Review for 10.1186/1471-230X-12-5 (2012)

Reviewer's report
Title:Value of fecal calprotectin in the evaluation of patients with abdominal
discomfort: an observational study
Version: 2Date:24 August 2011
Reviewer: Yue Li
Reviewer's report:
- Major Compulsory Revisions
1. (Methods, Endpoint) “The definition of this endpoint was based on the
assumption, that the finding would justify an endoscopic assessment.” The
definition of a clinically significant organic finding in the GI tract should be
addressed in details here with basis/ evidence for classification of significant/
minor/ normal findings under endoscopy.
2. (Discussion, the 8th paragraph) Here, the authors attempted to address why
RE LA-A was excluded from “clinically significant findings”. In table 2, patients
with LA-A (n=25) have a lower median calprotectin level (17). Classifying this
group of patients into no clinically significant findings will increase the specificity
of results. There is no strong evidence to exclude it from clinically significant
findings.
3. (Conclusion) “Our study demonstrated that fecal calprotectin is a useful
noninvasive marker to identify patients with clinically significant findings
throughout the gastrointestinal tract irrespective of age.” Conclusion should not
be applied to “throughout the GI tract” for only a small number of patients in your
study has been evaluated the lesions in the small intestine.
- Minor Essential Revisions
1. (Results, Diagnostic value of calprotectin in patients with negative initial
endoscopy, 1st sentence) “One hundred and thirty-six patients (25%) were
investigated with both EGD and colonoscopy; in 106 patients (78%) after no
clinically significant findings had been identified during the initial investigation.”
The sentence is confusing. Please rewrite.
2. (Discussion, 1st paragraph, last sentence) “calprotectin levels indicated
disease severity in patients with peptic lesions of the stomach.” In this study, the
level of fecal calprotectin was found to be higher in gastric cancer than ulcers
and erosions. Gastric cancer does not belong to peptic lesions; therefore this
conclusion is not justified.
3. (Discussion, 10th paragraph, 1st sentence) “All together, those results support
the concept that …..and that a biomarker guided strategy might be superior to a
strategy using clinical decision, including guidelines of appropriateness, to decide
on endoscopy.” From the present study, the authors could not say “superior to”,
but might be “adding additional value“.
4. (Discussion, 11th paragraph) “Fourth ….in expectorations of patients with in
acute and chronic pulmonary disease.” Please consider to delete “in” before
“acute….”
.
- Discretionary Revisions
1. (Discussion, 3rd paragraph, last sentence) “Applying these guidelines…..but
the selection criteria suffered from low sensitivity.” It would be better to add “,”
before “but”.
Yue Li, MD
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 interets.