JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/s12876-025-04024-5 (2025)

Title: A Preliminary Exploration of a Predictive Model and Nomogram for the Efficacy of
Compound Digestive Enzyme Therapy Based on Serum (PG#, PG#, VIP, and PRDX1) in
Patients with Functional Dyspepsia
Version: 1 Date: 19 May 2025
Reviewer's report:
Author, thank you for your revision of the manuscript and your careful response to the review
comments.  I carefully reviewed the revised original manuscript and the author's point-to-
point responses.  The overall evaluation is as follows: This article is highly scientific, the
methodological design is generally reasonable, and the results have clinical significance.  The
rigor of the research design and the comprehensiveness of the statistical analysis make it have
certain academic value.  Overall, all the problems have been basically solved and no further
modifications are needed.
Review for 10.1186/s12876-025-04006-7 (2025)

Title: Relative Fat Mass and Risk of Metabolic Dysfunction Associated Steatotic Liver Disease
and Severe Hepatic Steatosis in U.S. Adults: Analysis of NHANES 2017–2020 Data
Version: 2 Date: 17 May 2025
Reviewer's report:
questions answered.
Review for 10.1186/s12876-025-04006-7 (2025)

Title: Relative Fat Mass and Risk of Metabolic Dysfunction Associated Steatotic Liver Disease
and Severe Hepatic Steatosis in U.S. Adults: Analysis of NHANES 2017–2020 Data
Version: 2 Date: 18 May 2025
Reviewer:  Amira A. A. Othman
Reviewer's report:
I want to extend my congratulations to all those involved in this work. All the required
amendments have already been made carefully and satisfactorily. I hope that the research will
be presented to science.
Review for 10.1186/s12876-025-04014-7 (2025)

Title: Comprehensive Analysis of Risk Factors and Nomogram Development for Predicting
Hepatic Metastasis Following Radical Resection of Adenocarcinoma of the Esophagogastric
Junction
Version: 1 Date: 17 Mar 2025
Reviewer's report:
This paper is well-written original article concerning the risk of postoperative liver metastasis
in patients with gastric cardia cancer. The objective of this study is very curious and important,
however, there are several points that remain unclear.
Comments;
#1 Does this study include adenocarcinoma of the esophagogastric junction (AEG)? For
transthoracic cases, does this imply that esophageal invasion was present?
#2 Was P53 evaluated using immunohistochemistry (IHC)? If so, details regarding the antibody
type and staining protocol should be described in the Methods section. What is the reason for
measuring Ki-67, and what cut-off value was used?
#3 What does "transthoracic gastrectomy" refer to in this study? Please clarify the specific
surgical procedure.
#4 This manuscript states that "The thoraco-abdominal approach is associated with more
postoperative complications, which may affect prognosis," however no complication data are
provided. The complication data is necessary to support this statement.
#5 The Discussion section currently describes each risk factor separately. To improve clarity
and coherence, it should be systematically structured with a summary, background knowledge,
comparison with previous studies, study limitations, and interpretation of the results.
Review for 10.1186/s12876-025-04010-x (2025)

Title: Comparative Efficacy of Gelatin Sponge, Microcoils, and NBCA in Arterial
Gastrointestinal Bleeding: A Retrospective Study
Version: 2 Date: 19 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03962-4 (2025)

Title: Effectiveness of an app-based walking program for obese patients with inflammatory
bowel disease in Korea: a single-blind parallel-group randomized clinical trial
Version: 2 Date: 20 Jan 2025
Reviewer's report:
The RCT is a unique study in itself. I appreciate the authors initiation for conducting and writing
a very comprehensive  and detailed article for the study.  While reading the article I found some
of the points that could be included in the study so that it would be more detailed.
1. in the CONSORT diagram, the total number of participants assessed and randomized are same
this may lead to sampling bias. As there are samples who are not coming in inclusion criteria
some may deny to take part in the study .  This need to be clarified and mentioned in the diagram.
and the consort diagram can be more informative.
2. Informed consent is required for RCT and it needed to be mentioned in the article as it is a
crucial point in RCT.
3. it has to be mentioned that the Control Group received the intervention after the study or not
as it is an ethical aspect to provide the same intervention to the control group after the study
is being conducted.
4. Please expand the abbreviations inn the text wnen it appear in the text first like CD.
5. Any studies on general population can be mentioned in the discussion as it will give a
generalized result.
6. Measures taken to reduce sampling bias and inclusion bias needed to be mentioned in the
article, as the same number of samples taken for assessment are randomized.
7. It is required to mention the blinding method   as the study is a single blind study.
Review for 10.1186/s12876-025-03962-4 (2025)

Title: Effectiveness of an app-based walking program for obese patients with inflammatory
bowel disease in Korea: a single-blind parallel-group randomized clinical trial
Version: 3 Date: 07 Apr 2025
Reviewer's report:
I thank the reviewers for careful review of the article. But some concerns are still there which
needed to be addressed.
-The researcher has taken randomization method for the study but still in the methodology the
method of randomization is not clear. that needed to be addressed.
-as it is a single blinded study the blinding method is not mentioned in the study which is a major
part of the methodology.
-the measures to reduce bias as this is a app based study and the persons all were techno save
they were well versed with the app. it was not mentioned that the app was made by the researcher
so that it may be only available to the intervention group.
The limitation did not contain the bias part that needed to be mentioned in the limitation part .
I wish all the best to the writer of the authors.
Review for 10.1186/s12876-025-03962-4 (2025)

