Review for 10.1186/s12876-014-0225-7 (2014)

Reviewer's report
Title:Clinical value of wireless pH-monitoring of gastroesophageal reflux in
children before and after proton pump inhibitors
Version:3Date:20 November 2014
Reviewer: Edoardo Savarino
Reviewer's report:
I've opted to review the article by myself and here below you can find my revison
and my final decision:
Summary and Comments
The article entitled "Clinical Value of Wireless pH-monitoring of
gastro-esophageal reflux berfore and after proton pump inhibitor” by Boström et
al. is a prospective study designed to evaluate the feasibility of Bravo capsule
pH-monitoring on and off-PPI treatment in 106 children undergoing investigation
for GERD. The main result was that application of the capsule was successful in
103/106 (97.2%) children and interpretable in 99/103 (96.1%). Out of the latter
ones, 49/99 (49.5%) children had GERD according to reflux index and 51/90
(56.7%) according to DeMeester score.
The main idea of the study is original and interesting.
Major Compulsory Revisions:
1. The manuscript requires revision from professional editing service
2. Methods. Discontinuing anti-secretory treatment only one week prior to testing
represents a limitation of current study, since several studies demonstrated that
gastric secretion requires at least one week for recovering after PPI stopping.
Please, comment on that a mong the limitations of the study. Moreover, were
children allowed to use antacids or alginates for symptoms control?
3. Methods. I think that patients older than 18 years should not be considered in
this analysis
4. Methods. The Ismail-Belgi scale is an old diagnostic classification used to
identify histological abnormalities GERD-related. More recently, several papers
have been published in which a more reproducible and sensitive method was
validated in order to diagnose GERD based on histological findings (J
Gastroenterol. 2013 Apr;48(4):473-82; Am J Gastroenterol. 2005
Oct;100(10):2299-306). Please, consider to use them or at least to comment on
them. Moreover, which is the diagnostic significance of assessing these
histological alterations in patients with erosive esophagitis? In my point of view,
this analysis should be done exclusively in endoscopy-negative patients.
5. Methods. Is there any data about symptom association analysis in these
patients? Should be of interest evaluating the feasibility of the symptom
association analysis in children.
6. Methods. It is not clear whether the endoscopy was performed on or off PPI
therapy?
7. Results. Data on PPI use and response in these children has not been
provided and discussed. Please, add this crucial information
8. Discussion. The need of performing an endoscopy on propofol sedation should
be discussed more in deep among the limitations of the Bravo pH-monitoring
approach.
Level of interest: An article whose findings are important to those with closely
related research interest
Quality of written English: o Not suitable for publication unless extensively edited
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests: I declare that I have no competing interests'
I have evaluated the article entitled Clinical Value of Wireless pH-monitoring of
gastro-esophageal reflux berfore and after proton pump inhibitor” by Boström et
al. and my decision is: Unable to decide on acceptance or rejection until the
Authors have responded to the major compulsory revisions.