Review for 10.1186/s12876-016-0525-1 (2016)

Reviewer ’s report  
Title : Motility Characteristics in The Transition Zone in Gastroesophageal Reflux Disease 
(GORD) patients  
 
Version:  0 Date : 08 May 2016  
 
Reviewer : Mentore Ribolsi  
 
Reviewer's report:  
This investigation is aimed to transition zone (TZ) defect in GERD patients as well as to explore 
the relationship between transition zone defect and bolus transit. The  Authors studied 101 
patients with reflux symptoms and 20 healthy controls with upper gastrointestinal endoscopy, 
HRM combined with esophageal impedance and 24 -h ambulatory multichannel impedance pH 
monitoring. Patients were, thereafter, divided into reflu x oesophagitis (RE), Non -erosive Reflux 
Disease (NERD), hypersensitive oesophagus and functional heartburn (FH) group. According to 
the results, in liquid swallows, TZ were similar for length and duration among the groups. 
However, individuals with TZ defe ct had lower complete BT rates compared with those without 
TZ defect. There were also significantly more incomplete BT in RE, hypersensitive oesophagus 
and FH than in healthy controls.  
 
The study is well explained, however, I have several concerns:  
 
- Wher e FH patients not responding to PPIs? Since the Authors referred to Rome III criteria, 
the PPI response should be mentioned.  
- According to the results, the majority of patients have reflux esophagitis (38 vs 15 NERD and 
9 hypersensitive esophagus). This p roportion seems to be higher than that usually observed in 
a consecutive series of GERD patients. Moreover, the grading of esophagitis is not 
mentioned. It is thought that severe esophagitis might cause, or be caused, by weak 
peristalsis. I wonder if Autho rs provide the results of TZ and BT in the RE patients according 
to their grade.  
- The Authors stated that BT was calculated according Simren et al.. In my opinion the Authors 
should have to consider the duration (seconds) of BT also and, possibly, correla te this 
parameter with the length of TZ. Maybe, even if complete, a prolonged BT time could be 
relevant.  
- Were the study groups different in terms of reflux clearing time? Did patients with a higher 
frequency of incomplete BT have prolonged reflux clearin g as well as acid exposure time? 
These data should be provided.  
- Did patients have dysphagia also?  If so, there was any correlation with TZ and BT?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to  the authors.  
Yes 
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 statistica l 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 i n the manuscript:  
Needs some language corrections before being published  
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