Title: Effectiveness of an app-based walking program for obese patients with inflammatory
bowel disease in Korea: a single-blind parallel-group randomized clinical trial
Version: 3 Date: 07 Apr 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-03995-9 (2025)

Title: CD45+ erythroid progenitor cells as potential biomarkers for disease progression in
hepatitis B virus-related acute-on-chronic liver failure
Version: 0 Date: 04 Apr 2025
Reviewer's report:
This authors aimed to evaluate the impact of CD45 + erythroid progenitor cells (EPCs) on
disease progression of hepatitis B virus-related  HBV-ACLF. The subject is interested and
the findings may be significant for prediction of the prognosis of HBV-ACLF.  However, the
followings need to be considered:
1.  The abnormal coagulation function, such as markable  abnormality of prothrombin time (PT),
prothrombin time activity (PTA) and international normalized ratio (INR),  is the most common
manifestation and related with the progress of ACLF.   In this study, according to figure 2,  the
CD45+ EPCs were not correlated with the above markers, how to explate the results?
2. The conclusion should focus  the discussion on the mechanism and  important value  of the
findings, rather than literature review. Please enrich the content of the discussion.
3. In figure 2 and figure 3, there are multiple graphs showed no significant between the CD45+
EPCs with the blood markers or complications and outcome, I wonder whether the figures are
necessary to be displayed.
Review for 10.1186/s12876-025-03981-1 (2025)

Title: Accuracy of the diagnosis of gastroesophageal reflux disease by a trial of potassium-
competitive acid blocker treatment
Version: 2 Date: 15 Apr 2025
Reviewer's report:
This study investigated the accuracy of the P CAB diagnostic test for the diagnosis of GERD.
In this study, tegoprazan had a diagnostic sensitivity of 77.5% and specificity of 51.9%,  for
the diagnosis of GERD, using a 75% symptom improvement rate at 1 week after administration
as the diagnostic cutoff.  The P CAB responsiveness was compared endoscopy and pH
testing. Diagnostic sensitivity and specificity is better than previously reported accuracy of PPI
diagnostic tests
Minor comments
In this study, there were 4 patients with LA A erosive esophagitis among the patients categorized
as non-GERD. In the Lyon diagnostic criteria, LA A erosive esophagitis is not conclusive
evidence but inconclusive (borderline) evidence. Therefore, we cannot say with certainty that it
is not GERD. Would the results change if these four patients were excluded?
Excluding patients with Borderline GERD would improve diagnostic accuracy What are your
thoughts on this?
Review for 10.1186/s12876-025-03981-1 (2025)

Title: Accuracy of the diagnosis of gastroesophageal reflux disease by a trial of potassium-
competitive acid blocker treatment
Version: 2 Date: 18 Apr 2025
Reviewer:  Sergio Sobrino-Cossío
Reviewer's report:
Overall, the work meets all the requirements for publication. I would like to know why they
didn't compare patients with erosive esophagitis versus non-erosive patients with abnormal acid
exposure (AEA). This would allow us to understand the efficacy of AEA in subjects with AEA
in the distal esophagus.
Review for 10.1186/s12876-025-03789-z (2025)

Title: Effect of Synbiotics on the Cardiovascular Risk Factors in Patients with Non- alcoholic
Fatty Liver: A GRADE Evidence Systematic Review, Meta-analysis
Version: 0 Date: 30 Jan 2025
Reviewer's report:
The manuscript is well-structured and methodologically rigid, but addressing inconsistencies in
study selection, refining heterogeneity analysis, and improving clinical relevance discussions
would strengthen its impact.
In Section 3.1, Selection and Characteristics of Studies, the numbers do not seem to add up
correctly (full text: 17 - 3 - 1 = ?). Please verify and clarify the discrepancy.
Could you provide more details about the cohorts in Table 1? Specifically, including parameters
such as gender distribution, the type of symbiotic supplements used (bacterial strains, method of
bacterial cultivation), baseline comorbidities, and the classification criteria for NAFLD/NASH
severity. Additionally, would it be possible to conduct a subgroup analysis based on baseline
disease severity, NAFLD/NASH classification at enrollment, or variations in supplement types?
Given that many outcomes exhibit substantial heterogeneity (I² > 90%), could you discuss
potential key contributors to this variability for each outcome?
Can you provide additional evidence linking statistical significance to clinical relevance? While
the reductions in WC (5 cm) and SBP (10–20 mmHg) are mentioned as clinically meaningful,
could you extend this discussion to other parameters?
The discussion effectively compares findings with prior meta-analyses. However, differences in
study inclusion criteria (e.g., duration thresholds, population characteristics) should be compared
to explain conflicting results.
The figures should be refined and some should be rescaled, the error bars are not visible therefore
less informative.
Can you provide a list of full-text excluded articles in the supplementary files? This is customary
to meta-analysis.
Potentially over-stated claims that may need some modification
"Although other studies have been performed in this field, none were as comprehensive as ours.",
you may provide reasons.
"Overall, supplementation with synbiotics positively improved cardiovascular risk factors in
patients with NAFLD." "Synbiotics have improving and favorable effects on weight, WC, SBP,
DBP, CRP, TNF-a, TC, LDL-C, and TG.", you may refer to statistical significance but not
directly clinical significance in this preliminary reports of your findings.
Review for 10.1186/s12876-025-03789-z (2025)

Title: Effect of Synbiotics on the Cardiovascular Risk Factors in Patients with Non- alcoholic
Fatty Liver: A GRADE Evidence Systematic Review, Meta-analysis
Version: 0 Date: 31 Jan 2025
Reviewer's report:
This manuscript addresses an important topic regarding the effectiveness and safety of dietary
supplements in managing uric acid levels. Below are my comments and suggestions for
improvement:
General Comments
The manuscript presents a timely and relevant investigation into dietary supplements, given the
increasing prevalence of hyperuricemia and its associated health issues.
The research question is clearly defined, and the study aims are well-articulated.
Strengths
Comprehensive Review: The manuscript provides a thorough review of existing literature,
which helps contextualize the study within the broader field of dietary interventions for uric
acid management.
Methodological Rigor: The use of appropriate statistical methods for analysis adds credibility to
the findings. The network meta-analysis approach is particularly suitable for comparing multiple
interventions.
Areas for Improvement
Clarity in Methodology: While the methodology is generally sound, additional details regarding
the inclusion and exclusion criteria for studies would enhance transparency. A flow diagram
illustrating the selection process could be beneficial.
Statistical Analysis: More information on how heterogeneity was assessed and managed would
strengthen the manuscript. Additionally, discussing potential biases in the included studies
would provide a more nuanced understanding of the results.
Results Interpretation: The results section is well-organized; however, it would be helpful to
include more context regarding how these findings compare to existing literature. This would
aid readers in understanding the significance of the results.
Discussion of Limitations: While some limitations are acknowledged, a more in-depth
discussion regarding these limitations and their potential impact on the study's conclusions
would be valuable.
Clinical Implications: The practical implications of the findings should be emphasized more
clearly. Specific recommendations for healthcare providers based on the results would enhance
the manuscript's relevance to clinical practice.
Conclusion: The conclusion effectively summarizes key findings but should avoid making
overly broad claims without sufficient supporting evidence from high-quality studies.
Minor Comments
Ensure all references are up-to-date and formatted according to journal guidelines.
Consider revising some sections for clarity and conciseness to improve overall readability.
Final Recommendation
Overall, this manuscript provides valuable insights into dietary supplements' role in managing
uric acid levels. I recommend minor revisions to address the points raised above before it can be
considered for publication. Thank you for your important contribution to this field of research.
Review for 10.1186/s12876-025-03789-z (2025)

Title: Effect of Synbiotics on the Cardiovascular Risk Factors in Patients with Non- alcoholic
Fatty Liver: A GRADE Evidence Systematic Review, Meta-analysis
Version: 0 Date: 07 Feb 2025
Reviewer's report:
1) The introduction is well written, but it is too long and it should be shortened.
2) The methods section needs more explanations.
3) The search date should be updated.
4) What is your approach in searching for gray literature?
5) Data screening and selection should have kappa statistics between the authors
6)Please explain more about the strengths and limitations of this study
7) Please explain the method used to calculate publication bias and clarify how heterogeneity
among studies is assessed.
Review for 10.1186/s12876-025-03789-z (2025)

Title: Effect of Synbiotics on the Cardiovascular Risk Factors in Patients with Non- alcoholic
Fatty Liver: A GRADE Evidence Systematic Review, Meta-analysis
Version: 1 Date: 11 Mar 2025
Reviewer's report:
The manuscript presents a systematic review and meta-analysis assessing the effects of synbiotic
supplementation on cardiovascular risk factors in patients with non-alcoholic fatty liver disease
(NAFLD). The study is timely and addresses an important clinical question, given the increasing
prevalence of NAFLD globally. The authors have employed rigorous methodologies, including
adherence to PRISMA guidelines, use of the GRADE approach for evidence quality assessment,
and robust statistical analyses. However, several areas require improvement to enhance clarity,
scientific rigor, and presentation.
Strengths
Relevance: The topic is significant in addressing the role of gut microbiota modulation in
NAFLD management, which is a growing area of interest.
Methodological Rigor: The use of PRISMA guidelines, PROSPERO registration, and
comprehensive statistical techniques (e.g., meta-regression, sensitivity analysis) strengthens the
reliability of findings.
Transparency: The inclusion of detailed descriptions on study selection criteria, risk of bias
assessment, and publication bias evaluation adds credibility.
Focus on NAFLD: Unlike previous meta-analyses that target broader populations, this
manuscript specifically focuses on NAFLD patients, providing more targeted insights.
Conclusion
The manuscript is a valuable contribution to understanding the role of synbiotics in managing
cardiovascular risk factors among NAFLD patients.
Review for 10.1186/s12876-025-03789-z (2025)

Title: Effect of Synbiotics on the Cardiovascular Risk Factors in Patients with Non- alcoholic
Fatty Liver: A GRADE Evidence Systematic Review, Meta-analysis
Version: 1 Date: 11 Mar 2025
Reviewer:  Ali Jafari
Reviewer's report:
Thank you for taking the time to respond. My concerns have been addressed, and the article is
now ready for publication.
Review for 10.1186/s12876-025-03991-z (2025)

