Review for 10.1186/s12876-015-0408-x (2015)

Reviewer ’s report  
 
Title: Optimizing biologic treatment in IBD: objective measures, but when, how and how often?  
 
Version: 0 Date: 11 Oct 2015  
 
Reviewer: Jan Preiss  
 
Reviewer's report:  
The authors Shomron Ben -Horin et al. submitted a fine and exh austive review about the use of 
laboratory and imaging markers in assessing patients with inflammatory  bowel diseases. They 
cover the area by lo oking at the following situations:  
- before and during induction phase  
- after induction  
- at loss of response  
- before and after stopping therapy  
- role of endoscopy for optimizing treatment  
 
I only have very few comments:  
1. In the section "before and dur ing induction phase" the authors g ive an exhaustive review 
on the role of CRP. They should also discuss the role of fecal calprotect ion and 
abdominal ultrasoun d in this situation. In countries where ultrasound is routinely used by 
gastroenterologists thems elves at the bedside, e.g. Italy, Switzerland, or Germany, this 
techno logy proved to be excellent for verifying inflammation without relying on more 
invasive or c omplex imaging modalities, i.e. endoscopy or MRI, especially in terminal 
ileitis, where calpro tectin is often false negative.  
 
2. At the end of the section about therapeutic drug monitoring the a uthors give a caveat 
about this method: optimal thresholds need to be established. The authors mention 
themselves that "patients with adequate drug elvels a nd active inflammation  will 
USUALLY respond better to switch to another class of drugs". Relying to heavily on 
these algorithms might miss a few patients in whom a higher drug level will lead to 
clinical response  therby unnecessarily foregoing one of the f ew drugs that exist for 
Crohn's disease. I feel the auth ors need to discuss this caveat too. 
 
3. In discussing the role of mucosal healing the authors will have  to mention the POCER 
study and the role of endoscopy in optimizing post -operative treatment.  
 
 
conc lusions 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.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of c ompeting interests  
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