Review for 10.1186/1471-230X-10-74 (2010)

Reviewer's report
Title:A survey of abnormalities in the colon and rectum in patients presenting
with haemorrhoids.
Version: 1Date:4 March 2010
Reviewer: Varghese P Thomas
Reviewer's report:
Positive points about the article:
The article give the prevalence of colonic disease in patients with haemorrhoids
in Netherlands and the study spans over a period of 17 years. The article warns
us that there could be other associated colonic diseases in patients with
haemorrhoids.
Negative points
1.Title:
Title is misleading as it states that the patients presented with haemorrhoids. It is
not clear from the article as to whether all the patients included in the study
presented with clinical symptoms pertaining to haemorrhoidal disease or not.
The authors states in the material and methods section like this: The reasons for
doing the endoscopy were the normal clinical indications in daily practice
(abdominal complaints, diarrhoea, rectal bleeding, anaemia,changes in bowel
habits, family history of colorectal cancer and screening).All patients in whom
haemorrhoids were seen were included in the study.
Being a retrospective analysis of endoscopy records spanning 17 years , it is
unlikely that the authors could have obtained enough clinical data on presenting
symptoms with specific reference to symptoms of ano-rectal diseases.
2.Methodology:
The methodology also has flaws. Out of 1910 cases, colonoscopy was done in
1777 cases and only flexible sigmoidoscopy was done in133 cases. The authors
could have omitted the latter cases who had undergone flexible sigmoidoscopy
only.The inlusion of latter cases violates the aim of the study. This is a major
error as the findings in 133 cases could have significantly altered the final results.
The caecal intubation rates for the present study were 84.4% in group I and 88%
in group II. Though this may be acceptable for clinical use, those cases in which
colonoscopy were incomplete could have been avoided in this study with the
exceptions of cases in which further introduction of the scope was not possible
due to a cicatrising lesion.
3.Discussion
The authors’ observations that various colonic diseases other than colitis were
more often seen in elderly patients is a well established fact. The observations in
their study do not add anything new to the existing knowledge regarding the
prevalence of colonic disease. The authors have already published data
regarding other associated abnormities seen in patients presenting with
haemorrhoids. Moreover the authors also performed colonoscopy in their cases
even though some of their patients could have presented with symptoms
suggestive of haemorrhoidal disease. The indications for doing colonoscopy is
well established now and it is unlikely that the observations in this article will
change it. There is very little discussion on the prevalence of other colonic
lesions in patients with haemorrhoids and the review of literature is inadequate.
4.The message from the article is not clear.
Should we do colonoscopy even if the patient presents with clear cut symptoms
and signs of ano-rectal disease? Or should we advocate colonoscopy only in
persons above the age of 50 years even if they have symptoms of ano-rectal
disease? This should have been answered clearly with the analysis of presenting
symptoms and clinical findings against colonoscopic observations. If the authors
have details of clinical presentations of their patients, this paper could be
rewritten with those details and it will definitely give more information regarding
the utility of performing colonoscopy in patients presenting with symptoms of
haemorrhoidal disease.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I do not have any competing interests