Reviewer ’s report  
 
Title: Can microscopic ileitis in patients with clinically suspe cted inflammatory bowel disease 
predict the future?  
 
Version: 1 Date: 02 Dec 2019  
 
Reviewer: Leolin Katsidzira  
 
Reviewer's report:  
This is an interesting paper with clear clinical application. The authors m ust address the 
following concerns.  
 
Major  
1. It is more likely that those patients with microscopic ileitis who were subsequently 
diagnosed with Crohn's disease had the diagnosis missed at the time of the first ileo -colonoscopy 
rather than that they subseq uently developed IBD. After all, these patients already had clinical 
features suggestive of Crohn's disease, which is why the ileo -colonoscopy was performed.  The 
finding that those with severe microscopic ileitis or granulomas were more likely to have 
subsequent CD only makes it more likely that subtle mucosal disease may have been missed at 
the first procedure.  It could also be that they had obvious mucosal disease, but beyond the reach 
of the colonoscope. This must be made clear throughout the manuscrip t (e.g by replacing the 
phrase 'associated with the development of Crohn's disease' with 'associated with a subsequent 
diagnosis of Crohn's disease' where this appears in the text. This point should also be specifically 
mentioned in the discussion.  This e xplanation does not detract from the key point of this paper - 
which is that microscopic ileitis, particularly if severe, should trigger continued investigations in 
patients with suspected Crohn's disease. It would be interesting if the authors include the  location 
of the subsequent Crohn's disease in the manuscript if this is available. Was this within reach of 
ileo-colonoscopy in most cases?  
   
2. Related to the first comment, who did the colonoscopies? Where all procedures 
performed by experienced gastro enterologists or some were performed by fellows/trainees?  This 
should be stated in the methods, and if appropriate, included as a limitation in the discussion (or 
as a even as a strength if all were performed by experienced gastroenterologists  or by trai nees 
under direct supervision). How good was the bowel preparation for these procedures? Could this 
have affected the findings? Presumably this information was captured in the colonoscopy reports 
and should be included in the manuscript.  
 
  
3. The whole s ection on statistical analysis must be reworded -  it is not easily 
understandable to the average reader. For example, this sentence is not clear at all: 'Descriptive 
statistics in terms of mean, STD, and percentiles were presented to the whole parameter i n the 
study.'  
 
4. The standard deviation for the mean age in the two groups must be re -calculated, page 8, 
line 21 and Table 1.  (15.6±30.8 vs 16.6±33.2, P=0.25) As it stands, it suggests that it is possible 
for the mean age to be less than zero. Could it  be that the authors reversed these numbers in 
writing the manuscript!? i.e perhaps it was meant to be 30.8 ± 15.6?  
 
Minor  (These are mostly grammatical errors or matters of style)  
1. Replace 'revised' with 'reviewed'. Page 2, line 29 in abstract, Page 8 , line 7 under results  
2. Page 4, line 11, delete 'in presentation'.  
3. There are a number of places were the first letter in a new sentence is not capitalised. 
Please correct.  Eg. Page 7, line 40; Page 10, line 27;  
4. Figure 1. Include a breakdown of who were the 98 patients excluded from the study in 
the small box.  
5. Where a sentence begins with a number, this must be written in words as a rule. Can the 
authors correct these instances eg Page 2, line 42; Page 8, line  7 - 9.  
 
 
 
Are the methods appropriate and well desc ribed?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the futu re? 
 
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 I have no 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 f or publication, my named report 
including any attachments I upload will be posted on the website along with th e authors' 
responses. I agree for my report to be made available under an Open Acc ess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded 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: Can microscopic ileitis in patients with clinically suspe cted inflammatory bowel disease 
predict the future?  
 
Version: 1 Date: 02 Dec 2019  
 
Reviewer: Leolin Katsidzira  
 
Reviewer's report:  
This is an interesting paper with clear clinical application. The authors m ust address the 
following concerns.  
 
Major  
1. It is more likely that those patients with microscopic ileitis who were subsequently 
diagnosed with Crohn's disease had the diagnosis missed at the time of the first ileo -colonoscopy 
rather than that they subseq uently developed IBD. After all, these patients already had clinical 
features suggestive of Crohn's disease, which is why the ileo -colonoscopy was performed.  The 
finding that those with severe microscopic ileitis or granulomas were more likely to have 
subsequent CD only makes it more likely that subtle mucosal disease may have been missed at 
the first procedure.  It could also be that they had obvious mucosal disease, but beyond the reach 
of the colonoscope. This must be made clear throughout the manuscrip t (e.g by replacing the 
phrase 'associated with the development of Crohn's disease' with 'associated with a subsequent 
diagnosis of Crohn's disease' where this appears in the text. This point should also be specifically 
mentioned in the discussion.  This e xplanation does not detract from the key point of this paper - 
which is that microscopic ileitis, particularly if severe, should trigger continued investigations in 
patients with suspected Crohn's disease. It would be interesting if the authors include the  location 
of the subsequent Crohn's disease in the manuscript if this is available. Was this within reach of 
ileo-colonoscopy in most cases?  
   