Title: Neutrophil-Derived Ratios as Predictors of Short-Term Mortality in HBV-Associated
Decompensated Cirrhosis
Version: 0 Date: 27 Mar 2025
Reviewer's report:
Xiang and colleagues present an interesting retrospective observational study about the
performance of several new blood-cell based composed inflammation indices for discriminating
HBV-associated decompensated cirrhosis, a fatal liver infectious disease caused by Hepatitis-B
virus. The statistical design is valid and the results interesting. However, I have some suggestions
to make to improve the quality of the manuscript.
1) Why did the author choose 30 days as the research endpoint (rather than 3 month, 6 month
or 1 yr mortality)? Please, justify.
2) Moreover, authors should provide the causes of mortality.
3) Had the patients received antiviral HBV therapy? If yes, which?
4) What is the HBV prevalence? How many clinical records did the authors browse? What was
the time frame (month and year)?
5) Limitations of the study should be reported in a more extensive way, including the lack of
a validation cohort.
Review for 10.1186/s12876-025-03990-0 (2025)

Title: Prevalence-based Screening by Anti-HCV Reflex HCV Antigen Test and Accessible Post-
screening Care towards Elimination of Hepatitis C in Rural Villages
Version: 1 Date: 15 Feb 2025
Reviewer:  Federico García
Reviewer's report:
The authors present an interesting strategy to reach the infected population in rural villages using
reflex testing based on core antigen.
Minor comments:
Only around 15% of the population was screened. Given the high prevalence of chronic active
HCV, please discuss possible reasons for this low uptake and suggest measures to improve it.
The way the results are presented is confusing. In the abstract, it appears that 75 patients were
HCV Ag positive, while the actual number was 125. The figure of 75 corresponds to the number
of patients who attended the outreach clinic. Additionally, only six of the 125 viremic patients
were not linked to care. These results should be presented more clearly.
The strategy can only be implemented using the Abbott testing platform, as no other major
laboratory provider offers both anti-HCV and HCV core antigen testing within the same
platform. Please discuss.
HCV RNA levels and HCV genotype distribution are reported in the results section; however,
there is no corresponding description in the methods section. Please provide this information.
Although I agree with the conclusion that "We also verified that the HCV antigen assay is a
reliable tool for identifying viremic patients," I believe that no results in the study support this
statement. Since there is no HCV-RNA testing for patients who are anti-HCV positive but HCV
antigen negative, the authors cannot rule out the possibility that some patients with low-level
HCV-RNA may have been missed.
Review for 10.1186/s12876-025-03990-0 (2025)

Title: Prevalence-based Screening by Anti-HCV Reflex HCV Antigen Test and Accessible Post-
screening Care towards Elimination of Hepatitis C in Rural Villages
Version: 1 Date: 23 Mar 2025
Reviewer:  Joaquín Cabezas
Reviewer's report:
The authors nicely demonstrate the utility of HCV diagnosis with reflex test based on antibody
and core HCV-Ag which makes a great sense to reduce costs and improce accesibility.
Main concerns:
- Where all HCV-core Ag positive tested for HCV-ARN. Then, when treated, where they tested
with HCV core Ag to demonstrate SVR?
- Regarding screening rate, any barriers description? Important  to discuss in the manuscript
limitations.
- Data comes from 2020-2021 - is there any updated information to nowadays? or any data
regarding the impact of this study in the prevalence of hepatitis C?
- Any data on infected patients for elastografy if available?
- There is info on HBV, any on HIV?
Figures: I suggest to include a care cascade bars plot: from screening rate, to testing, testing
positive, treatment rate and SVR rate to make it ease to reference o cite the study, as well as
comparable to other strategies.
Review for 10.1186/s12876-025-03990-0 (2025)

Title: Prevalence-based Screening by Anti-HCV Reflex HCV Antigen Test and Accessible Post-
screening Care towards Elimination of Hepatitis C in Rural Villages
Version: 2 Date: 16 Apr 2025
Reviewer:  Federico García
Reviewer's report:
Thank you for addressing the queries/suggestions I provided
Review for 10.1186/s12876-025-03990-0 (2025)

Title: Prevalence-based Screening by Anti-HCV Reflex HCV Antigen Test and Accessible Post-
screening Care towards Elimination of Hepatitis C in Rural Villages
Version: 2 Date: 02 May 2025
Reviewer:  Joaquín Cabezas
Reviewer's report:
The authors have perfectly addressed reviewers' criticisms. The paper looks good and improved
impact and readability.
Review for 10.1186/s12876-025-04002-x (2025)

