Review for 10.1186/s12876-021-01913-3 (2021)

Reviewer’s report
Title: 
Hereditary hemorrhagic telangiectasia with liver cirrhosis, A case report
Version: 
1 
Date: 
20 Jul 2021
Reviewer's report:
This study reported a case of Hereditary hemorrhagic telangiectasia (HHT) with
liver cirrhosis admitted due to repeated melena and epistaxis which improved
after medical and endoscopic treatments. There are several concerns about this
manuscript.
Major:
1. It is known that the extent of telangiectasia correlates with the severity of a
patient's anemia and blood transfusion requirement. Therefore, the author should
describe more clearly and precisely about the extent of telangiectasia (ex:
numbers and locations).
2. It is known that hepatic involvement with vascular malformations may lead to
portal hypertension, biliary ischemia and high-output cardiac failure. As a result,
the author should describe more clearly about the liver disease in the HHT
patient (ex: symptoms, physical examinations, lab data, specific examinations
such as contrast-enhanced spiral CT scan and gastroscopy including the presence
of esophageal/gastric varices or portal hypertensive gastric mucosal lesions).
3. In the HHT patient with liver cirrhosis, combination treatments including
thalidomide and endoscopic thermos-coagulation with argon plasma coagulation
have successfully decreased transfusion needs. Moreover, I was very interested
to know if the liver disease in the HHT patient with liver cirrhosis had dramatic
improvement in his clinical state (reversal of cholestasis, resolution of cardiac
failure/ascites, nutrition status..etc.).
4. It is rarely reported that thalidomide had medical effects on Hereditary
hemorrhagic telangiectasia (HHT). Therefore, the author should offer more
literature review and provide the possible precise mechanisms for the medical
effect of thalidomide on this patient.
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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
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes