Review for 10.1186/s12876-023-03014-9 (2023)

Title: Prokinetics For the Treatment of Functional Dyspepsia: An Updated Systematic Review
and Network Meta-analysis
Version: 2 Date: 09 Oct 2023
Reviewer:  Zipan Lyu
Reviewer's report:
Reviewer Report
Manuscript Title: Efficacy and Safety of Prokinetics in the Treatment of Functional Dyspepsia:
A Network Meta-Analysis
Authors: Qingqing Qi, Nana Wang, Han Liu, Yanqing Li
General Comments:
I commend the authors for their thorough response to the previous comments. The manuscript
provides valuable insights into the relative efficacy of various prokinetic agents for treating
functional dyspepsia. The authors' commitment to improving the study's quality and clarity is
evident.
Specific Comments:
1. Statistical Methods and Clinical Significance: In response to the query about the interpretation
of statistical methods and the clinical significance of reported odds ratios, the authors
have provided a satisfactory explanation. To enhance reader comprehension, I recommend
incorporating this explanation directly into the manuscript's methodology section. Furthermore,
consider including an illustrative example or hypothetical scenario to illustrate the clinical
relevance of odds ratios, making the manuscript more accessible to a broader audience.
2. Variability in Outcome Definitions: The authors have addressed the issue of variability in
outcome definitions across studies. To reinforce the study's potential limitations, I suggest
including a brief mention of this concern in the discussion section of the manuscript. This
addition will help readers understand the study's constraints and emphasize the need for uniform
outcome definitions or validated tools in future research.
3. Heterogeneity in Study Designs and Patient Characteristics: The authors have acknowledged
the potential impact of heterogeneity in study designs and patient characteristics. While the
response clarifies the challenges of subgroup analysis due to limited data, it is crucial to
transparently convey these challenges and potential sources of heterogeneity in the manuscript.
Additionally, consider discussing the practical applicability of the study's findings to real-world
clinical practice, given the variations in study designs and patient populations.
4. Timing and Rationale for Subgroup Analysis: The response indicates that subgroup analysis
for heterogeneity will be conducted in the future. To enhance transparency, specify the criteria
or conditions that will trigger these subgroup analyses and provide an estimated timeline for
their execution. This will inform readers about the authors' plans for further analysis.
5. Robustness of Current Analysis: Provide reassurance to readers about the current analysis's
robustness, despite acknowledged heterogeneity. Briefly describe the steps or statistical methods
used to address or mitigate the impact of heterogeneity. This will instill confidence in the
reliability and significance of the study's findings.
6. Inconsistencies in Results Interpretation: Acknowledge that the manuscript presents essential
findings regarding the relative efficacy of prokinetic agents but may contain inconsistencies
in results interpretation. Offer a comprehensive discussion of how statistical methods were
applied and how odds ratios (ORs) translate into clinically meaningful differences in efficacy.
Strengthen the manuscript's clarity in this regard.
7. Transparency in Statistical Methods: To enhance transparency, provide a more detailed
description of the statistical methods used in the manuscript. This should include mathematical
formulas or models, data handling procedures, and specific R packages or functions employed.
Ensuring clarity in this area will empower readers to better understand and evaluate the statistical
analysis.
8. Clinical Relevance: While discussing the calculation and interpretation of the Surface Under
the Cumulative Ranking Curve (SUCRA), consider adding a section on the clinical implications
of these findings. Elaborate on how SUCRA values relate to real-world clinical decisions and
their potential impact on patient care.
9. Subgroup and Sensitivity Analysis: Address the inconsistency between the protocol (stating
"None" for subgroup and sensitivity analysis) and the manuscript. If no subgroup or sensitivity
analysis was conducted, provide a clear rationale for their omission in the manuscript.
10. Excluded Studies: Include a supplementary document listing the excluded studies for
transparency and reference.
I commend the authors for their dedication to improving the manuscript, and I believe that
addressing these specific points will further enhance the quality, clarity, and relevance of the
study. Once these minor revisions are made, I recommend that the manuscript be accepted for
publication in its current form.
Please feel free to reach out if you require any further clarification or have additional questions.
Overall Recommendation: Minor revisions are required.