Review for 10.1186/s12876-018-0853-4 (2018)

Reviewer ’s report  
 
Title: Faecal Calprotectin Level for Assessing Endoscopic Activity and Predicting Future Clinical  
Course in Patients with Moderately Active Ulcerative Colitis Undergoing 
Granulomonocytapheresis:  A Pros pective Cohort Study  
 
Version: 0 Date: 20 May 2018  
 
Reviewer: Frank Lehmann  
 
Reviewer's report:  
This study performed by Takahiro Shimoyama et al examined the concentration of fecal 
calprotectin (FC) before and after treatment of  UC patients with Adacolumn GMA  therapy. 184 
patients with endoscopically assessed moderate ulcerative colitis were examined. The authors 
found that FC significantly fell in patients achieving mucosal healing (MH). Furthermore, FC 
proved to be a reliable predictor of clinical relapse af ter discontinuation of Adacolumn GMA 
therapy.  
 
The study design is clear and focussed. The study population is well characterized. The data are 
interesting and new. The manuscript is well and concisely written. The conclusions correspond to 
the data presen ted. 
 
However, there are some concerns which need to be adressed  
 
(1) Assessment of clinical efficacy. The authors used exclusively "stool frequency" and "rectal 
bleeding" from the Mayo Score. The authors should refer in the references to the original cita tion 
of the Mayo Score and explain why they used only two parameters.  
 
(2) FC vs disease activity: In patients who achieved clinical remission, the initial FC levesl at entry 
were lower than in those who did not (99 vs 181). This is an interesting finding,  which should be 
discussed.  
 
(3) FC Level and future relapse.: First sentence: The sentence should be clarified: The median FC 
fevel at the end of the GMA therapy was significantly higher...  
 
(4) FC Level and future relapse: 8 of 47 patients is not 1%.  
 
(5) Discussion: The authors state that MH was more frequently observed in patients with moderate 
endoscopic activity compared to those with severe endoscopic activity. This statement is in 
contrast to the inclusion criteria, whereas only patients with modera te disease activity were 
examined  
 
(6) Discussion: The authors found that concomitant azathioprine therapy did not affect the 
remission rate. This is in contrast to other studies examining the effect of azathioprine in remission 
of UC. The authors should discuss the discrepancy.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
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.  
I recommend additional statistical review  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Acceptable  
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