Review for 10.1186/s12876-021-01758-w (2021)

Reviewer’s report
Title: 
Case Report: Restrictive Diet in a Patient with Irritable Bowel Syndrome
Leading to Wernicke Encephalopathy
Version: 
1 
Date: 
24 Sep 2020
Reviewer's report:
PI have read with interest the case report by Wang Q et al entitled "Irritable
Bowel Syndrome Leading To Wernicke Encephalopathy". While I find the
article interesting, I have several suggestions/comments for the authors.
1-I do not believe the title is appropriate for the following reasons:
a-IBS per se does not lead to vitamin malabsorption as can be inferred by the
title. In this patient, it was the clearly abnormal eating behavior that led to WE
("solely small amounts of non-fortified farina) in conjunction with the plausible
presence of SIBO or methanogenic small intestinal overgrowth (IMO), well
known causes of vitamin B1 deficiency. This is very relevant because if not
corrected, both SIBO/IMO and abnormal eating behavior, early recurrence of
WE and/or additional nutritional deficiencies should be expected and this
message needs to be sent to the readers.
b-Nausea and vomiting are not part of IBS diagnostic criteria, what reinforces
my idea that the underlying cause for this patient symptoms was other, including
SIBO/IMO, gluten or carbohydrate intolerance or even her mental disorder.
Although these conditions are frequently associated/overlapped with IBS, they
cannot be considered the same clinical entity Therefore, I think that testing for
SIBO/IMO needs to be included in the diagnostic work-up in patients suffering
from digestive symptoms and WE and better reflected in the discussion.
2-Could authors be more specific regarding vitamin and mineral compositional
differences between fortified and unfortified farina to understand why in this
patient isolated thiamine deficiency was detected and no other nutritional
deficiencies, i.e. iron or nicotinamide. I presume that eating solely unfortified
farina may have worsen also SIBO/IMO and digestive symptoms.
3-Authors state in the discussion that thiamine deficiency decreases gut motility.
However, I have not been able to find the basis for this assumption within the
references provided (8 & 9).
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