Title: Ascites Complications Risk Factors of Decompensated Cirrhosis Patients: Logistic
Regression and Prediction Model
Version: 0 Date: 12 Aug 2024
Reviewer's report:
First of all, I would like to thank the authors for their manuscript. The topic is very interesting
and I was very happy to read it. However, I don’t think that the manuscript in its present form
is ready for publication. I believe that there are some problems both with the methodology and
with the writing. Here I report my suggestions that I hope could help improving the work.
- I believe that the setting in which the analysis was made is well characterized. I understood that
they’re all inpatients with decompensated cirrhosis and discrimination between patients with and
without ascites is made at discharge. However, the reason for hospitalization is not very clear.
Are they hospitalized for an Acute Decompensation? If so, which type of decompensation? How
many patients had no signs of ascites at inclusion and developed it during hospital stay? Was
it subsequent to another decompensation?
- How many patients had previous decompensating event before the index hospitalization?
Further decompensation is known to have worse impact on prognosis than first decompensating
event
- Moreover, patients were diagnosed with ascites when they had at least 200 ml of intrabdominal
fluid. Therefore I believe that some of them had Grade 1 ascites, for which at present time there is
no treatment indication and that for the scarce present literature have no grater risk than patients
with no ascites of developing overt ascites. Therefore I believe that the authors should do a sub-
analysis excluding patients with Grade 1 ascites.
- How were patients with ascites treated?
- How many patients with ascites developed SBP and/or AKI? These complications could
worsen the prognosis of patients with ascites.
- Is it possible to calculate MELD score for the patients? I believe it’s pretty obvious that patients
with ascites had worse Child Pugh values since ascites is one of the components.
- How many patients with varices were treated with NSBBs?
- Finally, I suggest a revision in the writing of the manuscript. The introduction is way to long
and conveys messages related to the findings of the study that should be moved in the discussion
section. Methods’ section should be revised in order to make the setting clearer. There are
some abbreviations that are used once, and the non-abbreviated term is then used throughout
the text. I also suggest a revision of the references. For example, authors state that diagnosis of
decompensated cirrhosis is according to EASL CPGs. However, those are never cited in the text.
Review for 10.1186/s12876-025-04002-x (2025)

Title: Ascites Complications Risk Factors of Decompensated Cirrhosis Patients: Logistic
Regression and Prediction Model
Version: 0 Date: 09 Mar 2025
Reviewer's report:
The study presents an interesting predictive model for ascites development.
Although cohort size is small, the results seem quite usefull.
There are some issues that need to be solved though:
1. Line 97: The state regarding MAIT cells needs better explanation. It seems irrelevant
otherwise.
2. Line 179: Child-Pugh classification is 5-6 class A , 7-9 class B , and 10-15 class C.
3. Line 189: There are revisions of Declaration of Helsinki, last one on 2024.
4. Line 221: The correct Child-Pugh classification needs to be presented.
5. In general Introduction and Discussion have a lot in common. The text needs revision.
6. Line 443: Reference 21 & 22 are the same.
7. Figure 4 nomogram needs better legend that explains what it shows.
Review for 10.1186/s12876-025-04002-x (2025)

Title: Ascites Complications Risk Factors of Decompensated Cirrhosis Patients: Logistic
Regression and Prediction Model
Version: 2 Date: 24 Apr 2025
Reviewer's report:
The authors proceeded to the requested changes.
The manuscript seems more precise and has coherence.
It worths publishing.
Review for 10.1186/s12876-025-03972-2 (2025)

Title: Correlation analyses of ultrasonographic and histopathological characteristics of porta
hepatis lymph nodes in biliary atresia
Version: 0 Date: 27 Jan 2025
Reviewer's report:
Firstly, I congratulate you on your work.
Recommendations:
1- Demographic characteristics that may affect inflammatory cell migration in lymph nodes,
lymphocyte counts in peripheral blood at the time of operation
2- Patient age at the time of operation (mo),
3- Patients' bilirubin level, parameters that may be related to infection
With the addition of these parameters to the study, I believe that this study, which mostly
contains pathological data, can give correlated results with the clinic and subgroups can be
formed in which more meaningful statistical results can be obtained.
Review for 10.1186/s12876-025-03972-2 (2025)

Title: Correlation analyses of ultrasonographic and histopathological characteristics of porta
hepatis lymph nodes in biliary atresia
Version: 0 Date: 28 Jan 2025
Reviewer's report:
Authors provided sufficient information in material and methods for the analyses of the
correlation of ultrasonographic and histopathological characters of porta hepatic LNs.
-It is quite odd to provide a control group with completely different features in all aspects from
the study group in terms of age, gender and laboratory data. The fact that the control group has
choledochal cyst and the study group has biliary atresia which BA demonstrated significantly
more hepatic fibrosis and lymphocyte infiltration in all cell types seemed straight forward, is
there a reason to compare these two groups?
-The manuscript referred to supplementary table 1-8 whereas the supplementary tables were
named S1-S8.
-Table S2 "(days)" should be after "Age"
-Table S3 named "Pathological features of hepatic portal LNs in the BA group" while PHLN
(porta hepatis LN) throughout the manuscript.
-The abbreviations and their meanings used : , ; inconsistently.
-In the study of degrees of lymphocyte infiltration, most tables used "Manifold area" is that the
same as portal area used in the manuscript?
-Manuscript line 251-252 misspelled "fibrosis"
-It is interesting to find larger areas and higher numbers of germinal centers in PHLNs, along
with a high number ofCD8+ T lymphocytes in the livers of patients with BA correlating to
a higher degree of liver fibrosis and inflammation. Also that a greater number of CD8+ T
lymphocytes in the livers of patients with BA associated with a  worsen jaundice reduction after
surgery.  All of which differed from previous studies by Zhang et al, Ahmed et al. and Derkow et
al. On the contrary, according to supplementary table S6, CD3+ and CD4+ T cells and CD20+ B
cells were more infiltrated in the portal area than in the hepatic lobes which portal area is where
the bile ducts were destroyed. Any comments on these differences?
-CD8+ T cells and pathological size of the PHLNs were the only 2 factors associated with
poor prognosis after portoenterostomy, however the authors concluded that the enlarged PHLN
may predict the prognosis of KPE which the ultrasonographic size did not show significant
association.
-Some of the reference paragraphs were distributed too wide.
Review for 10.1186/s12876-025-03972-2 (2025)

