Review for 10.1186/s12876-020-01490-x (2020)

Reviewer’s report
Title: 
Does Sequential Balloon Expulsion Test improve the screening of
Defecation Disorders?
Version: 
0 
Date: 
01 Aug 2020
Reviewer's report:
The study aims to evaluate the potential utility 
of 
"low-cost" tests in the
screening of DD as separate or combined tools. This could be interesting in the
primary care but also in a specialist setting to save money avoiding many
diagnostic tests.
As the authors underline "A cheaper but satisfactory screening approach of DD
that promotes an adequate selection of complementary tests and an earlier and
adequate treatment seems ideal"
INTRODUCTION
-"...this physiological evaluation is not always easily accessible, moreover it can
be long and costly" 
ARM and dephecography are not so costly and 
so
inaccessibile
-"DRE under or 
inappropriately used".. The authors could profitably discuss the
results of the Chrocodite study (BMC Gastroenterology, 2017)
MATERIAL AND METHODS
-"BET: With the patient lying in the left lateral position…." The left lateral
position is not the most suitable one. The sitting position 
is more physiological.
The authors should briefly discuss the reasons for they had decided to use the left
lateral position.
-"A positive diagnosis of DD was considered according to 2 criteria of Rome IV,
excluding information from the BET" 
The authors should better and clearly
explain the reason of their choice. Among the patients they had excluded could
be present some DD patients according Rome IV criteria 
(ARM and BET
positives) 
Did they use only ARM, dephecography or EMG according Rome IV?
-Why did the authors prefer using Renzi score than Altomare score? Could 
the
authors show any data about the comparison of the reliability of these two scores
in 
their group of patients?
RESULTS
-35/98 patients 
with DD are not a very 
large group: it would be very interesting
to start a large multicenter study to assess the reliability of these interesting
results
-The authors should discuss the possible 
meaning of the 
different mean 
age of
the two groups 
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
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