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:9 November 2013
Reviewer: Sanjiv Mahadeva
Reviewer's report:
Review
Title:
Quality of life and health care consultation in 13 to 18 year olds with abdominal
pain predominant functional gastrointestinal diseases
ID: MS ID : 1386083855102325
Summary
This is a questionnaire-based, cross-sectional study of GI symptoms in
teenagers in Sri Lanka. The study design is community-based, with all subjects
within randomly selected schools in Western Sri Lanka. 16.5% of 1850 teenage
subjects had abdominal pain predominant functional gastrointestinal disorders
(AP-FGID) – a broad category encompassing IBS, FD, etc. These subjects had a
lower QOL compared to controls and a negative correlation was observed
between abdominal pain severity and QOL scores. 27.9% of subjects with
AP-FGID consulted healthcare facilities for their symptoms. Surprisingly, neither
socio-demographic factors nor symptom severity were predictive of healthcare
consultation.
This is interesting work and novel for this population, but there are several
queries:
MAJOR
1. No sample size calculation has been made to justify the number of subjects
recruited for the study. Please provide this in the methodology.
2. Pg 7, Para 2 – the random selection of 4 schools from a list of 427 needs
further clarification. How were these 4 schools “randomly” selected ?
3. It is difficult to comprehend how teenagers would obediently sit in a school hall
for several hours to complete a long questionnaire without any incentives. Were
any incentives provided for the study subjects ?
4. Pg 11, Para 3 – “HRQOL score had a negative correlation with symptom
severity”. This statement is not supported by any statistical measurement.
Furthermore, Figure 1 does not appear to demonstrate a clear negative
correlation between QOL scores and symptom severity scores. Please provide
more clarification on Figure 1 & further statistical measurements.
5. The discussion can be improved. I would suggest the following:
i) provide the strengths of the study & its’ limitations – eg: generalizability of the
data to the rest of the teenager population in Sri Lanka
ii) There is no discussion on the prevalence of FGID in teenagers – how does the
data in Sri Lanka compare to other publications ?
iii) More explanation for the lack of association between socio-demographic and
symptom severity factors with healthcare consultation needs to be explored. Why
should the type of symptoms – i.e. bloating and vomiting – and not severity, be
associated with healthcare consultation ?
Could this be a problem of the sample size ?
iv) The concluding paragraph on pg 18 claims that “Our findings highlight the
importance of assessing HRQoL during consultation of children with abdominal
pain predominant functional gastrointestinal diseases”
This is not correct – the use of HRQOL in this study is to demonstrate the impact
of FGID in teenagers – it has no bearing on clinical practice
MINOR
1. Table 3 & 4 should be combined. As this is a univariate analysis for predictive
factors, please provide unadjusted Odds Ratios with 95% CIs for each parameter
studied.
2. Pg 14, para 1 – please avoid using the phrase “for the first time”. This may not
be true.
3. There is no pagination throughout the manuscript
Discretionary revisions
None
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 interests