JerMa88/BMC_Gastroenterology_Peer_Reviews huggingface dataset:
Review for 10.1186/1471-230X-9-29 (2009)

Reviewer's report
Title:Outcomes and factors influencing the survival in cases with spontaneous
rupture of hepatocellular carcinoma: a multicenter study
Version: 2Date:9 January 2009
Reviewer: Kelvin K C Ng
Reviewer's report:
Major Compulsory Revisions
This is a retrospective multicenter study on the survival outcome and the
associated prognostic factors in patients with spontaneous ruptured
hepatocellular carcinoma (HCC). Transarterial embolization (TAE) was the only
independent prognostic factor affecting median survival. One criticism is the way
to elaborate the univariate and multivariate analysis of those prognostic factors is
not clear. First, the authors need to describe clearly all clinicopathologic factors
to be considered for the analysis. Second, the results of univariate analysis
needs to be presented and preferably tabulated. Third, the detailed results of
multivariate analysis needs to be mentioned. Moreover, due to small number of
patients in TAE group, the results of multivariate analysis in this subgroup is not
valid.
Minor Essential Revisions
1. Table 2 is not necessary since its information is repeated in Fig 1.
2. Was there any complication after TAE treatment?
3. What would be subsequent management protocol after successful TAE
treatment?
Discretionary Revisions
N/A
Level of interest: An article of importance in its field
Quality of written English: Acceptable
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 interests
Review for 10.1186/1471-230X-9-29 (2009)

Reviewer's report
Title:Outcomes and factors influencing survival in cirrhotic cases with
spontaneous rupture of hepatocellular carcinoma: a multicenter study
Version: 3Date:5 April 2009
Reviewer: Sven Wallerstedt
Reviewer's report:
I think that the authors have made a good revision of the manuscript, and I find
that they have responded to my criticism. The most important correction is the
change of the inclusion criteria for patients into group ConT by use of defined
exclusion criteria with the result that the two groups now are fairly similar.
However, I have two minor comments, of which one is a consequence of this
change and thus necessary to handle.
1. After reducing the ConT group from 38 to 32 persons the authors present a lot
of data from this new group. This is also done considering cause of death in
Results, last para. However, the authors have forgotten to change the figures in
Table 6, which must be done. I also think that it will be easier to understand the
table if the legend is completed with the following text: “In one of the 16 TAE
patients it was not possible to stop the hemorrhage by use of TAE”.
2. The authors have accepted my recommendation to insert “cirrhotic” at several
places in the text, which I think should be done also in the first sentence in
Methods between “48” and “patients”.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
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 interests.
Review for 10.1186/1471-230X-9-29 (2009)

Reviewer's report
Title:Outcomes and factors influencing survival in cirrhotic cases with
spontaneous rupture of hepatocellular carcinoma: a multicenter study
Version: 3Date:7 April 2009
Reviewer: Jeong Won W. Jang
Reviewer's report:
The revised version is clear, and substantiates the conclusion of this study. I am
satistified with this form.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
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 interests.
Review for 10.1186/1471-230X-9-29 (2009)

Reviewer's report
Title:Outcomes and factors influencing survival in cirrhotic cases with
spontaneous rupture of hepatocellular carcinoma: a multicenter study
Version: 3Date:8 April 2009
Reviewer: Spiros Delis
Reviewer's report:
A devastating entity such as rupture of HCC is rare in the west with a high
mortality rate.However is important that TACE can rescue patients and offer long
term survival especially in cirrhotics. Although some selection bias exist and the
treatment strategy is not new however a multy-institutional study herein is
valuable at least for the management standpoint and the aggressiveness of
treatment by the groups involved.
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.
Review for 10.1186/1471-230X-9-29 (2009)

Reviewer's report
Title:Outcomes and factors influencing survival in cirrhotic cases with
spontaneous rupture of hepatocellular carcinoma: a multicenter study
Version: 3Date:9 April 2009
Reviewer: Kelvin K C Ng
Reviewer's report:
Regarding the revised manuscript, the authors have revised it up to my
satisfaction and they have responded adequately to the points raised in the
reviewer's report. I do not have further questions.
Review for 10.1186/1471-230X-9-30 (2009)

