Review for 10.1186/1471-230X-8-7 (2008)

Reviewer's report
Title:Gastrointestinal symptoms and motility disorders in patients with systemic
scleroderma
Version: 1Date:24 September 2007
Reviewer: Petros Sfikakis
Reviewer's report:
General
The paper entitled ‘Gastrointestinal symptoms and motility disorders in patients
with systemic scleroderma’ is an interesting descriptive study. Addressing the
following points would enhance this manuscript.
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Major Compulsory Revisions (that the author must respond to before a decision
on publication can be reached)
Methods
a. SSc disease duration should be included.
b. Patients on treatment known to affect gastrointestinal motility were excluded. If
this is the case, then patients on cisapride (which is usually given in all patients
with upper GI involvement) or nifedipine (which is prescribed for Raynaud’s
phenomenon and ulcers) have been excluded (?). The authors should provide
detailed information on all prescribed medications at the time of the study and
discuss this limitations accordingly.
c. Could the authors describe further the characteristics of the “healthy controls”
group?
Results
a. The authors state that “The score for dyspepsia was abnormal in 61% of SSc
patients, with the mean score greater than healthy controls, but lower than
dyspeptic controls”. It would be more appropriate to compare the dyspeptic
controls with only those SSc patients who had abnormal dyspeptic score.
b. Could the authors report in which percentage of SSc patients with abnormal
dyspeptic score, the gastric emptying was also abnormal? If the gastric emptying
is not abnormal in all of them, is there any explanation?
c. The authors state that orocecal transit time was longer in the whole group of
SSc patients. Again, it could be useful, if they reported in which percentage of
SSc patients with abnormal dyspeptic score, orocecal transit time was also
longer. It would be useful to know what was the H.pylori status of the study
patients and then make the appropriate correlation.
Discussion
Essentially, this study involves patients with limited SSc (34 of 38 patients). This
limitation should be discussed; perhaps this is the reason why colonic function
(which is frequently abnormal in diffuse SSc) was preserved in this SSc cohort.
The authors also need to make a comment, whether they think that the abnormal
orocecal time was a result of small bowel involvement of the disease. Regarding
the implications of the findings described here on patient’s treatment, a comment
on the possible use of octreotide (J Clin Rheumatol 2007;13:119) for GI
involvement in SSc should be included.
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of
a term, which the author can be trusted to correct)
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Discretionary Revisions (which the author can choose to ignore)
Were the patients screened for coeliac disease (with tissue transglutaminase
antibodies)? There have been reports of co-existent systemic sclerosis and
coeliac disease, which can explain some of the upper GI symptoms in this group
of patients.
Is it possible for the authors to make clear, whether all the patients had
undergone upper GI endoscopy?
What next?: Unable to decide on acceptance or rejection until the authors have
responded to the major compulsory revisions
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.