Review for 10.1186/s12876-025-03904-0 (2025)

Title: Global, Regional, and National Burden of Disease Analysis on Paralytic Ileus and
Intestinal Obstruction in Adults Aged 65 and Over from 1990 to 2021, with Projections for 2030:
A Global Burden of Disease Study 2021 Analysis
Version: 1 Date: 22 Feb 2025
Reviewer's report:
This manuscript provides an analysis of the global disease burden of paralytic ileus and intestinal
obstruction patients >65y/o using the GBD 2021 data. Multiple statistical methods are used to
arrive at the reported findings. While the manuscript is overall organized and the approach to
the analysis is sound, there are several areas that require attention.
Major Aspects
1. Clarify data limitations and potential biases
o While this study is based on GBD data, the manuscript would benefit from a more explicit
discussion of the limitations inherent to such secondary data analyses. In particular, issues
such as potential misclassification, underreporting, and differences in diagnostic criteria across
regions should be addressed. It is absolutely critical to highlight limitations of this study and the
use of large data in detail before the conclusions are presented.
2. Methodological transparency
o Although the statistical methods (e.g., Joinpoint regression, decomposition, and Bayesian
models) are described, additional details on model assumptions, parameter settings, and
sensitivity analyses would enhance clarity and allow reproducibility. Please consider adding
supplementary details or clarifying within the “Methods” section how assumptions were checked
and how robust the models are to potential variations in input data.
3. Overstated conclusions
o Some parts of the Discussion and Conclusion sections appear to extend beyond the direct
findings of the data—for instance, in recommendations for healthcare policy. The conclusions
should closely reflect the data. Please revise the Conclusions to focus explicitly on what the
data demonstrate, avoiding extrapolations that are not directly supported by the analyses. Where
future policy recommendations are suggested, clearly indicate that these are inferences that
require further validation and future studies.
4. Interpretation of regional variations
o The authors describe significant regional differences in incidence, prevalence, DALYs,
and mortality. However, the discussion can be considered to be strengthened by explicitly
addressing potential (i.e. speculative) reasons for these disparities (e.g., differences in healthcare
infrastructure, diagnostic practices, or socio-economic factors between the evaluated regions).
For this reason, further elaboration on the possible explanations for the observed regional
variations are suggested, tying this to the presented data and/or existing literature. This will assist
in providing better grounds for the interpretation of the results.
Minor
1. Language clarity and redundancy
o There are some redundant phrases (e.g., “respectively, respectively”) and sections where
sentence structure could be simplified. A careful language edit would improve readability. Please
review the manuscript for clarity and conciseness, and consider revision by a native English-
speaking individual with medical background or by a professional language editing service to
improve readability.
2. Table 1 referencing
o This reviewer could not find the referenced “Table 1” on the manuscript or the provided
additional files.
3. In-text data overload
o While it is important to numerically-report results, current formatting of reporting all values
with respective 95% CI and other data can easily overwhelm the readership. This reviewer
frequently found himself going back in the text to the beginning of the sentence multiple times
to try and understand the reporting results. It would be advisable to construct orderly, easy-to-
understand tables and reference them in-text to direct the readership towards. This will facilitate
and enhance readership understanding, prevent the current run-on sentences, and decompress
the current number-overloaded text body.
4. Figure and Table References
o Some references to figures (e.g., “see Figure 1” or “Supplementary Figures 1-4”) are not
always accompanied by sufficient contextual information in the text. Please ensure that each
figure is clearly introduced and discussed, so that readers can understand the key findings even
if they do not immediately refer to the 121 pages of supplementary materials.
5. Methodological Detail on Software and Packages
o While the use of Excel and R (with packages such as dplyr, officer, and ggplot2) is mentioned,
additional context on why these tools were chosen and how they contribute to the analysis could
be helpful. Hence, a brief explanation of the role of these software tools in the analysis might
be included in the methods section, especially if there are specific advantages that strengthen
the current methodology.