Title: Correlation analyses of ultrasonographic and histopathological characteristics of porta
hepatis lymph nodes in biliary atresia
Version: 0 Date: 30 Jan 2025
Reviewer's report:
This manuscript clarifies that the ultrasonographic evaluation of PHLNs reflects their
pathological features and the liver as well as serum level of direct bilirubin in BA (echogenicity
vs. the number of bile granules, ultrasound and pathological size vs. the number of germinal
centers). The authors also showed that the pathological size of PHLNs correlated with the
number of CD8+ T cells especially in the hepatic lobules and the portal area in BA. However,
there was no significant correlation between the number of bile granules in PHLNs and the
proportion of lymphocytes in the liver. They also showed that they are negatively correlated
with the reduction of jaundice three months after KPE and concluded the severity of liver bile
duct injury could be reflected by the size of LNs.
There are some questions about undefined terms. This paper deserves publication in this journal
if these questions below are addressed.
1. Line 148-151
Please define the bile granules and bile particles.
2. Line 214
The authors stated that bile-stained macrophages are also one of the main factors contributing
to the enlargement of PHLNs.
First of all, how did the authors define these cells as macrophage? As the authors themselves
stated that there was no significant correlation between the number of bile granules in PHLNs
and the proportion of lymphocytes in the liver, it is hard to think that bile-stained macrophages
are antigen-presenting, eliciting immune response. They might be just the cells, phagocytosing
bile pigment. As the authors observed that germinal centers of PHLNs are correlated with the
degree of infiltration of CD8+ cells in the hepatic lobule and portal area, swollen PHLNs are
most likely to be the result of proliferation of CD4+, CD8+ T cells in the paracortical area and
activated B cells in the germinal centers.
3. Line 221
There is such a statement as “we showed that the enlargement of the pathological area of PHLNs
in BA reflected the presence of fibrosis in the liver”.  However, I could not find any findings in
result of this paper leading such a conclusion. Please show any evidence for this description.
4. TableS2
The unit of gender is described as (days), while the unit of age is blank. Please Correct it.
5. Table 3
In contrast to the medical term that the author used for “the portal areas” in the text, the term of
“manifold areas” is used instead in the table. Are these terms hold the same meaning? What is
the intention for the author to use these terms differently?
Review for 10.1186/s12876-025-03972-2 (2025)

Title: Correlation analyses of ultrasonographic and histopathological characteristics of porta
hepatis lymph nodes in biliary atresia
Version: 1 Date: 21 Apr 2025
Reviewer's report:
I appreciate a very clear and well organized response from the authors. All of my comments and
concerns were addressed accordingly. Congratulations again on these interesting results from
your study. I have no further questions.
Review for 10.1186/s12876-025-03987-9 (2025)

Title: Evaluation of Post-market Adverse Events of Lubiprostone: A Real-World Adverse Event
Analysis from the FAERS Database
Version: 4 Date: 23 Apr 2025
Reviewer's report:
I would like to thank the authors for their thoughtful and comprehensive revisions. The
manuscript has been significantly improved in both clarity and content. The authors have
adequately addressed the previous concerns, particularly with respect to the limitations of the
FAERS database, the methodology for signal detection, and the contextualization of novel
findings within the broader literature.
The expanded discussion now appropriately frames the findings as hypothesis-generating rather
than conclusive, and the added detail on data cleaning and signal validation enhances the
transparency and robustness of the analysis. Language and formatting have also been improved
throughout.
Given the strength of the revisions and the overall quality of the work, I now find the manuscript
suitable for publication.
Review for 10.1186/s12876-025-03987-9 (2025)

Title: Evaluation of Post-market Adverse Events of Lubiprostone: A Real-World Adverse Event
Analysis from the FAERS Database
Version: 4 Date: 28 Apr 2025
Reviewer:  Sheza Malik
Reviewer's report:
Thank you for submitting the revised version of your manuscript titled "Evaluation of Post-
market Adverse Events of Lubiprostone: A Real-World Adverse Event Analysis from the
FAERS Database."
We greatly appreciate the diligent and thoughtful revisions made in response to the reviewers'
and editorial comments. Your detailed point-by-point responses and the improvements
implemented in the revised manuscript have substantially strengthened the quality, clarity, and
scientific rigor of your work. Specifically, we commend the following enhancements:
Comprehensive Acknowledgement of FAERS Limitations: You have appropriately discussed
the limitations of spontaneous reporting databases, including underreporting, reporting biases,
and lack of causality, thus ensuring responsible interpretation of findings.
Detailed Methodological Clarifications: Clear descriptions of data extraction, de-duplication
methods, signal detection thresholds across multiple algorithms (ROR, PRR, BCPNN, EBGM),
and data cleaning procedures have greatly improved methodological transparency.
Robust Contextualization within Existing Literature: The discussion now thoughtfully compares
your findings with prior clinical trial data, approved labeling information, and previous
pharmacovigilance reports, situating your study within the broader safety landscape for
lubiprostone.
Balanced Interpretation of Rare Signals: The conclusions have been appropriately tempered
to highlight that findings are hypothesis-generating, and not indicative of confirmed causality,
particularly regarding rare events like ischemic colitis and gastric fistula.
Enhanced Discussion Organization and Clarity: The Discussion has been restructured to better
summarize key findings, discuss novel signals in context, and flow logically from general
findings to implications and limitations.
Improved Language, Terminology, and Formatting: The manuscript now uses standard medical
terminology, maintains consistency in abbreviations, and presents data in a more reader-friendly
manner across tables and figures.
Additional Analysis and Data Presentation: Subgroup analyses by sex and age, expanded
evaluation of gastrointestinal side effects, and explicit mention of dose-related differences in
adverse events have all enriched the results.
Review for 10.1186/s12876-025-04016-5 (2025)

