Review for 10.1186/s12876-020-01575-7 (2020)

Reviewer’s report
Title: 
Efficacy of Early Intervention on the Bowel Damage and Intestinal
Surgery of Crohn’s Disease, Based on the Lémann Index
Version: 
0 
Date: 
07 Nov 2020
Reviewer: 
Jimmy Limdi
Reviewer's report:
This is an interesting study exploring an evolving concept with the effect of early
versus late treatment on bowel damage in Crohn's disease using the Lemann
index(LI).
Please see my comments below :
Introduction 
Your comment that data supporting the effectiveness of infliximab on bowel
damage in patients with Crohn's disease are limited in China , " because of the
low infusion rate " Is difficult to understand. Do you mean that less patients are
able to access infliximab? 
Methods
1. Paragraph 3 :You state that the early group had no history of use of disease
modifying agents "which is independent of bowel damage ". this is also difficult
to understand. What exactly do you mean here? 
2. You have recorded CDAI for all patients at the beginning and at the end of the
study. Is it normal practice to record CDAI? Do you not regularly record some
other clinical scores such as Harvey Bradshaw ?
3. To calculate the LI, did you actually perform gastroscopy is on all your
patients and do you do this routinely? Or did you in fact report on those patients
in whom a gastroscopy was performed with an index of suspicion for upper GI
Crohn's disease? Then, would that not be a potentially more aggressive form of
disease that lends itself to bias? 
4. You also refer to endoscopy data being reviewed by senior gastroenterologists
with more than 10 years of experience. Can you explain what exactly was
reviewed? Did you video record all your ileo-colonoscopy procedures or were
images taken and then reviewed? Did you use an endoscopic scoring system ?
Results
1. How do you reconcile with there being no significant differences in the L1
score between the early CD group and the late CD group? Could this be a
function of your sample size? 
2. You noted that either infliximab or any other therapy could reverse bowel
damage in the early CD group, but you also had patients on steroid and
mesalazine .Did patients on either steroid or mesalazine show reduction in Ll
scores? Is mesalazine an acceptable form of treatment for patients with Crohn's
disease in your cohort? 
Table 1
Please explain what you mean by "stabilised", "improved" and "deteriorated"
under the bowel surgery heading.
Thank you for taking the time to consider these comments .
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
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from apparent manipulation?
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