Reviewer's report
Title:Detection of serum MMP-7 and MMP-9 in cholangiocarcinoma patients:
evaluation of diagnostic accuracy
Version: 2Date:16 February 2009
Reviewer: Stanley Zucker
Reviewer's report:
Review
This is a well written manuscript using state of the art approaches to address a
reasonable problem in clinical medicine relating to difficulty in diagnosis of
cholangitic carcinoma. The MMP-7 data is of interest and is deserving of
publication.
Major Compulsory Revisions
1. A major problem in technique in this manuscript relates to the concept of
measuring MMP-9 in blood using serum specimens. There have been numerous
publications describing the fact that most of the MMP-9 identified in serum
specimens is an artefact representing the release of MMP-9 from neutrophils
during the clotting process rather than from diseased tissues. To properly
measure MMP-9 in blood, the specimen should be anti-coagulated during blood
collection and plasma should be isolated without delay. This oversight has led to
many reports of elevated serum MMP-9 levels in various diseases and although
the results might appear relevant, the conclusions are based on erroneous
assumption. Nonetheless if the authors add this type of information to the
Discussion of their manuscript with appropriate references, it would be
reasonable to leave the MMP-9 data in the manuscript. Fortunately,
measurement of MMP-7 in serum specimens does not suffer the same artefact
as MMP-9.
2. The authors should clarify the issue of whether the serum MMP-7 will actually
be useful to clinicians in making decisions regarding patient care. I believe that
they have overstated their case. Although the authors correctly point out that the
specificity and sensitivity of MMP-7 measurement provides some predictive
power, they should address the practical issue of how clinicians may be able to
use the test in the current setting of a routine clinical labs. How variable will the
cut off levels for “normal” be between different labs? Do they think the test is
important enough to request that regulatory agencies approve the test for clinical
applications?
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
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 interests' below
Review for 10.1186/1471-230X-9-30 (2009)

Reviewer's report
Title:Detection of serum MMP-7 and MMP-9 in cholangiocarcinoma patients:
evaluation of diagnostic accuracy
Version: 2Date:26 February 2009
Reviewer: Gülsüm Özlem O Elpek
Reviewer's report:
Review,
This paper describes whether the serum levels of MMP-7 and MMP-9 can
discriminate cholangiocarcinoma (CC) from benign biliary tract diseases (BBTD)
in comparison to CEA and CA19-9. It appears that among these tumour markers
only the serum MMP-7 levels was significantly higher in patients with CC than in
patients with BBTD. It is concluded that serum MMP-7 measurement could be a
valuable diagnostic marker in the differential diagnosis of CC form BBTD.
It is basically a well written paper of an interesting study. Following comments
can be made:
1- In the conclusion part of the abstract section (p2, line 4) the statement ‘’Serum
MMP-7 appears to be a valuable diagnostic marker for cholangiocarcinoma.’’
must be changed as ‘’Serum MMP-7 appears to be a valuable diagnostic marker
in the discrimination of cholangiocarcinoma from benign biliary tract disease.’’ As
pointed by the authors in the background (p4, line 21-22) as well as in the
discussion sections (p11, line 10-11) MMP-7 levels might be significantly
elevated in ovarian and colorectal cancers. Therefore it is not possible to
discriminate these tumours from CC according to serum MMP-7 levels. Moreover
the aim and the design of the present study are intended for the evaluation of
MMP-7 levels in the differential diagnosis of CC from BBTD.
2- Some data in the results section are also repeated in the tables or illustrations.
Only important observations should be emphasized or summarized in the text.
Therefore this section must be simplified.
3- In the discussion section the statements in p9 and in lines 9,10 and 11 should
be omitted. Because similar statements has been used in the background
section.
4- The English needs some brushing up with regard to grammar and syntax.
Level of interest: An article whose findings are important to those with closely
related research interests
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 interests
Review for 10.1186/1471-230X-9-30 (2009)

Reviewer's report
Title:Detection of serum MMP-7 and MMP-9 in cholangiocarcinoma patients:
evaluation of diagnostic accuracy
Version: 3Date:9 April 2009
Reviewer: Stanley Zucker
Reviewer's report:
This manuscript has satisfied my criticisms and is now acceptable for publication
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
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 interests' below
Review for 10.1186/1471-230X-9-27 (2009)

Reviewer's report
Title:Development of functional gastrointestinal disorders after Giardia lamblia
infection
Version: 1Date:5 January 2009
Reviewer: Giovanni Barbara
Reviewer's report:
Post-infectious functional gastrointestinal syndromes, and particularly irritable
bowel syndrome have been mainly investigated following acute bacterial
gastroenteritis. The present study is of interest since it addresses the possibility
that the non-invasive protozoan Giardia lamblia is involved in the development of
long-lasting post-infectious functional symptoms after eradication.
The method used to identify successful eradication has some limitations since
micrioscopy of fecal samples has a sensitivity around 85%. This should be
acknowledged in the manuscript.
Although this is a prospective study the presence/absence of symptoms before
the infection was assessed retrospectively. This is a limitation since it appears
that many patients were asked about their previous symptoms a long time after
the diagnosis of Giardia infection. This may generate a recall bias.
The study is uncontrolled and this may overestimate the prevalence of
symptoms. What is the prevalence of FGID in age, gender and region matched
controls?
Could be the authors more precise on the tests they did on the patients to
exclude other diseases? Did they exclude celiac disease or major food allergies?
Review for 10.1186/1471-230X-9-27 (2009)