Title: The effect of chewing gum on postoperative ileus after laparotomy for gastroduodenal
perforations: A randomized controlled trial.
Version: 2 Date: 13 Jun 2024
Reviewer:  Akira Umemura
Reviewer's report:
Mastication after abdominal surgery is very important to hasten postoperative recovery, and this
concept has been included in the ERAS protocol. On the other hand, you have to introduce MIS
in upper gastointestinal perforation in clinical practice.
Review for 10.1186/s12876-025-04016-5 (2025)

Title: The effect of chewing gum on postoperative ileus after laparotomy for gastroduodenal
perforations: A randomized controlled trial.
Version: 2 Date: 17 Jun 2024
Reviewer's report:
This study evaluated the effect of chewing gum on the postoperative ileus which develop after
laparotomy for gastroduodenal perforations. The results demonstrated that chewing gum shorten
the duration of post-operative ileus and the length of hospital stay. Although the sample size is
relatively small, the outcome assessors were blinded about this trial, and these findings are likely
valid. On the other hand, since relatively more patients in chewing gum group had leakage and
burst abdomen, it is difficult to interpret the outcomes regarding the superiority of chewing gum.
Major points
1.The resolution of postoperative ileus and the timing of discharge is also affected by the degree
of inflammation including peritonitis and SIRS as well as postoperative complications, but the
findings of inflammation during or after surgery is not evaluated. Furthermore, according to the
protocol, postoperative antibiotics are supposed to be administered for 5 days, but some patients
discharged before POD5.
2.This study did not evaluate the type of surgical procedure, which can affect the postoperative
course. In addition, resumption of oral take after surgery of gastroduodenal perforations may be
complicated compared to other surgeries, which should be described.
Review for 10.1186/s12876-025-04016-5 (2025)

Title: The effect of chewing gum on postoperative ileus after laparotomy for gastroduodenal
perforations: A randomized controlled trial.
Version: 2 Date: 17 Jun 2024
Reviewer:  Yoichi Nakagawa
Reviewer's report:
Thank you for your manuscript.
In the manuscript, the authors discuss the effect of chewing gum on postoperative ileus. The main
contribution of the paper is that gum chewing reduces postoperative ileus even after laparotomy
for gastroduodenal perforations. The authors made a good attempt to evaluate this clinical
question by a randomized controlled trial. This study area and methods are overlapped previous
study such as “Effect of chewing gum in reducing postoperative ileus after gastroduodenal
perforation peritonitis surgery: A prospective randomised controlled trial” by Sanjay Muwel,
et al.; however, I believe that this paper can contribute in some way to the postoperative
management of gastroduodenal perforations.
Minor comments
Table1
The authors present categorical variables as n (% in raw) in each group. It is just a matter
of preference, but I found the numbers presented as n (% in raw) a bit confusing. I would
recommend describing the numbers as n (% in each group). For example, Male 22 (85%)/Female
4 (15%) in chewing gum group.
Surgery
The authors provide the site of perforation at surgery, but I would recommend adding details of
the surgery, e.g. procedure (bowel resection, simple suture, omental patch closure, etc).
Review for 10.1186/s12876-025-04016-5 (2025)

Title: The effect of chewing gum on postoperative ileus after laparotomy for gastroduodenal
perforations: A randomized controlled trial.
Version: 3 Date: 25 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The term "prolonged postoperative ileus" (PPOI) is used inconsistently. While it is defined
earlier in the text, the abbreviation “POI” appears to be used more frequently throughout the
study, and it might cause confusion. It would be helpful to standardize the terminology to avoid
ambiguity.
-The mention of Enhanced Recovery After Surgery (ERAS) protocols is important but feels
slightly underdeveloped. The authors state that ERAS measures have been shown to shorten
POI in elective surgeries but provide no evidence or explanation for their lack of application
in emergency cases. Given the focus of this study on emergency surgery, further elaboration
on how ERAS components could relate to chewing gum would help to contextualize this in the
existing framework for postoperative care.
-While the introduction emphasizes the benefits of chewing gum (e.g., reducing POI duration
and hospital stay), it would be helpful to mention any potential risks or limitations of this
intervention, even if minimal. For instance, issues such as difficulty chewing, poor tolerance
among patients, or possible concerns for patients with gastrointestinal issues (e.g., strictures,
obstructions) could be mentioned briefly to present a more balanced view.
-The introduction mentions that many hospitals in low-income countries still face challenges
such as access to minimally invasive surgery, but does not fully explore how this context might
affect the feasibility of implementing chewing gum as an intervention. It would be beneficial
to link the low-cost and readily available nature of chewing gum to the resource constraints in
these settings to underscore its potential value in such environments.
-It would be beneficial to include a brief mention of how tolerance to chewing gum was
monitored. For instance, were any participants unable to tolerate chewing gum, and how were
these instances handled? This is an important consideration given that some patients may
struggle with oral intake or have contraindications for early feeding.
-Although the authors note that complications were not statistically significant, the discussion
could benefit from more detailed exploration of why certain complications (e.g., burst abdomen
and leakage) were more common in the control group. Were there any patient-specific factors
(e.g., age, comorbidities, pre-existing nutritional status) that could explain these complications?
-Given that gum chewing was hypothesized to stimulate bowel motility and reduce
inflammation, it would be useful to discuss whether these mechanisms could have indirectly
influenced the risk of complications. For example, chewing gum could have led to improved
motility and better gut perfusion, reducing the incidence of bowel anastomosis leakage or
abdominal distension.
Review for 10.1186/s12876-025-04016-5 (2025)

