Review for 10.1186/s12876-018-0894-8 (2018)

Reviewer ’s report  
 
Title:  Improving basic skills in celiac -like disease diagnosis : a case report.  
 
Version: 0 Date: 30 Jul 2018 
 
Reviewer:  Riccardo  Troncone  
 
Reviewer’s report:  
 
In this paper a case report is discussed that highlights the concept that the diagnosis of celiac 
disease (CD) is not exclusively or almost  exclusively based on duodenal histology, rather on the 
combination of clinical features  (mainly the response to gluten -free diet, lacking in this 
particular case), serology (negative in this case),  genetics (HLA) and histology (in this case 
consistent w ith the diagnosis of CD).  
 
The paper is clearly presented  Although of educational value, it is not really innovative, not 
providing any new info.   Giardiasis  is discussed in all textbooks in the differential diagnosis of 
CD. Hovewever it offers a number  of issues that in the discussion could be more expanded on 
the basis of more recent references.  
 
 
Specific issues  
 
In the presentation of this case it would be useful to have:  
 
* HLA typing: being not a classical case because of the negative serology,  the a bsence of 
HLA alleles associated with CD would have immediately led to a diagnosis alternative to 
CD. 
 
* Count of gammadelta IELs : important in the differential diagnosis of villous atrophy.  
 
 
In the discussion useful to expand:  
 
* Rate of false negative in adults with CD  
 
* Non coeliac villous atrophy (several recent papers on this topic)  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
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