Review for 10.1186/s12876-021-01673-0 (2021)

Reviewer’s report
Title: 
The impact of symptoms on quality of life before and after diagnosis of
coeliac disease: the results from a Polish population survey and comparison with
the results from the United Kingdom
Version: 
1 
Date: 
07 Sep 2020
Reviewer's report:
General Comment 
The paper addresses relevant aspects of QoL in CD patients, in a comprehensive
population . Reported results are interesting as well as the comparison with a
similar British study which reveals important differences between both
populations. 
However there are some major issues to consider: 
How reliable is it to answer a survey related to an event years after the event has
occurred? In adult participants many years elapsed between diagnosis and the
survey concerning the Diagnosis period and the years before. Specifically how
reliable are data concerning consultations before the diagnosis . etc 
Similarly the lower change in EQ-Index in Polish coeliac respondents as
compare to UK could be related 
to QoL information given by parents and
children being less accurate as compared to the personal feeling refered by the
adult patient. In the British study as the cipher of <18y at dx was 
12% its impact
on the whole population 
is probably very low. In the polish serie , <18 y
represents 
exactly the same number as the 18-34 y subgroup , i.e . 282 ( 36.7%) 
These limitation needs to be addressed in the Discussion.
The pediatric population representing 36% of the study population the results of
this subgroup should be analysed separately and compared with data from adults
. This would give more reliable 
information on the characteristics of CD
diagnosis in Poland 
and give some clues on how to improve awareness and
earlier diagnosis. 
At least it is worthy to analyze this subgroup separately 
r parameters like ; 
Symptoms
Duration of symptoms before Dx 
Compliance with the GFD
Also comparing 
Diagnosed 
before and after the year 2000 
It would be also interesting to compare 
Diagnostic process in children versus
adults . This could support the view outed in the Discussion of 
CD being still
considered a pediatric disease in Poland in the late 90´s . 
Some specific comments 
Page 2 L 52 Many researchers have suggested that extra-intestinal symptoms are
increasingly frequently the only manifestation of CD, especially in older children
and adults. 
The writing leads to confusion . Please modify it 
Page 2 L 54 It has not been established whether this results from an increasing
incidence of non-classical CD, greater awareness in physicians and CD patients
(6), or more effective detection of CD in adults in recent years.
I suggest to modify the writing into: 
It has not been established whether this results from a true 
increasing incidence
of non-classical CD, or from 
greater awareness of physicians and CD patients
(6), or from 
more effective detection of CD in adults in recent years.
Page 3 L 3 : 
Reference is missing 
Page 3 L9 That finding, and suspicion that in Poland the mean time between the
onset of coeliac symptoms and CD diagnosis can be even longer than in the UK,
encouraged the authors of this study to conduct a similar study using comparable
instruments and methods among Polish CD patients.
I suggest to modify the writing into: 
That finding, and suspicion that in Poland the mean time between the onset of
coeliac symptoms and CD diagnosis could 
be even longer than in the UK 
lead us
to 
conduct a similar study using comparable instruments and methods among
Polish CD patients.
Page 3 L 7 Suspicion that in Poland the mean time between the onset of coeliac
symptoms and CD diagnosis can be even longer than in the UK, encouraged the
authors of this study to conduct a similar study using comparable instruments
and methods among Polish CD patients.
What was the rationale for this suspicion ?
Also it looks like the main aim is to compare the data from Poland to those of
the British study 
either than to learn about the specific situation in Poland . 
Page 4 L 22 respondents were asked to assess their quality of life at the time of
their diagnosis and at the time of the survey.
How reliable is to answer a survey related to the time of diagnosis 
years after the
diagnosis has been made . 
Are responses to Questions like Q8 
reliable ??
8. During the time that you had symptoms related to coeliac disease but had not
yet been diagnosed, approximately how many days did you take off work due to
your symptoms? 
Page 8 L17 : Polish answerers before CD diagnosis had more problems with
anxiety and depression (p<0.001) and self-care (p<0.002). 
I suggest to modify the writing into: 
Polish answerers 
had before CD diagnosis 
more problems with anxiety and
depression (p<0.001) and self-care (p<0.002).
Page 11 L 23-32 
Those results met with some disbelief among Polish clinicians, which
encouraged the authors of this study to conduct a similar analysis in Poland,
using a similar questionnaire and methods. 
A similar number of surveyees took part in the Polish and in the British study.
CD affects females more often than males and this was confirmed in both
studies, with a majority of females in each study group.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
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No
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