Title: The effect of chewing gum on postoperative ileus after laparotomy for gastroduodenal
perforations: A randomized controlled trial.
Version: 3 Date: 26 Dec 2024
Reviewer:  Akira Umemura
Reviewer's report:
The  authors have described a case of PPCCC complicated with peptic ulcer disease. However,
I do not have any ideas about direct relationships between PPCCC and peptic ulcer disease.
Simply complicated situation can not bring scientific findings for readers. The authors have to
investigate this issue more concisely.
In addition, there are too few figures for readers. The highlight of this article is intraoperative
findings and pathological examinations. They have to present these findings by more pictures.
Moreover, treatment of ulcers should be presented by figures.
They concluded that immediate  multidisciplinary efforts are essential for cases like this case.
It is not the conclusion you should emphasize.
Review for 10.1186/s12876-025-04016-5 (2025)

Title: The effect of chewing gum on postoperative ileus after laparotomy for gastroduodenal
perforations: A randomized controlled trial.
Version: 3 Date: 26 Dec 2024
Reviewer:  Yoichi Nakagawa
Reviewer's report:
The manuscript has been revised well.
Review for 10.1186/s12876-025-04016-5 (2025)

Title: The effect of chewing gum on postoperative ileus after laparotomy for gastroduodenal
perforations: A randomized controlled trial.
Version: 3 Date: 28 Dec 2024
Reviewer's report:
I believe the author has clearly responded to the question. I have no comments to add.
Review for 10.1186/s12876-025-04016-5 (2025)

Title: The effect of chewing gum on postoperative ileus after laparotomy for gastroduodenal
perforations: A randomized controlled trial.
Version: 4 Date: 14 May 2025
Reviewer:  Akira Umemura
Reviewer's report:
The authors have revised their manuscript along with reviewers’ comments and suggestions.
Review for 10.1186/s12876-025-04016-5 (2025)

Title: The effect of chewing gum on postoperative ileus after laparotomy for gastroduodenal
perforations: A randomized controlled trial.
Version: 4 Date: 14 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
The responses are satisfactory
Review for 10.1186/s12876-025-04016-5 (2025)

Title: The effect of chewing gum on postoperative ileus after laparotomy for gastroduodenal
perforations: A randomized controlled trial.
Version: 4 Date: 16 May 2025
Reviewer:  Yoichi Nakagawa
Reviewer's report:
The manuscript has been revised well. I think this manuscript will be acceptable.
Review for 10.1186/s12876-025-03998-6 (2025)

Title: Aggregate index of systemic inflammation tied to increased fatty liver disease risk:
insights from NHANES data
Version: 2 Date: 06 Apr 2025
Reviewer:  Hyungjune Ku
Reviewer's report:
My primary concern is the potential of the selection bias  in this study. The clinical guideline
may differ between nations and even institutions. But generally, patients with higher probability
of having FLD is more prone to undergo fibroscan. Therefore, the studied population after
application of exclusion criteria which excluded significant portion of sample patients due to
missing CAP data may have brought bias to the results of the study.
Although, I understand that this is inevitable to some extent due to the retrospective nature of
the study design. However, since the size of the excluded sample population is so large, it is
worth mentioning this in the maunscript for the minor revision.
Review for 10.1186/s12876-025-03998-6 (2025)

Title: Aggregate index of systemic inflammation tied to increased fatty liver disease risk:
insights from NHANES data
Version: 3 Date: 04 May 2025
Reviewer's report:
The authors have significantly strengthened the manuscript in response to my feedback.
The only substantive gap is the lack of head-to-head comparison between the proposed AISI-
inclusive nomogram and established FLD risk scores (e.g., Fatty Liver Index, Hepatic Steatosis
Index). Demonstrating whether the nomogram improves upon these widely used tools would
solidify its clinical value.
Review for 10.1186/s12876-025-03998-6 (2025)

Title: Aggregate index of systemic inflammation tied to increased fatty liver disease risk:
insights from NHANES data
Version: 3 Date: 04 May 2025
Reviewer:  Amira A. A. Othman
Reviewer's report:
The updated manuscript shows sincere and commendable effort in addressing the reviewer's
concerns. Including critical elements such as ICA-AKI criteria, renal biomarkers, and Doppler
results brings useful depth to the research. However, there is still a need for some critical
clarifications to strengthen the manuscript further. Specifically, we would like the authors to
clearly state the absence of follow-up after long periods and point-of-care volume measurements
(e.g., POCUS) as study limitations, and to elaborate a bit on the consideration of nephrotoxic
drug exposures. These revisions will not only help to enhance the scientific transparency of
the report but also guide future studies in this worthwhile area. We believe the manuscript is
nearly complete, and we look forward eagerly to seeing a version that fully incorporates these
considerate revisions.