Review for 10.1186/1471-230X-13-145 (2013)

Reviewer's report
Title:Possible etiology of improvements in both quality of life and overlapping
gastroesophageal reflux disease by proton pump inhibitor treatment in a
prospective randomized controlled trial
Version: 1Date:6 August 2013
Reviewer: Edoardo Savarino
Reviewer's report:
Summary and Comments
The article entitled "Possible etiology of improvements in both quality of life and
overlapping gastroesophageal reflux disease by proton pump inhibitor treatment
in a prospective randomized controlled trial” by Monnikes et al. is a study
designed to evaluate the correlation of
symptomatic relief and health-related quality of life (HRQoL) with healing of reflux
esophagitis in a large series of prospectively enrolled patients with GERD. .
The main results of the investigation are that symptoms assessed by
ReQuestTM questionnaire substantially decreased from baseline to end of
treatment by about 85% in both treatment groups, whereas quality of life,
assessed by HRQoL, substantially increase from baseline to end of treatment as
well. Thus, the Authors concluded that pantoprazole is effective in relieving
functional symptoms overlapping with erosive esophagitis, and provides
sustained improvement in HRQoL post-treatment.
The main idea of the study is interesting, although lacks of originality since
different recent studies already underlined as the response to PPI therapy in
patients with reflux disease may be largely affected by overlapping functional
symptoms (Gut. 2012 Apr;61(4):501-6; Gut. 2009 Sep;58(9):1185-91). Moreover,
the manuscript is very difficult to read and follow. I believe that it should be at
least simplified and shortened in order to help readers in understanding the
results as well as the conclusions.
Major Compulsory Revisions:
1. Introduction. Please, cite more recent manuscript describing the frequent
overlap between reflux disease and FD or IBS (Gut. 2012 Apr;61(4):501-6; Gut.
2009 Sep;58(9):1185-91). Indeed, since the main aim of the investigation is to
study the effect of PPI on reflux symptoms and esophageal lesions, and then the
effect of PPI on functional symptoms and quality of life, the Authors should “start”
from GERD and then moving to FD or IBS and not the contrary.
2. Introduction. It is well known that the large majority of patients with reflux
disease are affected by Non-Erosive Reflux Disease (Nat Rev Gastroenterol
Hepatol. 2013 Jun;10(6):371-80) and only a minority may present with erosive
esophagitis. Thus, the sentence “…a patient population that closely resembles
the general population,….” appears really misleading and this concept should be
deleted from the introduction and from the discussion sections.
3. Introduction. Third paragraph (from cumulative to IBD) is really difficult to
understand. Please, try to simplify these concepts.
4. Results. Do you have endoscopic data on erosive esophagitis relapse after
PPI suspension. No data are present in medical literature assessing this topic
and this data would be very interesting for the readers.
5. Discussion. It should be shortened and simplified.
Level of interest: An article of limited interest
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