Review for 10.1186/s12876-025-03685-6 (2025)

Title: Quality of life, functional impairment and healthcare experiences of patients with irritable
bowel syndrome in Norway: An online survey
Version: 5 Date: 03 Feb 2025
Reviewer's report:
Reviewer 2
Thank you for your comments, which we believe has improved the manuscript considerably.
1-I'm not convinced by the relevance of the responses from people under the age of 18, i.e.
25 persons (according to question 2) and 38 persons according to the ‘school pupil’ category
(question 4). We are not sure that they are capable of understanding and answering the questions.
If it wasn't the parents who answered for them, I suggest that these questionnaires should not
be included in the analysis.
Response: We agree completely with the reviewer. People under 18 years of age were among
the 327 persons answered the survey were excluded. This was clarified in page 4, line and table
1 (marked yellow).
Reviewer’s response : Ok
2-You rightly excluded 327 questionnaires from the analysis because the diagnosis had not
been made by a doctor. I am surprised to find results for n= 2727 (in figure 5 ). These
questionnaires should be excluded from the analysis. I would go further and also exclude the
158 questionnaires where people answered question 7: "Yes, it was diagnosed by another doctor
(not a GP or gastrointestinal specialist)". In my opinion, only a GP or gastroenterologist can
correctly diagnose IBS. It would also have been better to cross this with the response ‘I haven't
been diagnosed by a doctor 249’ in question 10.
Response: This was corrected in the figures.
Reviewer’s response : Ok
3-There seems to be a percentage error in figure 4a. In fact, there are 158 people who were not
seen either by a GP or by the gastroenterologist according to question 7.
Response: The was corrected in the figures.
Reviewer’s response : Figure 3a remains unchanged.
Either the 3rd category is taken into account, i.e. n=2400 (i.e. 805 +1473+158), in which case
the percentages must be modified and the 3rd category included in the graph.
Or you do not want to take into account the 3rd category n=158, then the total number of
employees is equal to 2242.
Please make one of the 2 choices.
4- In Table 1, you were able to classify people according to their type of IBS, i.e. IBS-C, IBS
D or IBS-M. Did you get this information directly from the people or did you deduce it? In my
opinion, question 8 doesn't allow you to classify patients with any certainty because it doesn't
meet the definition. For example, an IBS patient with constipation predominance must have
hard stools > 25% of the time and soft stools < 25% of the time. To be correct, these should be
indicated in the same way as the other symptoms (as for headache and fatigue) in the table.
Response: We agree with the reviewer. This was corrected in Table 1 (marked yellow)
Reviewer’s response : Forgive me, but it seems to me that the data on the table has not been
changed. You can still read:
Table 1. Demographic and clinical characteristics of the irritable bowel syndrome (IBS) patients
who participated in the survey.
.....
IBS-D 1024 (37%)
IBS-C 728 (27%)
IBS-M 975 (36%)
.......
Data are n, n (%), or median [range] values.
IBS-D, diarrhoea-predominant IBS; IBS-C, constipation-predominant IBS;
IBS-M, mixed-diarrhoea-and-constipation IBS
5-We do not understand how the ‘unemployed’ category is calculated. Table 1 shows 1035
(38%) “unemployed”. In the discussion section, it says: ‘The present survey revealed that the
unemployment rate among IBS patients was 29%, which is therefore more than 8-fold that of
the general population.’ I think there may be some confusion about the term “unemployed”. At
times in your article it refers to all the categories in question 4 without the ‘employed’ category,
and at other times it refers to ‘people of working age who are looking for work’. Please clarify
these points.
Response: You are quite right. We clarified this in page 7, lines 6-8 (marked yellow).
Reviewer’s response: Forgive me, but the only element in yellow on page 7 is the following
sentence: “It noteworthy that it takes time to gain the indispensable patients confidence where
MD's time for each patient is limited.” I don't see your clarification.
6- It would have been interesting to have information on income brackets or socio professional
categories.
Response: We agree with the reviewer, but we do not have this information
Reviewer’s response: Ok