Review for 10.1186/s12876-021-01781-x (2021)

Reviewer’s report
Title: 
Hospitalization and surgery rates in patients with inflammatory bowel
disease in Brazil: a time-trend analysis
Version: 
0 
Date: 
08 Mar 2021
Reviewer's report:
Dear Authors,
I have two issues
The first one; the study 
did not documented some of currently important medical
IBD burden indicators i.e. years of lost, the years of life lived with disability and
disability-adjusted life years. The focus of the manuscript was surgical outcomes
which were stated well and the DATASUS system may not be allowing the
extraction of such IBD burden indicators. Still the authors may state these
important indicators and why these could not be extracted and demonstrated in
the discussion section. 
The second one: In the introduction section, the authors admits the effect of
medical treatment of surgical endpoints by the statement of 
'' Despite the
increasing incidence and prevalence rates of IBD, recent information supports
the idea that the dramatic advances in treatment, especially in the last two
decades, with new drugs and therapeutic strategies [23], have had a remarkable
impact on the overall surgical interventions and hospitalization rates [24-27].'' 
Although the scope of the study did not designed for the documention 
or
demonstration of 
the temporal effect of the medical IBD treatment changes
(especially effects of the anti- TNF drug treatment and immune modulator
combination treatment implemented on the first two decades of milenium) on the
surgical burden of the IBD and that effect somewhat well discussed on the
diccusion section, still I think the authors should put a sentence to the
conclusison part and also to the abstract section indicating that the effects of
these medical treatment changes may have some effect on the decreasing
surgical burden of IBD in Brazil. Otherwise the temporal changes between
January 2005 through December 2015, as of 
a decreased rate of hospitalization,
decreased rate of 
IBD related surgeries and 
a decreased rate of 
IBD-related
surgical lethality then suggested to be only related to ''the effect of
decentralization and improvements in the quality of public health services in
Brazil'' as the authors calimed which is a very strong but contraversial and an
argueable statement. To put such a strong statement, the absence of contribution
of the effect of medical treatment changes should be have demostrated.
Thank you in advance
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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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