2. Related to the first comment, who did the colonoscopies? Where all procedures 
performed by experienced gastro enterologists or some were performed by fellows/trainees?  This 
should be stated in the methods, and if appropriate, included as a limitation in the discussion (or 
as a even as a strength if all were performed by experienced gastroenterologists  or by trai nees 
under direct supervision). How good was the bowel preparation for these procedures? Could this 
have affected the findings? Presumably this information was captured in the colonoscopy reports 
and should be included in the manuscript.  
 
  
3. The whole s ection on statistical analysis must be reworded -  it is not easily 
understandable to the average reader. For example, this sentence is not clear at all: 'Descriptive 
statistics in terms of mean, STD, and percentiles were presented to the whole parameter i n the 
study.'  
 
4. The standard deviation for the mean age in the two groups must be re -calculated, page 8, 
line 21 and Table 1.  (15.6±30.8 vs 16.6±33.2, P=0.25) As it stands, it suggests that it is possible 
for the mean age to be less than zero. Could it  be that the authors reversed these numbers in 
writing the manuscript!? i.e perhaps it was meant to be 30.8 ± 15.6?  
 
Minor  (These are mostly grammatical errors or matters of style)  
1. Replace 'revised' with 'reviewed'. Page 2, line 29 in abstract, Page 8 , line 7 under results  
2. Page 4, line 11, delete 'in presentation'.  
3. There are a number of places were the first letter in a new sentence is not capitalised. 
Please correct.  Eg. Page 7, line 40; Page 10, line 27;  
4. Figure 1. Include a breakdown of who were the 98 patients excluded from the study in 
the small box.  
5. Where a sentence begins with a number, this must be written in words as a rule. Can the 
authors correct these instances eg Page 2, line 42; Page 8, line  7 - 9.  
 
 
 
Are the methods appropriate and well desc ribed?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the futu re? 
 
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 I have no 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 f or publication, my named report 
including any attachments I upload will be posted on the website along with th e authors' 
responses. I agree for my report to be made available under an Open Acc ess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded 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: Can microscopic ileitis in patients with clinically suspe cted inflammatory bowel disease 
predict the future?  
 
Version: 1 Date: 02 Dec 2019  
 
Reviewer: Leolin Katsidzira  
 
Reviewer's report:  
This is an interesting paper with clear clinical application. The authors m ust address the 
following concerns.  
 
Major  
1. It is more likely that those patients with microscopic ileitis who were subsequently 
diagnosed with Crohn's disease had the diagnosis missed at the time of the first ileo -colonoscopy 
rather than that they subseq uently developed IBD. After all, these patients already had clinical 
features suggestive of Crohn's disease, which is why the ileo -colonoscopy was performed.  The 
finding that those with severe microscopic ileitis or granulomas were more likely to have 
subsequent CD only makes it more likely that subtle mucosal disease may have been missed at 
the first procedure.  It could also be that they had obvious mucosal disease, but beyond the reach 
of the colonoscope. This must be made clear throughout the manuscrip t (e.g by replacing the 
phrase 'associated with the development of Crohn's disease' with 'associated with a subsequent 
diagnosis of Crohn's disease' where this appears in the text. This point should also be specifically 
mentioned in the discussion.  This e xplanation does not detract from the key point of this paper - 
which is that microscopic ileitis, particularly if severe, should trigger continued investigations in 
patients with suspected Crohn's disease. It would be interesting if the authors include the  location 
of the subsequent Crohn's disease in the manuscript if this is available. Was this within reach of 
ileo-colonoscopy in most cases?  
   
2. Related to the first comment, who did the colonoscopies? Where all procedures 
performed by experienced gastro enterologists or some were performed by fellows/trainees?  This 
should be stated in the methods, and if appropriate, included as a limitation in the discussion (or 
as a even as a strength if all were performed by experienced gastroenterologists  or by trai nees 
under direct supervision). How good was the bowel preparation for these procedures? Could this 
have affected the findings? Presumably this information was captured in the colonoscopy reports 
and should be included in the manuscript.  
 
  
3. The whole s ection on statistical analysis must be reworded -  it is not easily 
understandable to the average reader. For example, this sentence is not clear at all: 'Descriptive 
statistics in terms of mean, STD, and percentiles were presented to the whole parameter i n the 
study.'  
 
4. The standard deviation for the mean age in the two groups must be re -calculated, page 8, 
line 21 and Table 1.  (15.6±30.8 vs 16.6±33.2, P=0.25) As it stands, it suggests that it is possible 
for the mean age to be less than zero. Could it  be that the authors reversed these numbers in 
writing the manuscript!? i.e perhaps it was meant to be 30.8 ± 15.6?  
 
Minor  (These are mostly grammatical errors or matters of style)  
1. Replace 'revised' with 'reviewed'. Page 2, line 29 in abstract, Page 8 , line 7 under results  
2. Page 4, line 11, delete 'in presentation'.  
3. There are a number of places were the first letter in a new sentence is not capitalised. 
Please correct.  Eg. Page 7, line 40; Page 10, line 27;  
4. Figure 1. Include a breakdown of who were the 98 patients excluded from the study in 
the small box.  
5. Where a sentence begins with a number, this must be written in words as a rule. Can the 
authors correct these instances eg Page 2, line 42; Page 8, line  7 - 9.  
 
 
 
Are the methods appropriate and well desc ribed?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the futu re? 
 
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 I have no 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 f or publication, my named report 
including any attachments I upload will be posted on the website along with th e authors' 
responses. I agree for my report to be made available under an Open Acc ess Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant