Review for 10.1186/s12876-024-03166-2 (2024)

Title: Hemorrhoidal Disease among doctors from Grade-A Tertiary Hospitals in Big Cities of
China: results from web-based doctors as patients survey
Version: 2 Date: 25 Jun 2023
Reviewer's report:
Title: Hemorrhoidal disease among doctors from grade-A tertiary hospitals in big cities in China:
results from web-based doctors as patients survey
Summary:
The present manuscript is a cross-sectional study evaluating the prevalence, awareness,
diagnosis, and treatment of hemorrhoidal disease (HD) among doctors in big cities in China.
They performed web-based surveys on doctors and found a high prevalence of hemorrhoidal
disease in doctors as well as low awareness of adequate treatment. It is an interesting descriptive
study, however, due to the lack of details in the methods and potential selection bias to
generalize the study results, the manuscript requires substantial improvement to be considered
for publication.
Major comments:
General
1. The manuscript requires substantial improvement to the English language to be published in
an English language journal.
2. In addition, the manuscript needs a careful review and revision of the writing to be of
publication quality.
Introduction
1. The Introduction section does not sufficiently describe the implications of this research and
limitations of previous relevant research.
Methods
1. The authors need to clarify the details of data collection. In particular, it would be helpful to
include how the stratified probability sampling was designed and what are the exact questions
included for both the screening and main questionnaires.  In addition, please describe if these
questions have been validated elsewhere.
Results
1. Of the people who passed the screening test, the number of doctors who completed the main
questionnaire seems quite low. Do you have any explanations on why this is the case? Please
also describe the potential selection bias between people who passed the screening test and those
who completed the main questionnaire because those who have HD seem to be more likely
to have completed the main questionnaire. Are there differences in the characteristics between
those who completed the main questionnaire and those who did not?
2. What was the rationale to evaluate the prevalence of cervical or lumbar spine disease, sleep
disorder, chronic venous disease, chronic gastritis or gastric ulcers, hypertension, and urinary
calculation? Was there a biological reason why these specific diseases were evaluated? Was
there any difference in the prevalence of these diseases between those who had HD vs. those
who did not?
3. In Tables 1 and 2, the comparison of previous pregnancy history should be limited to women.
4. The abbreviation “CVD” commonly refers to cardiovascular disease, so I would recommend
refraining from using an abbreviation for chronic venous disease to avoid confusion.
5. As for the diagnosis of HD, physical examination is not mutually exclusive with self-
diagnosed or professional diagnosed and, therefore, the definition of how HD was diagnosed
needs clarification.
6. As for the treatment of HD, it is not very clear if they are describing the “awareness” or the
“personal experience” of the physicians. For instance, in the description for treatment efficacy,
are the percentages indicating how the doctors perceive the efficacy of treatments to be or their
experience of the treatments they have received?
Discussion
1. What are strengths and limitations of the study?
2. Please include also the potential clinical or public health implications of your findings.