Reviewer's report
Title:Annual pattern of peptic ulcer hospitalizations: a retrospective analysis of
hospital discharge data of the Emilia-Romagna region of Italy.
Version: 2Date:7 November 2009
Reviewer: Jin-Yong Kang
Reviewer's report:
Seasonal variation in peptic ulcer disease has interested many investigators for
many years and these studies are listed by the authors in Table 1. There is no
clear-cut consensus, although the majority of studies point to a trough in the
summer. It is therefore unsurprising that the present study again produced
equivocal findings, the two analytical methods applied by the authors on the
same dataset giving rise to somewhat different results.
As peptic ulcer disease and Helicobacter infection are chronic conditions, with
their natural history going over years rather than months, it would seem intuitively
likely that any seasonality which can be demonstrated would relate to factors
which affect the severity of symptoms or presentation to medical attention, rather
than to the pathogenesis of the ulcer diathesis. It is also possible the two casues
of ulcer disease i.e. H pylori and NSAIDs, may have different seasonal patterns.
These points should be mentioned in the discussion.
With the lack of consensus despite numerous previous studies, and the lack of
clear-cut results despite the large patient numbers used in the present study, any
seasonal difference in the presentation of peptic ulcer disease is unlikely to be of
major clinical significance.
Specific comments:
Discussion
'Anedoctal evidence reports a classical biphasic pattern (Spring-Autumn) for
acute PUD, and clinical evidence supports the hypothesis of a relationship
between severe PUD, defined here in terms of the requirement for acute
management by hospitalization, and season.'
Presumably by 'anecdotal evidence' the authors mean the various studies
quoted- I think these constitute 'previous studies' rather than 'anecdotal evidence.
There is no 'clinical evidence' on this poiint at all as what evidence there is come
from analyses of databases.
'The demonstration of seasonal variation in PUD hospital admissions seems to
be of practical interest.' II do not agree. Any interest would relate more to
provision of insight into patho-genetic factors, rather than beint 'practical'
I am not a statistician and suggest an expert opinion be obtained regarding the
statistical methods used in this study. However, it seems to me that with the large
number of comparisons made, the p value used to indicate statistical significance
should not be the standard p<0.05. My recommendation of acceptance is
provisional upon a satisfactory statistical opinion, but there is no suitable option
in the list given below for this.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
'I declare that I have no competing interests'
Reviewer's report
Title:Annual pattern of peptic ulcer hospitalizations: a retrospective analysis of
hospital discharge data of the Emilia-Romagna region of Italy.
Version: 2Date:7 November 2009
Reviewer: Jin-Yong Kang
Reviewer's report:
Seasonal variation in peptic ulcer disease has interested many investigators for
many years and these studies are listed by the authors in Table 1. There is no
clear-cut consensus, although the majority of studies point to a trough in the
summer. It is therefore unsurprising that the present study again produced
equivocal findings, the two analytical methods applied by the authors on the
same dataset giving rise to somewhat different results.
As peptic ulcer disease and Helicobacter infection are chronic conditions, with
their natural history going over years rather than months, it would seem intuitively
likely that any seasonality which can be demonstrated would relate to factors
which affect the severity of symptoms or presentation to medical attention, rather
than to the pathogenesis of the ulcer diathesis. It is also possible the two casues
of ulcer disease i.e. H pylori and NSAIDs, may have different seasonal patterns.
These points should be mentioned in the discussion.
With the lack of consensus despite numerous previous studies, and the lack of
clear-cut results despite the large patient numbers used in the present study, any
seasonal difference in the presentation of peptic ulcer disease is unlikely to be of
major clinical significance.
Specific comments:
Discussion
'Anedoctal evidence reports a classical biphasic pattern (Spring-Autumn) for
acute PUD, and clinical evidence supports the hypothesis of a relationship
between severe PUD, defined here in terms of the requirement for acute
management by hospitalization, and season.'
Presumably by 'anecdotal evidence' the authors mean the various studies
quoted- I think these constitute 'previous studies' rather than 'anecdotal evidence.
There is no 'clinical evidence' on this poiint at all as what evidence there is come
from analyses of databases.
'The demonstration of seasonal variation in PUD hospital admissions seems to
be of practical interest.' II do not agree. Any interest would relate more to
provision of insight into patho-genetic factors, rather than beint 'practical'
I am not a statistician and suggest an expert opinion be obtained regarding the
statistical methods used in this study. However, it seems to me that with the large
number of comparisons made, the p value used to indicate statistical significance
should not be the standard p<0.05. My recommendation of acceptance is
provisional upon a satisfactory statistical opinion, but there is no suitable option
in the list given below for this.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
'I declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:Annual pattern of peptic ulcer hospitalizations: a retrospective analysis of
hospital discharge data of the Emilia-Romagna region of Italy.
Version: 2Date:7 November 2009
Reviewer: Jin-Yong Kang
Reviewer's report:
Seasonal variation in peptic ulcer disease has interested many investigators for
many years and these studies are listed by the authors in Table 1. There is no
clear-cut consensus, although the majority of studies point to a trough in the
summer. It is therefore unsurprising that the present study again produced
equivocal findings, the two analytical methods applied by the authors on the
same dataset giving rise to somewhat different results.
As peptic ulcer disease and Helicobacter infection are chronic conditions, with
their natural history going over years rather than months, it would seem intuitively
likely that any seasonality which can be demonstrated would relate to factors
which affect the severity of symptoms or presentation to medical attention, rather
than to the pathogenesis of the ulcer diathesis. It is also possible the two casues
of ulcer disease i.e. H pylori and NSAIDs, may have different seasonal patterns.
These points should be mentioned in the discussion.
With the lack of consensus despite numerous previous studies, and the lack of
clear-cut results despite the large patient numbers used in the present study, any
seasonal difference in the presentation of peptic ulcer disease is unlikely to be of
major clinical significance.
Specific comments:
Discussion
'Anedoctal evidence reports a classical biphasic pattern (Spring-Autumn) for
acute PUD, and clinical evidence supports the hypothesis of a relationship
between severe PUD, defined here in terms of the requirement for acute
management by hospitalization, and season.'
Presumably by 'anecdotal evidence' the authors mean the various studies
quoted- I think these constitute 'previous studies' rather than 'anecdotal evidence.
There is no 'clinical evidence' on this poiint at all as what evidence there is come
from analyses of databases.
'The demonstration of seasonal variation in PUD hospital admissions seems to
be of practical interest.' II do not agree. Any interest would relate more to
provision of insight into patho-genetic factors, rather than beint 'practical'
I am not a statistician and suggest an expert opinion be obtained regarding the
statistical methods used in this study. However, it seems to me that with the large
number of comparisons made, the p value used to indicate statistical significance
should not be the standard p<0.05. My recommendation of acceptance is
provisional upon a satisfactory statistical opinion, but there is no suitable option
in the list given below for this.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
'I declare that I have no competing interests'
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