Review for 10.1186/s12876-014-0210-1 (2014)

Reviewer's report
Title:Management of Upper Gastrointestinal Bleeding in a Nigerian tertiary health
facility
Version:2Date:13 September 2014
Reviewer: Sylvester Chuks Nwokediuko
Reviewer's report:
MAJOR COMPULSORY REVISION
COMMENTS
Title:
1. It is noted that none of the patients studied presented with chronic iron
deficiency anemia from slow but persistent ooze. The authors concentrated on
acute/overt upper GI bleeding, judging from the study population as stated on
page 6, line 17. This should be reflected in the title.
2. The study took place in a resource-poor setting where treatment decisions
were determined mainly by availability of resources rather than international
standards. This should also be captured in the title.
Objectives:
One of the objectives of the study is to “outline methods of stratification” (lines 1
and 2 of page 5). It is not clear if that objective was achieved as only the Rockall
scoring system was mentioned in the manuscript.
Ethical Issues:
The study included “all consenting patients who had overt upper GI bleeding”.
What does consent mean here? Is it consent for routine upper GI endoscopy or
consent for inclusion in the study? What about patients who were not fit to give
consent (over a third of patients presented with shock)
Study design:
1. It is not clear if this study was a retrospective one in which the authors
reviewed endoscopy records and case notes of patients who were managed for
upper GI bleeding or a prospective study as the authors tried to infer on line 17 of
page 6. The data presented is actually more in keeping with a retrospective
analysis. For instance, there were no criteria for assigning patients to treatments.
Some patients received sclerotherapy for varices while others received band
ligation for the same indication.
2. The author lumped all cases of upper GI bleeding together in most of the
analyses. It is convenient to divide upper GI bleeding into variceal and
non-variceal. This sub-classification has strong implication for morbidity,
treatment and prognosis. Rockall scoring system was calculated for all patients,
regardless of cause of bleeding. Was the calculation based on the clinical criteria
alone or did it include the endoscopic findings and stigmata of recent
hemorrhage?
3. The authors used PPIs and beta blockers for the treatment of patients with
upper GI bleeding (lines 9 and 10 of page 7). What is the role of beta blockers in
the management of bleeding generally and upper GI bleeding in particular?
Results:
There are no tables to illustrate such variables as Rockall score, transfusion
requirements, length of hospital stay, co-morbidities and mortality.
Statistics:
Only P-value was quoted in the inferential statistical analyses. In the case of
correlation, the Pearson correlation coefficient or Spearman rank order
correlation coefficient should also be included.
Grammer:
There are numerous grammatical errors in the manuscript.
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests