Review for 10.1186/s12876-021-01736-2 (2021)

Reviewer’s report
Title: 
Gastrointestinal symptoms as the first manifestation of antiphospholipid
syndrome
Version: 
0 
Date: 
03 Feb 2021
Reviewer's report:
The manuscript entitled "Gastrointestinal symptoms as the first manifestation of
antiphospholipid syndrome" describes a clinical autoimmune condition involving
auto antibodies to phospholipids that cause systemic effects that can present
differently in those afflicted. This manuscript describes a case study of a patient
that presented with severe, intractable intestinal pain. After visits to several
hospital departments, it was found that she was positive for autoantibodies that
characterize antiphospholipid syndrome. The authors intent is to inform medical
professionals of this condition and to consider this condition when severe
intractable gastrointestinal symptoms present.
The manuscript is largely well written with minor typos:
Title Page Abstract:
...history of two miscarriages [add s]
Abstract:
line 3 
condition, which produces [add s]
line 15 
miscarriages [add s]
Background:
Line 26 
reduce missed diagnosis. [delete remaining words]
Case Presentation:
Line 4 relieved her symptoms [add s]…
Line8 
However, the symptoms [add s]…
Line 13 
and splenic vein (Fig 1.1)
Line 25 multiple thrombi [plural]
Page 5 
The authors say that after months of discharge with treatment, the patient was
eventually hospitalized with recurrent abdominal pain. Can the authors speculate
on why they think the therapy became ineffective. Was it noncompliance?
Discussion and Conclusion:
Is APS more prominent in women similar to other autoimmune diseases?
Based on the biochemical tests, the patient apparently did not have liver
involvement, yet it is the most common manifestation in APS. Is this correct?
Line 48 
Hamilton [remove all caps] et al, reported a [a instead of the] case...
Page 6
It is implied that the patient eventually progressed to CAPS criteria? Is this
correct? It would be helpful if the authors could provide a timeline of the disease
progesssion.
Line 18 
For [add] patients with …
Line 20 
...or INR 3-4 is [add] suggested for...
Line 46 Surgery [instead of Surgically] should be performed...
Line 55 
other clinical studies are [add] lacking to show whether...\
Page 7:
Line 3 
There is no [delete any] case...
Line 4 
reported. [delete comma]
Line 9 
Text says that thrombectomy is feasible with 72 hours of venous
thrombosis yet the prior text says that there is no case of venous trombotomy that
has been reported. These sentences appear to contradict.
Line 46 
signs of abdominal involvement should be considered in patients with
APS. Can the authors comment on other demographics that are associated with
this disease? Women? Age? etc.
Figures
Fig 1.1 and 1.2 have misplaced hyphens in words in the text of the legend.
The dark arrows in all of the figures are difficult to see. Make them light colored
(white)
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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
Are the methods sufficiently described to allow the study to be repeated?
Yes
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Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes