Review for 10.1186/s12876-024-03296-7 (2024)

Title: Insights into the Current State of Knowledge, Practice, and Attitudes of Physicians
Regarding Gastrointestinal Motility Disorders in Egypt
Version: 3 Date: 21 Mar 2024
Reviewer:  Greger Lindberg
Reviewer's report:
I sympathize with the idea underlying the study resulting in this manuscript. I agree with the
authors that knowledge about disorders of neurogastroenterology is insufficient among many
doctors but so also among gastroenterologists. However, I am uncertain if the present study
was done with sufficient care to highlight this problem. The manuscript suffers from numerous
linguistic errors and I would urge the authors to have someone fluent in English to revise the
manuscript and delete several direct translations from Arabic to English and tidy up English
language in general. Apart from that I have several questions to the authors:
1. The questionnaire was answered by 461 (or 462) doctors. How many of those were qualified
specialists in gastroenterology (or hepatology), how many were qualified general practitioners
and how many were young doctors in training to become specialists in either specialty? Table
1 only lists the numbers working in gastroenterology, internal medicine and other but since the
age of participants was quite young, I would like to know how many were in training to become
specialists.
2. It is quite a difference to have MD compared to PhD (Table 1). The latter means research
training and a thesis. It is therefore unfair to group the two together. I don’t understand what
a master’s degree means in this respect. I would be more interested in finding out how many
worked as physicians and at what level.
3. It is difficult to understand what participants have been asked about and there are different
messages in figure legends and text:
3.1 Which question was asked for Figure 1 and first part of Table 2? Was it whether participants
knew what motility investigations were, or what constitutes a motility disorder, or what. The
legend to Figure 1 says “knowledge…about GI motility”, whereas the table says, “know what
motility studies are”. Please explain and clarify.
3.2 The legend to Table 3 states “Knowledge of the participants about motility disorder” whereas
the text below Table 3 talks about “priorities in diagnosing different GI motility disorders”.
Table 3 lists several investigations and participants can disagree or agree regarding the priority
of investigations in the diagnosis of different motility disorders. The question is very unspecific,
and the answer must depend on what type of symptoms you are investigating. If the question
was asked as described in Table 3 I think it is impossible to understand the answers without
knowing what respondents were thinking about type of motility disorder.
4. I am uncertain what the authors mean by motility disorders. I can find no definition in the
manuscript. Was a definition offered to participants? Achalasia, gastroparesis and intestinal
pseudo-obstruction are the severe motility disorders. GERD, enteric dysmotility, and slow transit
constipation are also considered clearcut motility disorders. It is more difficult when it comes to
eosinophilic esophagitis, functional dyspepsia, IBS, functional constipation, and various forms
of anorectal outlet obstruction. How were participants informed about the scope of motility
disorders considered for the present study? Do the authors think that participants had a uniform
understanding of the concept of GI motility disorders?
5. The authors use both GI motility disorders and GIT motility disorders. The latter is probably
an abbreviation of gastrointestinal tract motility disorders which makes the word “tract”
superfluous. Hence, the abbreviation GIT should not be used.
6. Table 4 includes questions that in my view are impossible to answer without more information
about symptoms. For example, the question “How frequently do you see patients with any GI
motility disorder cannot be answered without defining the meaning of GI motility disorder. If
the definition includes functional gastrointestinal disorders the answer should be much more
frequent than what it is in Table 4. Please elaborate and clarify.
7. Also the answer to the question “what do you do when you suspect a GI motility disorder”
would be influenced by the respondent’s perception of what constitutes a GI motility disorder.
Please explain.
8. The question “How frequent do you refer patients for these investigations/specialities if you
suspect a GIT motility disorder?” lists actions for achalasia and gastroparesis but not so many
other GI motility disorders. I wouldn’t consider POEM if the patient has constipation. Please
rephrase or explain!
9. I am currently unable to hold a view on the discussion since there are so many problems with
questions that need to be sorted out.
10. The manuscript need a thorough linguistic revision. It is currently very difficult to read.
Please have someone fluent in English to revise the manuscript.
11. There are several mistakes in the list of references. Please update the reference list according
to instructions for authors.