Review for 10.1186/1471-230X-13-156 (2013)

Reviewer's report
Title:Limited utilization of serologic testing in patients undergoing duodenal
biopsy for celiac disease
Version: 2Date:15 May 2013
Reviewer: Raffaella Nenna
Reviewer's report:
The paper of Homer O Wiland 4th et al. investigated the causes of a high number
of negative biopsies in the diagnosis of celiac disease. It could be an interesting
topic but further clarifications are needed.
Major Compulsory Revisions:
1. Chart review: you revised clinical data only from the 161 patients who had
positive results for either serology or duodenal biopsy. Did you consider if among
patients negative for serology/biopsy there were celiacs on gluten free diet
(GFD)?
2. Chart review: you considered patients to be affected by CD if they had both
positive serologic and biopsy results although adults with CD may also have
negative antibodies (A report on the international transglutaminase autoantibody
workshop for celiac disease. Am J Gastroenterol. 2009; 104: 154–163).
3. Results: page 7, lines 18-21# Recent findings (Duodenal bulb biopsies in
celiac disease: a multicenter study. J Pediatr Gastroenterol Nutr
2008;47:618–22; Importance of duodenal bulb biopsies in children for diagnosis
of celiac disease in clinical practice. BMC Gastroenterol 2009;9:78) suggest that
CD could be limited to the duodenal bulb or have a so called “patchy” pattern.
Performing only one biopsy could lead to miss diagnosis. Did you consider the
biopsy site?
4. Discussion: page 9-10, lines 24-1# Partial villous atrophy (PVA) is considered
as a CD related histological finding (European Society for Pediatric
Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of
Coeliac Disease, JPGN 2012;54: 136–160; AGA Institute Medical Position
Statement on the Diagnosis and Management of Celiac Disease,
Gastroenterology, Volume 131, Issue 6 , Pages 1977-1980, December 2006).
5. In Table 1 you should consider PVA as CD (1.6% + 6.2% and 1% + 4.4%).
Minor Essential Revisions:
1. Introduction: page 3, lines 1# insert “space” between is one.
2. Introduction: page 3, lines 9# correct disease with diseases.
3. Introduction: page 3, lines 11-20# you wrote that “diagnostic options for celiac
disease can be divided into three categories[…]”. However what you discussed
later are not “options” but different steps through the diagnosis of CD.
4. Introduction: page 4, lines 3-5# please indicate performances of each
autoantibodies (tTG, dGDN, EMA).
5. Materials and Methods: page 5 # please provide patients sex, age range and
median age.
6. Materials and Methods: page 5 # please provide autoantibodies positive
patients divided as tTG +, dGDN + or EMA +.
7. Materials and Methods: page 5 # please check total serum IgA titer in order to
identify patients with serum IgA deficiency.
8. Results: page 8, lines 3-5 # We are not surprised about that as extra-intestinal
findings in CD have already been studied (Endoscopic and histological gastric
lesions in children with celiac disease: mucosal involvement is not only confined
to the duodenum, J Pediatr Gastroenterol Nutr. 2012 Dec;55(6):728-32;
Lymphocytic gastritis in pediatric celiac disease, Pediatr Dev Pathol
2011;14:280-3.) Please compare your results to others.
9. Table 2: please provide percentage values.
10. Table 2: PVA results should be unified with CD results.
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: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests