Review for 10.1186/s12876-023-02758-8 (2023)

Title: Gastroesophageal reflux disease symptoms and associated factors among university
students in Amhara region, Ethiopia, 2021: A cross-sectional study
Version: 3 Date: 20 Dec 2022
Reviewer's report:
This manuscript was well drafted and structured. Forwarded below are my comments and
suggestions to improve its scientific acceptance.
General:
There are inconsistencies in the use of some commonly used words throughout the document.
I recommend revision of the language with special concern on the abstract, introduction and
discussions sections.
Example: GERD and Gastrointestinal reflex disease, if abbreviation is given once, no need of
using an unabbreviated phrase again and again. Visit line 53, 71, and many others
Methodological concerns:
The authors reported that they have used GerdQ developed for healthcare setting. As it is
understandable from the article that the authors referred in the method section. Therefore I
have methodological concern whether it is possible to use this GerdQ research to screen out
prevalence of GERD among university students or not. Thus, the authors are expected to clearly
state how they adopted it and include other available methodological recommendations if any.
Besides the authors themselves generalized in limitation section that “Furthermore, because
only GERDQ was used for diagnosis, there are a significant number of false positives and
false negatives.” Therefore in my view this gap need to be addressed well by referencing
methodological recommendations supporting this approach.
Discussion:
1. The description given on age as risk factor for GERD is less convincing to the scientific
community since the statistical analysis showed that age category at the middle was    significant
predictor of GERD. The possible reasons discussed are less logical since it could not hold true
for the next age category. Therefore the possible reason shall be discuss by considering the age
categories of all the participants by mentioning specific issues of this age group.
2. Discussion on urban and rural residence as a protective/risk factor to GERD is not supported
with references although there are reported similar findings.
Operational definitions:
The terms operationally defined in this article are already present in standard books. I suggest
deletion of operational definition written in the manuscript.
Reference style: some reference styles are out of BMC recommendations
1. reference style which is based on superscriptions than brackets.
Example look at Line numbers:
• 120, …..in data collection tools and procedures section I have noted the following, “…. and
assess GERD symptoms without requiring an initial expert referral or endoscopy.52”
• 128, “….  and GERD symptoms were diagnosed if the sum was greater than or equal to 8
points.52””
2. Reference citation placement gaps:
• As an example please have a look at the following paragraph taken in the discussion section
where it is not in line with BMC style and also found to affect the grammar. “This finding is
consistent with the study carried out in Nigeria (32.8%), (12) Saudi Arabia (33.18%), (25), and
India (30%). (9) The finding of this study was lower than the studies conducted in Sri Lanka
(52%), (7), and  Saudi Arabia ( 52.6%). (8) However, it is higher than the studies conducted
in  Iran (19.3%), (34) and  Saudi Arabia (25.9%), (42)  and  Syria (16%),(36) India (14.4%),
(10) Italy (26.2%), (11)  Brazil (11.8%), (6) and Nigeria (26.34%). (13)  Differences in lifestyle,
socioeconomic and demographic characteristics of the study population might contribute to these
discrepancies. (4, 53-55)”