Reviewer's report
Title:Development of functional gastrointestinal disorders after Giardia lamblia
infection
Version: 2Date:21 February 2009
Reviewer: Peter Whorwell
Reviewer's report:
The authors seem to have made all the necessary revisions
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
Review for 10.1186/1471-230X-9-26 (2009)

Reviewer's report
Title:No evidence for protective erythropoietin alpha signalling in rat hepatocytes
Version: 1Date:24 September 2008
Reviewer: Necati Gokmen
Reviewer's report:
They do not have major compulsory revisions,minor essential revisions and
discretionary revisions
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
'I declare that I have no competing interests'
Review for 10.1186/1471-230X-9-26 (2009)

Reviewer's report
Title:No evidence for protective erythropoietin alpha signalling in rat hepatocytes
Version: 2Date:17 March 2009
Reviewer: Constance Noguchi
Reviewer's report:
The authors have addressed most of the concerns raised in the first review.
However, the figure legends for figures 1, 2 and 4 need to be corrected to include
the identification of the closed squares, circles, triangles and diamonds.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
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 interests
Review for 10.1186/1471-230X-9-25 (2009)

Reviewer's report
Title:Decreasing Incidence of Peptic Ulcer Complications Despite Increasing
Sales of Prescribed NSAID:s, a study of the Swedish Population from
1974-2002.
Version: 3Date:5 November 2008
Reviewer: Henrik Sorensen
Reviewer's report:
I have reviewed this paper before and, as mentioned, I believe that the material
is of high quality and eminently suitable to study trends in peptic ulcer
complications. However, the paper still has some problems:
1. The authors go too far in their interpretation of the data. For example: in the
title only NSAIDs are mentioned. However, in the conclusion of the abstract the
only explanation for the change in incidence that is mentioned is the introduction
of PPIs. As written before (and partly covered by the authors in the discussion),
there are several other explanations, such as the decreasing prevalence of
smoking and the introduction of eradication therapy in the same period.
2. The tables regarding the spline regression analysis do not provide information
in themselves. Only the figures should be included in the paper.
3. As for the figures, the changes in incidence look dramatic, but the reader
needs to be aware of the fact that the authors have truncated the y-axis. The axis
thus does not start with 0 and therefore the figures distort the changes.
4. The paper needs a thorough technical and editorial revision. For example, as
mentioned before, NSAIDs are sometimes written with an ‘s’ in the abbreviation,
and sometimes without. In the abstract ‘AcetylSalicylic Acid’ is written with
capitals and in the text without.
5. In the results of the abstract, the incidence rates are mentioned in the results
section, sentence 2. However, these incidences cannot be found anywhere in the
main text.
6. In the references the authors sometimes list one author, sometimes three.
7. There are several spelling mistakes scattered around the paper.
Level of interest: An article whose findings are important to those with closely
related research interests
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 interests
Review for 10.1186/1471-230X-9-23 (2009)

