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:9 October 2007
Reviewer: Virginia Steen
Reviewer's report:
This is an interesting well done study looking at various motility studies in
scleroderma and comparing them to dyspeptic and healthy controls. This design
in important and may be one of the only ones which compared scleroderma
patients to dyspeptic non scleroderma patients. I have the following comments.
1. Would NOT try to make comparisons between limited and diffuse scleroderma.
One, there are far too few diffuse patients to compare meaningfully and two, no
one has really shown any meaningful differences so it just clutters up the paper
with non meaningful data. I feel it is okay to combine them.
2. While there may be sympathetic neurological abnormalities in the GI tract, it
isn’t necessarily autonomic dysfunction that results in the GI motility problems.
Others have questioned whether it is an independent ischemic process to the
local nerves resulting in the dysmotility and not a generalized process. The
authors need to at least touch on the potential vascular process rather than just
the muscular fibrosis.
3. Background. Minor comments of inaccurate statements. Renal failure is
associated with a malignant hypertension crisis rather than oliguric renal failure.
Raynaud’s and skin are most common and then GI. L 17sentence beginning with
“GI involvement in SSc……” is not clear.
4. Methods. Variety of comments: cardiovascular system-most don’t consider
Raynaud’s as part of cardiovascular. Diagnosis of myocardial fibrosis?? It isn’t
localized scleroderma it is limited scleroderma.
5. I was unfamiliar with the gastric and gallbladder emptying studies which were
used. Perhaps you could add a bit of comment on what is usually seen with
dyspeptics.
6. Do you know that the Sweat Spot Test would be valid in the dorsum of the
foot, even in limited scleroderma patients. Certainly diffuse scleroderma have
altered sweat glands although I don’t know in SSc patients without skin
thickening.
7. I was intrigued with the results and the fact that the dyspeptics were worse
than the scleroderma in many things.
8. The disease duration for the values must be off. Since an abnormal score for a
dyspepsia score is 8 and the mean for abnormals is only 7. What is the value for
long disease vs short disease(another way of looking at it. Did any other
parameter correlate with disease duration. If not I wouldn’t make so much of it in
your discussion. Also, although there is damage of the muscular layer through
the GI tract this is not necessarily related to disease duration.
9. Again don’t have a table for limited vs diffuse.
10. Would emphasize and comment and refer to other studies of the gastric
emptying studies in dyspeptic patients. Also, comment on these findings
compared to the nuclear medicine studies in these patients.
11. Was the feeling or epigastric fullness and the presence of a small antral area
directly correlated. I don’t see this correlation. That should be easy to do.
12. You don’t mention much about the esophagus, which is the primary part of
the GI tract that is involved in scleroderma. Other studies on gastric involvement
have shown the gastric motility promotes dyspepsia but it is not clear to me
whether the findings in this study are similar to the other studies and whether the
problem in scleroderma is really the same as in dyspepsia. More emphasis in this
area is necessary.
13. Also the correlation of symptoms and abnormalities do not seem as close in
other studies as you have found, and your discussion doesn’t reflect that.
14. Interesting that the small bowel studies really do not differ much between the
dyspepsia and SSc patients, Any suggestions why?
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.
Declaration of competing interests:
I declare that I have no competing interests