Review for 10.1186/s12876-022-02240-x (2022)

Reviewer’s report
Title: 
A descriptive study of high resolution total colonic intracavitary
manometry and colonic transit test in the diagnostic efficacy of functional
constipation in Chinese patients
Version: 
2 
Date: 
22 Jan 2022
Reviewer's report:
The paper presented by Wang et al., despite addressing an interesting topic and a
novel diagnostic tool (high resolution colonic manometry) has relevant
limitations that preclude its publication.
The diagnosis of constipation is a clinical diagnosis based on the Rome criteria.
This said, I think that colonic manometry has a limited role in the pure diagnosis
of constipation (in fact, authors decided to treat surgically also patients with
normal manometry and colonic transit test), while it may be useful to further
classify constipation in different patterns in order to guide surgical treatment in
severe, drug resistant cases. This topic has already be adressed in a previous
paper by the same group (Li et al., Use of high-resolution colonic manometry to
establish etiology and direct treatment in patients with constipation: Case series
with correlation to histology; J Gastroenterol Hepatol 2018), while in this paper
the impact of colonic manometry results on the surgical management has not be
adressed. 
Moreover, the authors included in the present study only patients with extremely
severe constipation that needed surgical treatment. Diagnostic performance of
either colonic transit test or colonic manometry in this particular group of
patients may be overestimated. On the other hand, I am afraid that an invasive,
complex procedure such as colonic manometry may be of difficult application in
the clinical practice in patients with less severe forms of functional constipation.
I think that other topics, such as the corrispondence of manometry and
histological findings in the different colonic segments or the impact of
manometry findings on the clinical outcome (do patients with positive
manometry respond differently from patients with negative manometry to the
surgical treatment?), may be of interest and should be adressed by the authors.
Other relevant concerns are about the structure and the language of the paper.
Methods and results are presented in a confused manner, and also background
and discussion may be markedly improved.
Furthermore, English language needs a complete revision by a native speaker.
Overall, the paper is very difficult to read.
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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?
No
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