Reviewer's report
Title:Helicobacter Pylori Infection: Approach Among Primary Care Physicians Of
Developing Country
Version: 2Date:1 December 2008
Reviewer: Ernst Kuipers
Reviewer's report:
This paper describes the results of a cross-sectional study analysing the
response of 426 primary care physicians based in Karachi, Pakistan, to a
self-designed questionnaire containing 11 items on Helicobacter pylori with focus
on transmission, diagnosis, treatment and follow-up. It turns out that the majority
of the physicians were aware of Helicobacter pylori, and gastric ulcer disease
was the most frequent indication for treatment in this population, with the majority
preferring clarithromycin-based triple therapy. The authors conclude that these
findings contrast with published guidelines for the management of H. pylori
infection and that these internationally published guidelines have little impact on
current practices in their country. They recommend more teaching programs and
frequent interaction between primary care physicians and gastroenterologists.
General comments
1/ The authors make some comparisons with similar studies from other
geographical areas. This is relevant to put their data into a larger perspective.
For that reason, it would be logical and attractive to expand the perspective a
little further adding other studies with similar results, and also if possible to
provide information with respect to the scores of Pakistan gastroenterologists on
the same survey. In other words, are the results from the primary care physicians
very different from those that would be given by gastroenterologists?
2/ The exact questions and their transposal into sentences in the abstract and
discussion do not always perfectly match. As an example; when physicians are
asked about the indications for testing for H. pylori, this is not the same as that
they actually test (and treat) patients with these indications. In that respect, I
propose that the text is once more carefully read with the exactly formulated
questions of the questionnaire in hand. To give a specific example, if 19% of the
primary care physicians knows that gastric maltoma is an indication for H. pylori
testing, this is not the same as “only 19% of phycicians tested for H. pylori in
maltoma” (page 17, line 4 from below).
Specific comments
1/ The presentation of the results can be shortened, in particular the figures are
redundant apart from table listing the proportions of positive answers.
Furthermore, I would list those proportions as full numbers (i.e. 19% instead of
19.40%).
2/ Final recommendation in abstract and both conclusions (page 19: to
recommend more teaching is an obvious step to go for, however, can the authors
provide some data on how this population of physicians is being taught on H.
pylori, and can they present any data that teaching on this topic also increases
the correct response rate as well as changes clinical practice?
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Review for 10.1186/1471-230X-9-23 (2009)

Reviewer's report
Title:Helicobacter pylori infection: Approach of primary care physicians in a
developing country
Version: 3Date:10 January 2009
Reviewer: Andrew S Day
Reviewer's report:
The authors have improved the manuscript following review of the reviewers'
comments.
1. Unfortunately, the authors appear to have mis-interpreted my comment about
the presentation of Helicobacter pylori (and H. pylori). This bacterial name should
be italicised in every instance.
2. I would suggest that the authors report the percentage of practitioners who
completed the questionnaires out of the total who were asked to complete them
(i.e. the response rate).
3. I assume that the 509 physicians who were given the questions to answer
were a convenience sample. Are the authors confident that this group represents
the total group of over 4000 primary care physicians in Karachi? If this group of
591 are the doctors who attend CME, perhaps the knowledge of this group is
vastly different to the other doctors?
4. I am unclear of the rationale for the adjustment in the sample size based on
the population of physicians in Karachi.
5. The authors have improved the language and grammar throughout the
manuscript, but there remain a number of errors that require attention.
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
Review for 10.1186/1471-230X-9-23 (2009)

Reviewer's report
Title:Helicobacter pylori infection: Approach of primary care physicians in a
developing country
Version: 3Date:6 February 2009
Reviewer: Ernst Kuipers
Reviewer's report:
The authors have addressed my comments, with exception of my request to
present the same survey to gastroenterologists from the same region to ask for
their clinical approach and knowledge on the same topic. I think this could be
easily done and would increase the interest of the paper to a future readership.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare I have no competing interests.
Review for 10.1186/1471-230X-9-23 (2009)

Reviewer's report
Title:Helicobacter pylori infection: Approach of primary care physicians in a
developing country
Version: 4Date:19 March 2009
Reviewer: Andrew S Day
Reviewer's report:
The revised manuscript by Ahmed and colleagues focuses on the understanding
of Pakistani general practitioners about Helicobacter pylori infection.
Overall comment:
This manuscript is important as it provides a mechanism to promote optimal care
and management of individuals with H. pylori in Pakistan and other countries.
This information should assist educators and administrators to consider more
appropriate opportunities for practitioners to learn. It should also encourage
individual practitioners towards self-directed learning.
Specific Comments:
The authors have further improved their manuscript.
The authors have attended to the reviewers comments in almost all instances.
Many of the typographical errors have been corrected: others remain. Most of the
time H. pylori is mentioned it is italicised as required.
The authors should consider adding Figure Legends to the Figure Titles.
It would be of great interest to learn if practitioners in this area of Pakistan who
do not attend CME activities know less or the same about this important area.
Furthermore, it would be most interesting to do a parallel study in rural
practitioners in Pakistan and/or to compare and contrast with another country in a
parallel fashion. The authors may wish to consider such endeavours to follow the
current study.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
'I declare that I have no competing interests'
Review for 10.1186/1471-230X-9-24 (2009)

