Review for 10.1186/s12876-015-0229-y (2015)

Reviewer's report
Title:Characteristics and factors related to quality of life in Mexican Mestizo
patients with celiac disease.
Version:2Date:3 October 2014
Reviewer: Anna Myléus
Reviewer's report:
- Major Compulsory Revisions
1. I think the aim of the paper could be made clearer. Moreover, if also including
the aspect to assess clinical features and QoL at two points in time it would be
more reflective of the paper.
2. The paper assesses symptoms and QoL in CD patients both before and after
diagnosis. However, it is not always clear whether the results refer to the current
status (i.e. diagnosed with CD and recommended a GFD) or retrospective report
of previous status (i.e. prior to diagnosis). Please clarify the design in the
beginning of the methods section and throughout the methods and results make
clear to which status the findings refer. This needs to be clarified also in the
abstract.
3. I think one thing which could help to make it easier to read would be to
organize the different measurements (EQ5D, CSI, HAD etc) in the same order
both in the methods section and results section.
4. Materials and methods. The authors describe that CD cases were
consecutively enrolled during a period of time. In total, 80 CD patients were
included. How many were excluded and why?
5. When assessing symptoms prior to diagnosis it would be of great interest to
know how long recall period it is. What was the mean and range of time since CD
diagnosis?
6. Diagnosis of CD was made by following established criteria. However, it would
be of interest to see how many cases were diagnosed by using serological
markers only and how many were biopsied.
7. I would suggest a table presenting basic characteristics of the included CD
patients. That table could also include symptoms prior to diagnosis (Result
section first paragraph line 148-153).
8. Methods, second paragraph. Regarding symptoms prior to CD diagnosis, was
this an open ended question or were there alternatives given? If the latter, which
symptoms were asked for? Please give more details.
9. Methods, third paragraph, Results, paragraph 6 and Table 2. Regarding the
Celiac Symptom Index (CSI). According to the developers of this scale it sets out
to measure CD-specific health or disease-specific symptoms. Although a high
score was associated with poor QoL, the CSI does not measure QoL and cannot
be used as a instrument for QoL. Please revise and indicate that this instrument
measures symptoms or CD-specific health.
10. Discussion first paragraph. Reference 13 and 14 are both prevalence studies
from US but are used as suggesting that CD is common worldwide. I would
suggest adding also a reference from a recent review summarizing CD
occurrence in other parts of the world.
11. Discussions paragraph four. I suggest removing this paragraph from the
discussion as you did not analyze HLA-DQ2/8 in the study. Parts regarding
occurrence of HLA-DQ2/8 in Mexico and thus relevant for the paper could be
integrated into the introduction.
12. Discussion paragraph seven (line 242). While EQ-5D is a generic HRQoL
instrument the HAD instrument measures depression and anxiety and not
HRQoL in general. I suggest that the different instruments used are not groups
as QoL instruments as they are not. The findings from the scales might suggest
that Mexican patients with CD have low QoL but this is a suggestion based on
other scores and not measured directly other than with EQ-5D.
13. Discussion paragraph seven (line 246). There are only 2 studies using EQ5D
in CD, to my knowledge. I suggest that you also compare your findings with
Nordstrom et al (reference 3).
14. Discussion paragraph seven (line 256). It would be interesting to see gender
differences in the result section also for EQ-5D (as this measured QoL).
15. Limitations, what are the routines in Mexico for treatment of CD and visits to
the hospital? Could it be possible that there is a selection bias towards those who
feel worse and therefor seek medical care?
- Minor Essential Revisions
1. Abstract first line, it is not a complete sentence before the comma and I
believe that prevalence is underestimated in most populations, not only some.
2. Please use abbreviations consistently. For example line 71 coeliac disease,
line 75 quality of life, line 187 health related QoL.
3. Anti-tissuetransglutaminase (tTG-IgA) should be added to the abbreviation list.
4. Journal style, the reference should come before the punctuation and not after.
5. Reference 20 is the same as reference 4
6. Line 262-263. Anxiety and depression added twize.
7. Line 280. Gluten free diet to be removed.
8. Please use references also in the discussion paragraph on GFD (line 273) to
back up your statements.
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: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare I have no competing interests