Review for 10.1186/1471-230X-10-32 (2010)

Reviewer's report
Title:Prevalence of inflammatory bowel disease in two districts of Sri Lanka: a
hospital based survey
Version: 1Date:24 November 2009
Reviewer: Morten H Vatn
Reviewer's report:
This is a well written article with a well defined aim of examining a hospital based
prevalens of IBD in Sri Lanka in the course of one year. The results showed a
reduced prevalens rate compared to industrialized countries, but comparable
data with countries in the same geographic areas. A surprising higher prevalens
among females than males with UC and a high frequency of large bowel
involvement in CD, comparable to western societies, are striking. My comments
to this article are as follows:
1) The authors have a relatively balansed discussion regarding the epidemiologic
limitations of the study,
but one would need additional information on the cohort, which might at least
partly explain some of the
results in the article. One question would be if the project is able to estimate the
stability of the population in the area. In other words: Do the region leak patients
to other
districts?
2) Regarding the differens between gender,- is the male population in the area
less stable?
Could the conflicts of the country have affected the accessability to diagnosis
differently between
males and females? This question would be relevant for both sexes in the
population at risk between
20 and 30 years old, since the patients with CD in this study were approximately
10 years older
than incident cases of CD in population based studies. Another question,
therefore is: What was the
disease duration before diagnosis in the different groups?
3) When looking at the age distribution curve for CD on Fig.2 one gets the
impression that the disease peaks
in the 20ies similar to in Western societies, and that it continues on a plateau
level during the next decades.
Could this be explained by a reduced accessability in the 20ies?
4) For both curves on fig.2 one could get the impression of a second peak
between 50 and 70, which should be discussed
by the authors, and which again would be similar to industrialized
countries(ex.Moum B et al.)
4) Was the gender difference constant when the material was divided into 5-year
age groups?
5) Another important question is if any considerable group of the population
would seek health care performed
by other treatments than those offered by the official health care system? Are
many people helped by
non professionals or offered alternative treatments, thereby ommitting
registration?
6) An important objection to this study is the total lack of histologic results, which
is generally needed to support
diagnosis and disease activity, partly also disease distribution. I assume that the
endoscopic diagosis was supported by
histology, which should be included in the article.
In conclusion, all the above mentioned comments should be responded to before
publication. Having said that, I think that information on the prevalens of IBD in
Sri Lanka is very much welcomed among colleagues around the world. The
ability to collect material and characterize IBD patients would qualify the group
for participation in a new started study on Early IBD, an IOIBD project(see
ioibd.org/), a world wide characterization of newly diagnosed treatment naive
patients. They should therefore contact me in person regarding this, in order to
look at the protocol and agree on collaboration if possible.