Reviewer's report
Title:Use of an Electromagnetic Colonoscope to Assess Maneuvers Associated
with Cecal Intubation
Version: 1Date:9 October 2008
Reviewer: Michael Bretthauer
Reviewer's report:
The usefulness of different maneuvres during the insertion phase of colonoscopy
(patient repositioning, endoscop stiffening, external abdominal pressure) have
been described as helpful to intubate the ceacum and are widely used. However,
evidence for their effect are largely lacking. Therefore, the study by Heigh and
c-workers therefore deals with an important topic.
However, unfortunately, in my opinion, he study fails to address the
abovementioned issues properly and I would therefore recommend to reject the
paper.
Flaws:
1. the study lacks a clear statement of the study aim and an explanation of the
methods used to accomplish this aim. While a definiton of the study aim is
completely lacking in the introduction, the abstract states that the authors would
aim to "better understand how these maneuvres affect coecal intubation".
However, the study does not give any answers to that question. To address this,
the invetigators would have chosen a different design, allowing the reader to
distinguish between insertion with and witghout the attempted maneuvres and
their effect. A back-to-back desgin would have been the better approach.
2. Only about 1 patient per day has been included in the trial during the study
period. This questions the validity of the results as a selection bias must be
considered.
3. The choice of both the endoscopse used and the maneuvres applied are not
clear to the reader and may affect the outcome of the study.
3. the authors fail to acknowledge a number of papers that already exist on the
topic (e.g. Shah et al GIE 2002, Hoff et al Scand J Gastro 2007).
4. It is unclear how a success/non-success of the different maneuvres are
defined.
5. The use of the stiffening function is not explained (grade of stiffening)
6. statistics are lacking completely
7. the conclusion of the trial does not fit to the aim at all. Moreover, the trial
cannot tell anything about the usefulness of the Em endoscope with regard to
visualisation of the endoscope in realilty (however, other studies have lloked at
taht in the past).
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
Review for 10.1186/1471-230X-9-24 (2009)

Reviewer's report
Title:Use of an Electromagnetic Colonoscope to Assess Maneuvers Associated
with Cecal Intubation
Version: 1Date:13 October 2008
Reviewer: Arthur Kaffes
Reviewer's report:
Review of manuscript: Use of an Electromagnetic Colonoscope to Assess
Maneuvers Associated with Cecal Intubation
Overall a nice paper and quite interesting work. Some minor discretionary
revisions are suggested as follows;
Abstract
Last paragraph of the methods section does not make sense.
Fifth sentence in the results does not make sense
Background
There is too much about the Olympus device in this section I would prefer to see
it in the methods section
Results
Colonoscopy information section: you comment about the 5 cases with the paed
VS but not on the rest. In fact, there is more info in the abstract on this.
ETM: third paragraph makes little sense and requires referral to the table. This
should be better explained in the text. There is no real comment about how you
measure success of ETM in the methods.
Conclusion is far too long.
Reference section needs to be tidied up.
Figure 2 adds nothing to the paper.
Suggest accept after discretionary revisions
An article of importance in its field
Minimal statistical input required for this work
No disclosures to be made.
Review for 10.1186/1471-230X-9-24 (2009)

Reviewer's report
Title:Use of an Electromagnetic Colonoscope to Assess Maneuvers Associated
with Cecal Intubation
Version: 2Date:4 February 2009
Reviewer: Michael Bretthauer
Reviewer's report:
Abstract: please give actual numbers for endoscope postion and use of ETM,
rather than "most often" and "less"
Abstract: It would be helpful to include the most important specifics with regard to
ETM in the abstract, eg. which ETM was used how often, sucess rate for the
different ETM's.
Results section: Please add a sentence on the use of sedation in the study
participants. I assume that all pts' were sedated but none had assisted
ventilation? What drug did you use?
Review for 10.1186/1471-230X-9-22 (2009)

Reviewer's report
Title:Interferon beta-1a for the maintenance of remission in patients with Crohn's
disease: results of a phase II dose-finding study
Version: 1Date:6 August 2008
Reviewer: E Ebert
Reviewer's report:
Interferon beta 1a for the maintenance of remission in patients with Crohn’s
disease: results of a phase 2 dose-finding study
The authors claim that interferon beta is no different in efficacy than placebo in
patients with Crohn’s disease.
Major compulsory revisions:
1. Two major problems with the study are the small numbers of patients and the
large drop-out due to treatment failures. Surprisingly, these problems are not
mentioned in the Abstract or Discussion. There is no information regarding the
treatment failures.
2. Interferon may in fact worsen the disease process as suggested by the
increased ESR and C-reactive protein compared to placebo. (Is this difference
significant?) In addition, the only significant finding was a worsening of disease
with interferon at week 52. Furthermore, the placebo group had a smaller mean
increase in CDAI score than the interferon group (Is this difference significant?
The changes in the CDAI score should be included.) The fact that interferon may
worsen the disease should be addressed in the Abstract and Discussion.
Minor essential revisions:
The significantly different values are from week 52. This should be stated in the
legend.
The abstract should indicate that the protocol was a steroid taper.
Level of interest: An article of limited interest
Quality of written English: Acceptable
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 interests
Review for 10.1186/1471-230X-9-22 (2009)

Reviewer's report
Title:Interferon beta-1a for the maintenance of remission in patients with Crohn's
disease: results of a phase II dose-finding study
Version: 1Date:15 August 2008
Reviewer: Francesco Patti
Reviewer's report:
I find the paper as acceptable for publication without any revision.
Review for 10.1186/1471-230X-9-22 (2009)

Reviewer's report
Title:Interferon beta-1a for the maintenance of remission in patients with Crohn's
disease: results of a phase II dose-finding study
Version: 1Date:28 August 2008
Reviewer: Susanna Nikolaus
Reviewer's report:
the authors report results of a multicentre controlled phase II dose-finding study
with Interferon ß-1a for maintenance of remission in Crohn´s disease. 67 patients
were included in the trial and were randomized to either IFN-ß 44 µg biw, 44 µg
tiw, 66µg tiw or placebo. The primary endpoint was relapse-free remission at
week 26. After an interim analysis of the week 26-data, the trial was terminated
because there were no differences in between the four groups in the proportion
of patients who remained in relapse-free remission.
The study was well designed and results were presented and discussed
adequately. Because the results of a planned interim analysis at week 26
showed no significant benefit of interferon beta in comparison with placebo, the
trial was terminated. Due to the unplanned early termination the number of
patients in each treatment arm that finished the study became very small. To
facilitate an easy overview, the authors additionally provided the study design as
a flow chart with the numbers of patients in each group at each time point.
Major essential revisions:
The introduction should be overworked. The statement that CD is a condition of
T-cell activation is only one hypothesis to explain the pathogenesis of CD. Other
conditions (like genetics, enviromental factors, other immunological conditions)
should also be shortly mentiontioned.
Discussion/References:
The authors sould discuss previous experiences with interferon in Crohn´s
disease as well as results from controlled trials with IFN-b in ulcerative colitis.
none of the original articles about Interferon a/b (pilot trials or phase II-trials) in
IBD were cited.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Review for 10.1186/1471-230X-9-22 (2009)

Reviewer's report
Title:Interferon beta-1a for the maintenance of remission in patients with Crohn's
disease: results of a phase II dose-finding study
Version: 2Date:13 November 2008
Reviewer: Susanna Nikolaus
Reviewer's report:
After all the revisions the authors made I consider this paper ready for
publication.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
Review for 10.1186/1471-230X-9-21 (2009)

Reviewer's report
Title:Blood ammonia levels in liver cirrhosis: a clue for the presence of
esophageal varices.
Version: 1Date:12 December 2008
Reviewer: Stephen Harrison
Reviewer's report:
Tarantino and colleagues present an interesting analysis of 201 cirrhotic patients
and correlate blood ammonia level with the presence of esophageal varices
(EV).. While expert statistical analysis may be beneficial, these results do confirm
a novel association between blood ammonia level & EV. While novel in their
findings, these likely will not change clinical practice as all patients with cirrhosis
undergo surveillence for EV, typically with an EGD. These authors propose
empiric treatment for EV with beta-blockers if blood ammonia levels are elevated
and that is certainly too much of a leap at this point. However, it would be
interesting to see if putting pt's on beta blockers or performing EVL on their
varices changed the ammonia level (an area of future study that might lead to
blood ammonia level's utility in clinical practice).
No major revisions required.
Minor essential: some minor wording issues throughout likely related to english
not being the primary language of the authors that could be easily corrected.
Overall, an interesting study that may lead to further study in the field relating
ammonia level to EV.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
Review for 10.1186/1471-230X-9-21 (2009)

Reviewer's report
Title:Blood ammonia levels in liver cirrhosis: a clue for the presence of
esophageal varices.
Version: 1Date:24 December 2008
Reviewer: Bader Faiyaz Zuberi
Reviewer's report:
The study is well designed and conducted and does not have any major faults in
it. I feel that it should also be reviewed by a statistician.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
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 interests
Review for 10.1186/1471-230X-9-21 (2009)

