Review for 10.1186/s12876-020-01244-9 (2020)

Reviewer’s report
Title: Functional constipation masked as irritable bowel syndrome
Version: 0 Date: 29 Jan 2020
Reviewer: Francesca Galeazzi
Reviewer's report:
RE: Manuscript  BMGE-D-19-01142
Author: Monica Tosto et al
TITLE: Functional constipation masked as irritable bowel syndrome
The present paper addresses the management of IBS-D and IBS-M in children, aiming to verify the
hypothesis of an underlying functional constipation in these patients. The topic is interesting and could
lead to a different work up and management of these young patients. 
However, some important issues need to be clarified: 
1. The sample is very limited (10 patients in IBS D and 16 in IBS M) and imbalanced in gender (9
males vs 1 female in IBS-D) and age distribution (9.5 - 18 yrs in IBS-D). 
It is well known the IBS is more prevalent in the female population, and hormonal and psychological
factors play a pivotal role in the pathophysiology; as well, the placebo effect cannot be ruled out in
such a small population. 
2. The authors do not describe a control group (patients with IBS-D / IBS-M and suspected occult
constipation untreated) 
3. Symptoms have been investigate using a validated questionnaire? 
4. Diet habits have been investigated? Diet may substantially vary between 9 yrs and 18 yrs of age 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
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No conflict of interest
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