Review for 10.1186/s12876-024-03153-7 (2024)

Title: Gender Differences in Gastrointestinal, Biopsychosocial and Healthcare-seeking
Behaviors in Chinese Patients with Irritable Bowel Syndrome Predominant with Diarrhea
Version: 2 Date: 11 Jan 2024
Reviewer:  Zipan Lyu
Reviewer's report:
Reviewer Report
Title: Gender Differences in Gastrointestinal, Biopsychosocial and Healthcare-seeking
Behaviors in Chinese Patients with Irritable Bowel Syndrome Predominant with Diarrhea
Authors: Wenjuan Fan, Yang Chen, Xiucai Fang, Liming Zhu, Guijun Fei, Jia Lu, Xiaoqing Li
Overall Assessment:
The manuscript is well-structured, offering a thorough exploration of the biopsychosocial traits
among Chinese men and women with IBS-D. The research methodology is robust, and the results
make a meaningful addition to the existing body of knowledge on IBS. They offer valuable
insights into gender-specific aspects of IBS. Some minor enhancements, like improving the
coherence of the discussion, would strengthen the manuscript overall.
Recommendation:
I recommend accepting the manuscript for publication once the mentioned minor revisions
are addressed. The study's contribution to comprehending gender distinctions in IBS-D is
commendable, and the findings are pertinent for practitioners and researchers in the field.
Discussion Section Comments for Further Consideration:
1. Sentence: "Female patients reported more abdominal pain, especially severe pain, and had
a higher IBS symptom score than male patients, although there were no significant differences
in stool form."
Comment: Delve into the potential implications of the observed differences in abdominal pain
and IBS symptom scores despite similar stool forms. Explore whether non-gastrointestinal
factors, such as pain perception or coping mechanisms, may contribute to these variations.
2. Sentence: "This result was consistent with previous studies which showed severe abdominal
pain was significantly more often reported by women than by men [11], and women had overall
a higher total IBS symptom severity, but there were no gender differences in stool frequency
[23]."
Comment: While citing previous studies, consider addressing any conflicting findings in the
literature and discuss how your study contributes to resolving or adding nuance to existing
knowledge on gender differences in IBS symptomatology.
3. Sentence: "Women tended to report more severe, more frequent, and longer-lasting pain than
men [11, 24]."
Comment: Explore potential underlying factors contributing to gender differences in pain
perception, such as hormonal influences, psychosocial factors, or central nervous system
modulation, to provide a more comprehensive understanding.
4. Sentence: "Explanations for this difference included differences in pain sensation, cognitive
response to pain."
Comment: Elaborate on the specific cognitive responses to pain that may differ between genders
and how these cognitive factors might contribute to the observed gender differences in pain
perception.
5. Sentence: "Women exhibited lower pain thresholds, higher pain ratings, and less tolerance
of noxious stimuli than men during rectal distension [25], and in the central nervous system,
there were differences in pain modulation and in brain regions activated by the same visceral
stimulus [26]."
Comment: Discuss the implications of these physiological differences in pain modulation and
brain activation on the broader understanding of gender differences in IBS-D. Consider how
these findings may inform potential targeted interventions.
6. Sentence: "There was also a study showed women with IBS did not report abdominal pain
more often than men [27]."
Comment: Address the inconsistency highlighted in this sentence, discussing potential reasons
for the disparate findings and how your study contributes to resolving or elucidating these
discrepancies.
These comments encourage a more in-depth exploration of the study's findings and implications,
fostering a richer and more nuanced discussion of gender differences in IBS-D.