Reviewer's report
Title:Blood ammonia levels in liver cirrhosis: a clue for the presence of
esophageal varices.
Version: 1Date:29 December 2008
Reviewer: Roberto de Franchis
Reviewer's report:
Major compulsory revisions
This study evaluates the suitability of measuring blood ammonia levels as a
marker of the presence of esophageal varices.
The issue of identifying patients with esophageal varices at risk of bleeding by
non invasive means is relevant and has been addressed in several recent
studies. This is yet another attempt to tackle this goal.
The Authors deserve to be commended for their thorough statistical analysis, but
the bottom line is that the performance of the measurement of blood ammonia for
the identification of patients with varices is simply not good enough for this test to
be proposed as a suitable alternative to upper GI endoscopy
Major points
a. In the results, there seems to be a contradiction concerning the relationship
between spleen longitudinal diameter (SLD) and variceal grade. In the second
paragraph on page 7 the Authors say that “splenomegaly, assessed as SLD at
US, was present in 50 patients... and evidenced no relation to the grades of EV”.
In the second line of the “Associations” paragraph , they state that “A significant
correlation was evidenced between SLD values and EV grades”. Please explain.
b. The Authors should calculate how many patients could have avoided
undergoing EGD if the cut-off of 42 microMoles/liter had been used for selection,
and how many patients with varices would have been missed if this threshold
had been used.
c. The discussion is out of focus and should be totally rewritten, in that it
discusses pathophysiological aspects which are largely unrelated to the aim of
the study, and totally fails to put the value of measuring blood ammonia in the
context of other non invasive methods to detect the presence of varices.
Minor essential revsions
a. The English form is awkward at some points and needs revision by a native
English speaker; spelling mistakes should also be corrected
b. Ascites was detected in 35 of 61 decompensated patients: in general, the
appearance of ascites is considered the hallmark of decompensation: how was
decompensation diagnosed in non-ascitic patients ?
c. The numbering of the tables jumps from 3 to 5
d. The figures are reported twice
Level of interest: An article of limited interest
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 interests
Review for 10.1186/1471-230X-9-21 (2009)

Reviewer's report
Title:Blood ammonia levels in liver cirrhosis: a clue for the presence of
esophageal varices.
Version: 2Date:6 February 2009
Reviewer: Roberto de Franchis
Reviewer's report:
Minor essential revisions
1)An important piece of information which is missing is the number of patients
with NH4 levels above the 42 microMoles threshold who had no varices. This
would give a measure of the number of unnecessary endoscopies that would
have been made if the threshold was adopted.
2) The English form has somewhat improved, but the paper still needs revision
by a native English speaker, since the form is awkward in several points.
Level of interest: An article whose findings are important to those with closely
related research interests
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 interests
Review for 10.1186/1471-230X-9-20 (2009)

Reviewer's report
Title:The EQ-5D (Euroqol) Is A Valid Generic Instrument For Measuring Quality
Of Life In Patients With Dyspepsia
Version: 1Date:6 January 2009
Reviewer: Jan JV Busschbach
Reviewer's report:
This is a very nice written, helpful article about the validity of the EQ-5D in
Dyspepsia. It not really a 'breakthrough' in research, but it will serve a notable
place in the literature, as all who will use the EQ-5D in Dyspepsia hereafter will
refer to this article investigating the validity (there is indeed no article that
examine the validity of the EQ-5D in Dyspepsia).
I like the way the authors have written a condense manuscript, without missing
the mean and critical; points in this kind of research. My suggestion would be to
accept the article as it is.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I am a member of the EuroQol group, and the EuroQol group reimburses
research and related travel, including mine. My salary does not depend in
anyway to the goods or bad of the EQ-5D.
Review for 10.1186/1471-230X-9-20 (2009)

Reviewer's report
Title:The EQ-5D (Euroqol) Is A Valid Generic Instrument For Measuring Quality
Of Life In Patients With Dyspepsia
Version: 1Date:9 February 2009
Reviewer: Fabio Pace
Reviewer's report:
I have no comments on this paper, since it is clear, well written and precisely
addressing the issue.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
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 interests
Review for 10.1186/1471-230X-9-19 (2009)

Reviewer's report
Title:Validation study of villous atrophy and small intestinal inflammation in
Swedish biopsy registers
Version: 2Date:9 October 2008
Reviewer: Vincenzo Villanacci
Reviewer's report:
The paper is well written and worthy of publication in particular compliments for
the extensions of the work and the data presented exaustive and complete.
I think that only minor revisions or suggestions are necessary.
I have no observations on the architecture of the paper the introduction, materials
and methods and results are perfect. I think that in the discussion is necessary to
spend some words about the definition of inflammation used in Sweden that
correspond to both Marsh 1 and Marsh 2 and Grade A of the new proposed
classification.
In this sense I think useful to cite also in the bibliography the paper of Brown and
coll : Brown I, Mino-Kenudson M, Deshpande V, Lauwers GY
intraepithelial lymphocytosis in architecturally preserved proximal small intestinal
mucosa: an increasing diagnostic problem with a wide differential diagnosis.Arch
Pathol Lab Med 2006 (130): 1020-5.It is important to remember that also in this
situation there is the possibility of coeliac disease with clinical symptoms and
laboratory and genetical test positive.
In table 1 it is important also to introduce the new proposed classification cited in
the discussion and relative bibliography :Corazza GR, Villanacci V
Coeliac Disease.Some considerations on the histological classification.
Journal of Clinical Pathol. 2005; 58, 573-574
No other observations
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I have no competing interests' below.
Review for 10.1186/1471-230X-9-19 (2009)

