Review for 10.1186/1471-230X-14-150 (2014)

Reviewer's report
Title:Quality of life and health care consultation in 13 to 18 year olds with
abdominal pain predominant functional gastrointestinal diseases
Version:1Date:27 February 2014
Reviewer: Miguel Saps
Reviewer's report:
Congratulations on your article “Quality of life and health care consultation in 13
to 18 year olds with abdominal pain predominant functional gastrointestinal
diseases”. You show that having an AP-FGID results in a lower quality of life on
all four domains, which proofs the significant effect these disorders have on
teenagers. To further assess your work I will use the points given by the BMC
guidelines.
1. Is the question posed by the authors well defined?
Yes, it is made clear that there are no previous studies to evaluate the QoL in Sri
Lankan teenagers, and only few studies have assessed QoL in general.
2. Are the methods appropriate and well described?
The methods are well described, but few questions arise:
Discretionary Revisions - You have selected four mixed schools, are most
schools mixed in the province or are most separated? Did these selected schools
only have children aged 13-18 or were certain age groups not contacted? Do you
think these four schools are a good representation of children in the Western
province of Sri Lanka?
Discretionary Revisions - Second paragraph:” … were collected using a
validated, self-administered questionnaire…” I think readability is better if you first
explain which questionnaires you used (paragraph 3) and then how you
conducted them and how you got consent.
Minor Essential Revisions – Third paragraph: “… PedsQL self report for from for
teen.” Please correct this.
Discretionary Revisions - Third paragraph: … Has undergone linguistic validation
by Mapi Research Trust.” This sounds trustworthy but please add a reference if
you could.
Discretionary Revisions – Scales used, first paragraph: I would change last line
to: “… zero to 100 scale (0=100, 1=75, 2=50, 3=25, 4=0). Final HRQoL scores
were computed out of 100, with higher scores indicating better HRQoL.
Minor Essential Revisions – Statistical analysis: “ Healthcare consultation
between patents (change to patients) and controls…” Last line: “All correlations
wee” Should be were
3. Are the data sound?
- Impressive that all questionnaires were returned
- You found a prevalence of AP-FGD of 16.5%, another Sri Lankan study
(Devanarayana, N. M., et al. (2011). "Prevalence of functional gastrointestinal
diseases in a cohort of Sri Lankan adolescents: comparison between Rome II
and Rome III criteria." J Trop Pediatr 57(1): 34-39.) found a prevalence of 13.8%,
and a study by our group (Saps, M., et al. (2013). "Prevalence of Functional
Gastrointestinal Disorders in Colombian School Children." J Pediatr. ) found
AP-FGID in 12% of the children in Colombia. These numbers seem similar.
Discretionary Revisions – Your study found functional dyspepsia in only 0.6%,
while the previous Sri Lankan data showed dyspepsia in 3.5%, and Saps found
1.7%. Can you think of a reason for this?
This is also the case for functional abdominal pain; you found 9.7% while the
previous study found 3% and saps found 2.7%. Could you explain this
difference?
Discretionary Revisions – Last line of paragraph HRQoL in children with
AP-FIGD: “Such a difference…” I would say: There was no statistical difference
between children with FD and controls.
Discretionary Revisions – “When HRQoL scores were compared... lowest
HRQoL scores were observerd in children with AM and IBS” I would add the
numbers of the scores here so readers don’t have to look back to the table.
Discretionary Revisions – “HRQoL scores were significantly higher in children
with FD compared to other three types.” I would delete this, you make the same
point a line above.
Discretionary Revisions – “(p>0.005)” Please give the precise P value.
Discretionary Revisions – Table 3, could you add p-values in the table where
appropriate? Please be consistent with the use of %.
4. Does the manuscript adhere to the relevant standards for reporting and data
deposition?
Yes
5. Are the discussion and conclusions well balanced and adequately supported
by the data?
Discretionary Revisions – You state a weak inverse relationship between severity
and scores was found, and you argue that this is consistent with other studies. It
makes sense that having worst symptoms results in lower QoL, but why is it only
a weak relationship, could you perhaps give reasons why there is only a weak
relation?
Minor Essential Revisions – You use the line “we could not make a comparison”
very often in the discussion, if possible change or delete it sometimes. If there
are no other studies you don’t have to add that you could not make a
comparison.
Discretionary Revisions – You state that only vomiting was associated with more
consultation, this was the same in the previous Sri Lankan study, can you explain
this, perhaps it is culturally defined to see a doctor sooner when you’re vomiting
or another reason you can think of?
Minor Essential Revisions – “These need to be taken into consideration…. ,
those looking after children….” I would make it this: This needs to be taken into
consideration…, especially those looking after…”
Overall I feel the discussion mainly compares your findings to other studies. I
hope you can add some of your own hypothesis and of the effects it should or
could have on the management of FGID in day to day practice
6. Are limitations of the work clearly stated?
You do not clearly state limitations, perhaps you could add these. From the
article it looks like there are not many limitations.
7. Do the authors clearly acknowledge any work upon which they are building,
both published and unpublished?
Yes
8. Do the title and abstract accurately convey what has been found?
Yes. In the abstract I would only change “A significant negative correlatioin
between HRQOL and addominal pain… I would make it “A weak but significant
negative correlations…”
9. Is the writing acceptable?
Yes the writing is acceptable.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interest
Stijn Mintjens
research intern