Reviewer ’s report  
 
Title:  The Role of Small Intestinal Bacterial Overgrowth (SIBO) in Non -alcoholic Fatty Liver 
Disease (NAFLD) Patients evaluated using Controlled Attenuation Parameter (CAP) Transient 
Elastography (TE): A Tertiary Referral Center Experience  
 
Version: 0 Date: 30 Dec 2018 
 
Reviewer:  Giuliano  Ramadori  
 
Reviewer’s report:  
 
This is a timly paper dealing with the possible microbioma role in fatty liver developemnt and 
possible progress of liver damage by dibiosis in  the small intestine.  
 
The definition of NASFLD accept some consumtion of alcoholic beverages.This should be 
carefully evaluated in the anamnesis.This is a difficult task but it has to be mentioned and 
discussed.  
 
Also the measurement of "disbiosis is diffic ult when intestinal fluid culture is not performed.  
 
Also when clearance efficacy of the RES -System of the liver is not sufficient production of 
mediators by Kupffer cells and also by hepatocytes become measurable in the serum..  
 
Authors should at least disc uss this point in the disussion section if they are not able to perform 
some measurements.  
 
As a cliniscian I must say that bacterial owergrowth in small intestine normally causes clinical 
symptoms  
 
Are the methods appropriate and well described?  
If not, please specify what  is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete  a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I do not have competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any  attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creative commons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title:  The Role of Small Intestinal Bacterial Overgrowth (SIBO) in Non -alcoholic Fatty Liver 
Disease (NAFLD) Patients evaluated using Controlled Attenuation Parameter (CAP) Transient 
Elastography (TE): A Tertiary Referral Center Experience  
 
Version: 0 Date: 30 Dec 2018 
 
Reviewer:  Giuliano  Ramadori  
 
Reviewer’s report:  
 
This is a timly paper dealing with the possible microbioma role in fatty liver developemnt and 
possible progress of liver damage by dibiosis in  the small intestine.  
 
The definition of NASFLD accept some consumtion of alcoholic beverages.This should be 
carefully evaluated in the anamnesis.This is a difficult task but it has to be mentioned and 
discussed.  
 
Also the measurement of "disbiosis is diffic ult when intestinal fluid culture is not performed.  
 
Also when clearance efficacy of the RES -System of the liver is not sufficient production of 
mediators by Kupffer cells and also by hepatocytes become measurable in the serum..  
 
Authors should at least disc uss this point in the disussion section if they are not able to perform 
some measurements.  
 
As a cliniscian I must say that bacterial owergrowth in small intestine normally causes clinical 
symptoms  
 
Are the methods appropriate and well described?  
If not, please specify what  is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete  a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I do not have competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any  attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creative commons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title:  The Role of Small Intestinal Bacterial Overgrowth (SIBO) in Non -alcoholic Fatty Liver 
Disease (NAFLD) Patients evaluated using Controlled Attenuation Parameter (CAP) Transient 
Elastography (TE): A Tertiary Referral Center Experience  
 
Version: 0 Date: 30 Dec 2018 
 
Reviewer:  Giuliano  Ramadori  
 
Reviewer’s report:  
 
This is a timly paper dealing with the possible microbioma role in fatty liver developemnt and 
possible progress of liver damage by dibiosis in  the small intestine.  
 
The definition of NASFLD accept some consumtion of alcoholic beverages.This should be 
carefully evaluated in the anamnesis.This is a difficult task but it has to be mentioned and 
discussed.  
 
Also the measurement of "disbiosis is diffic ult when intestinal fluid culture is not performed.  
 
Also when clearance efficacy of the RES -System of the liver is not sufficient production of 
mediators by Kupffer cells and also by hepatocytes become measurable in the serum..  
 
Authors should at least disc uss this point in the disussion section if they are not able to perform 
some measurements.  
 
As a cliniscian I must say that bacterial owergrowth in small intestine normally causes clinical 
symptoms  
 
Are the methods appropriate and well described?  
If not, please specify what  is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete  a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I do not have competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any  attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creative commons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant