Review for 10.1186/s12876-023-02682-x (2023)

Title: Frequency, outcomes, and need for intervention in stricturing gastrointestinal
tuberculosis: A systematic review and meta-analysis
Version: 6 Date: 27 Jan 2023
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The article is interesting, addresses a broad question, and important
for medical field. The authors have conducted a rigorous search on two databases and have
performed overall, subgroup and sensitivity analysis to address the question. Few limitations
include: using only two databases for the literature search, high heterogeneity in outcomes, and
inclusion of abstracts.
REQUESTED REVISIONS:
I read with interest the article by Jena et al regarding the frequency, outcomes and interventions
in GI tuberculosis. The manuscript is well written. I also reviewed the comments from other
reviewers and the responses that were submitted by authors. Following are my comments:
1. The authors only searched two databases. For an ideal systematic review, at least 3
databases should be searched (including PubMed and Embase). Some studies even recommend 4
databases (Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH. Optimal database combinations
for literature searches in systematic reviews: a prospective exploratory study. Syst Rev.
2017;6(1):245).
2. Was the search strategy developed by an expert, e.g., a librarian with background in healthcare.
Also, please provide the search strategy for other databases as supplementary material.
3. The authors mentioned using MOOSE guidelines, but I did not see checklist. Please include
this.
4. The authors mentioned that two authors independently performed screening of articles. How
was discrepancy resolved? Mutual discussion? Third reviewer? Any other objective method?
5. The exclusion criteria are not clear. Did you also exclude review articles, guidelines and
abstracts?
6. When calculating the overall prevalence of stricture, was prior treatment taken into
consideration? Also, did patients have TB of other organs?  Immunosuppressive drug use or
state such as HIV?
7. The term abdominal tuberculosis and GITB have been used throughout and it sounds
confusing. The authors should include actual definitions of these terms in the methodology
section for ease of readers.
8.  Please be consistent with decimal points. The leave one out meta-analysis was included with
4 decimal points and other results with 2.
9. Given the significant publication bias, I recommend applying the “trim-and-fill” technique to
see if the effect size changes for the outcomes.
10. Would also suggest that authors perform a separate subgroup analysis of full studies as well
excluding abstracts.
11. If possible, I would suggest authors include meta-regression of outcomes to assess the impact
of confounders in their study."