioembolization in intermediate-
advanced hepatocellular carcinoma: Systematic review and meta-analyses. Oncotarget.
2016;7(44):72343-72355. doi:10.18632/oncotarget.11644
2.  Facciorusso A, Muscatiello N, Serviddio G. Transarterial radioembolization vs
chemoembolization for hepatocarcinoma patients: A systematic review and metaanalysis. World
J Hepatol. 2016;8(18):770-778. doi:10.4254/wjh.v8.i18.770
Review for 10.1186/s12876-021-01783-9 (2021)

Title: Impact of second forward-view examination on adenoma detection rate during  unsedated
colonoscopy: a randomized controlled trial
Version: 2 Date: 08 Feb 2021
Reviewer's report:
1. the ADR of included colonoscopists should be illustrated
2. 2L-dose PEG might be inadequate for bowel preparation and I belive that the patients with
poor bowel preparation should be much more than 6 patients.
3. did the trial include patients with the indication of diagnosis?
4. the influence of only including unsedated patients should be discussed
5. how about the withdrawing techniques used in the trial and keeping them similar in for the
two arms?
6. did the withdrawing time include time for polypectomy?
7. "Endoscopic polypectomy or biopsy was performed when necessary." how does the author
define "necessary"?
8. sample size and outcomes should be separated from Statistical analysis, and more detail about
Statistical analysis should be addressed. 400 are needed for the trial while the final number of
included should be fewer than 400?
9. which one was the main outcome ADR or PDR? (used for sample size)
Review for 10.1186/s12876-021-01799-1 (2021)

Title: CURRENT DIAGNOSIS AND TREATMENT OF ACUTE PANCREATITIS IN
CHINA – A REAL-WORLD, MULTICENTER STUDY
Version: 2 Date: 22 Mar 2021
Reviewer:  Abdullah Yildirim
Reviewer's report:
The authors reviewed the medical records of AP patients from four different hospitals in the
major regions of China and discussed the current status of AP patients and the therapeutic
efficacy of somatostatin analogues. This study demonstrated that the use of somatostatin and
its analogs in AP patients was positively associated with clinical efficacy and that somatostatin
was more effective than octreotide and combined analogs.  I have read it carefully and I think
there are some points that need clarification.
1. There are many definitions that need to be explained in the method part of the study.
2. According to which criteria was the diagnosis and severity of acute pancreatitis? Atlanta
criteria or other criteria?
3. Somatostatin and octreotide doses and administration duration are not clearly defined. The
drug's adverse events were not described.
4. What does the somatostatin / octreotide treatment arm define? Combination therapy, add on
(addition) or switch to another (replacement)?
5. The total number of patients who received and did not receive medication according to
the flowchart is 2099. However, the number of patients included in the study is 2775 (2437
medication arm and 338 no medication arm). There is a mistake in flowchart.
6. Complications were 7.0% in the somatostatin group, 8.6% in the octreotide group and 10.9%
in the somatostatin / octreotide group (line 191-192). What complications?  Complications due
to medication or acute pancreatitis?
7. The authors suggested that it was statistically significant in terms of hospital stay days,
complications, organ failure, and ICU admission (P <0.05). However, there was no significant
difference between no-medication and medication groups in cases of entering the intensive
care unit (13.3% vs 9.3%, p = 0.24). (According to Supplementary Table 1). This is a serious
confusion that needs to be solved.
8. Why there is a difference between somatostatin and octreotide has not been evaluated in the
discussion section.
Review for 10.1186/s12876-021-01799-1 (2021)

Title: CURRENT DIAGNOSIS AND TREATMENT OF ACUTE PANCREATITIS IN
CHINA – A REAL-WORLD, MULTICENTER STUDY
Version: 4 Date: 25 Apr 2021
Reviewer:  Abdullah Yildirim
Reviewer's report:
The authors carefully reviewed and revised their articles. Some confusing parts of the article are
clearly discussed and compiled point by point. The fact that the article is designed retrospectively
is a major limitation. High volume patients make it attractive and interesting. As a result, I think
this revised article is acceptable and can be published
Review for 10.1186/s12876-021-01799-1 (2021)

Title: CURRENT DIAGNOSIS AND TREATMENT OF ACUTE PANCREATITIS IN
CHINA – A REAL-WORLD, MULTICENTER STUDY
Version: 4 Date: 26 Apr 2021
Reviewer's report:
The authors responded properly to my comments. Despite the limitations of analyzing data from
electronic records, I believe this manuscript is valuable for BMC gastroenterology.
Review for 10.1186/s12876-021-01792-8 (2021)

Title: Retrieval of lost patients in the system for hepatitis C microelimination: A single-center
retrospective study
Version: 2 Date: 04 Apr 2021
Reviewer's report:
Reviewing " Retrieval of lost patients in the system for hepatitis C microelimination: A single-
center retrospective study " from Hsu-Heng Yen et al.
In this manuscript Hsu-Heng Yen et al evaluated campaign for retrieving patients who were
lost to follow-up, for subsequent re-evaluation. 3783 patients with positive anti-HCV antibody
documentation were identified. They found that a significant number of patients with positive
HCV serology were lost for HCV confirmatory test or therapy in the hospital, and this targeted
HCV callback approach in the hospital is feasible and effective in achieving micro-elimination.
The micro-elimination model presented in this paper provides a good reference for the realization
of the elimination of chronic hepatitis C.
The minor comment for the article, the discussion should be supplemented by an analysis of the
reasons why antiviral therapy has not been received after this recall.
It is suggested that the manuscript be accepted with minor revisions.
Review for 10.1186/s12876-021-01792-8 (2021)

Title: Retrieval of lost patients in the system for hepatitis C microelimination: A single-center
retrospective study
Version: 2 Date: 13 Apr 2021
Reviewer:  Anne-marie Roque-afonso
Reviewer's report:
Authors describe a hospital-based microelimination approach not targeting risk groups. This is
a simple and straightforward approach based on the identification and recall of patient found
HCV Ab positive in a county hospital in Taiwan.
HCV positive patients with unknown RNA status were retrospectively identified from 10 years
medical records. A significant manpower was invested during one year for the catch-up strategy,
2 nurses and an hepatologist) The catch-up strategy for the patients was double: first a strategy
that can be described as “passive” for patients returning to hospital, physicians are systematic
made aware through diverse electronic reminding systems; and second, an active call-back
strategy by contacting patients directly. The efficacy was enhanced by implementing a reflex
HCV RNA and genotyping testing. The efficacy of the catch-up strategy is very well summarized
in the flow chart with impressive results with >60% of patients being catched up, and nearly
90% of patients secondarily identified as HCV RNA -positive being treated treated
There is still a long was to obtain physicians awareness on HCV elimination. About 2/3 of HCV
Ab positive patients were not referred for HCV evaluation during the past 10 years; is this a lot?
may be this can be discussed and compared to other studies.
The retrieval rate is higher than reported in other studies. Were catch-up strategies different?
Most “back” patients were retrieved by the reminder strategy underling the importance of
physicians awareness. Only a few patients were retrieved by call. Indeed, the reasons for patient
refusal during telephone call have to be further investigated, as stated by authors. The barriers
to testing could be further discussed. Education for both patients and health professionals are
clearly needed, but what other avenues to enhance acceptance ?
Review for 10.1186/s12876-021-01792-8 (2021)

Title: Retrieval of lost patients in the system for hepatitis C microelimination: A single-center
retrospective study
Version: 3 Date: 22 Apr 2021
Reviewer:  Anne-marie Roque-afonso
Reviewer's report:
I thank the authors for their point by point response, and the modifications made in the
manuscript
typographical errors, such as reflux instead of reflex (line 174) will certainly be corrected during
the edition process
Review for 10.1186/s12876-021-01745-1 (2021)

Title: The emerging epidemic of inflammatory bowel disease in Asia and Iran by 2035: A
modeling study
Version: 2 Date: 10 Feb 2021
Reviewer's report:
In this article, the authors present and discuss an approach to estimate the prevalence of
inflammatory bowel disease (IBD) in Asia regions and Iran from 2017 to 2035. Their results
show an emerging epidemic situation in all the countries considered and the authors conclude
with a call for action in this sense.
I find this article useful since it is focused on the optimization of future health care resources in
this field. However, there are some passages I find that must be revised to make reading clear
and more fluent.
First, the introduction is confusing. The information are mixed together and without a clear
presentation of the context in which this research come. Please reorganize all the introduction
and also specify better the concept of the life long treatment management of these patients.
Please anticipate also in the introduction that it is a modeling study.
Second, if your aim is to focus also on the Iranian trend, please reorganized the results section
giving more emphasis on it. In the results section and in the discussion you cited also north Africa
however it was not cited in the introduction and the analysis seems limited only to Asia and Iran.
Finally, also the discussion is confusing and needs to be revised especially in the second half.
Some concepts are repeated.
Minor corrections:
1. Line 78: Please start with the full name, Inflammatory Bowel Disease and not with the
acronymous.
2. Lines 78-81: Please try to create a unique sentence. Space was lost before the reference.
3. Line 91: Space was lost before the reference.
4. Line 107: Space was lost before the reference.
5. Line 109: it is not clear to me to which the previous study are you alluding with the phrase:
“that was not included in the previous study”, please specify or provide the right citation.
6. Please add a space after the words Table or Figure presented in the text.
7. Please add a space between the methods and the results section.
8. Line 152: Space was lost before (.
9. Several lines (156, 162….) lack spaces within the text or the references.
10. Please add a space between the methods and the results section.
11. Please add a space between the discussion and the conclusion sections.