Reviewer's report
Title:Validation study of villous atrophy and small intestinal inflammation in
Swedish biopsy registers
Version: 2Date:29 October 2008
Reviewer: Riccardo Troncone
Reviewer's report:
In this paper the Authors have searched all pathology Departments in Sweden
with the aim of validating the histopathological classification of small intestinal
biopsy by Swedish pathologists. They found a 90 % correct classification of
biopsies labeled as villous atrophy and only 56% of those characterized by
mucosal inflammation.
Although there was no effort to further grading villous atrophy according to the
severity of mucosal damage this is the most interesting and sound part of the
paper. The finding of high specificity for coeliac disease of villous atrophy is
useful to use those histological reports as a data source for coeliac disease.
Over the last decade the concept that CD may be characterized by minor
enteropathy has emerged. It would be important to know the specificity for the
diagnosis of CD of such minor degrees of enteropathy (here considered as
“inflammation”). It is unexpected the very low percentage of causes other than
celiac disease responsible for that (less than 2% attributed to IBD). In this
respect table 4 is unclear: should the second column read VA and not CD?
The authors wish also to look for other info (i.e. characteristics of serology,
symptoms of individuals with celiac disease, use of small biopsies for the
diagnosis of coeliac disease), but the data reported in this second part of the
paper do not allow to draw firm conclusions.
The paper, although potentially providing useful info (specificity for diagnosis of
different histological patterns) is in many sections not clearly written and difficult
to follow. It aims to answer too many questions at one time. Limitations of the
methodological approach are not satisfactorily discussed. It needs extensive
revision and clarification.
Level of interest: An article whose findings are important to those with closely
related research interests
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.
Review for 10.1186/1471-230X-9-19 (2009)

Reviewer's report
Title:Validation study of villous atrophy and small intestinal inflammation in
Swedish biopsy registers
Version: 3Date:26 January 2009
Reviewer: Riccardo Troncone
Reviewer's report:
The Authors should be congratulated for the effort made to comply with the
referees requests. This paper is a useful piece of information for clinicians,
pathologists and epidemiologists. The subtitle headings help to follow the result
section and the discussion now revises critically the most debatable issues. In
conclusion the paper looks now suitable for publication.
Review for 10.1186/1471-230X-9-18 (2009)

Reviewer's report
Title:First attack of acute pancreatitis in Sweden 1988 - 2003: incidence,
aetiological classification, procedures and mortality - a register study
Version: 1Date:9 November 2008
Reviewer: Masahiko Hirota
Reviewer's report:
This is an important report on acute pancreatitis. However, the following remarks
need to be addressed.
Major:
1. High percentage of other etiologies is the week point of this manuscript.
According to the data on Table 5, many patients with other diagnoses were
received sphincterotomy and cholecystectomy. This fact means that the quality of
the data in this manuscript is too poor. Authors should make efforts to obtain
correctly specified etioloties. Furtheremore, authors should discriminate between
the idiopathic pancreatitis and pancreatitis with other minor etiologies. The details
of the etiologies other than alcohol and gallstone should also be specified.
2. Please specify the definitions of alcohol-related pancreatitis and biliary
pancreatitis in Sweden.
3. Please compare the incidence and mortality with the data from other countries.
4. Overall mortality should also be described (Table 6).
Minor:
1. There are some typographical errors.
2. In Tables 1, 2, and 6, equal stratification of age may give the readers better
informations.
3. What is the difference between Table 6 and Table 7? What does "cause of
death" mean? Please describe on this matter more plitely.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
Review for 10.1186/1471-230X-9-18 (2009)

Reviewer's report
Title:First attack of acute pancreatitis in Sweden 1988 - 2003: incidence,
aetiological classification, procedures and mortality - a register study
Version: 1Date:27 November 2008
Reviewer: Hein Gooszen
Reviewer's report:
This is a well-balanced description of a population-based study.
Suggested revisions
Critical look at the tables presented and select the data essential for the
message of this study.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.