Reviewer ’s report  
 
Title: Ramosetron for the treatment of irritable bowel syndrome with diarrhea: a systematic 
review and meta -analysis of randomized controlled trials  
 
Version: 0 Date: 20 Oct 2016  
 
Reviewer: Nilay Kumar  
 
Reviewer's report:  
 
I have read with interest the systematic review and meta analysis  by Qi et al where the authors 
studied the safety and efficacy of Ramosetron in patients with diarrhea predominant IBS.  
 
1. Introduction may be shortened. Lines 2,3,4 on page 5 can be removed  from the introduction.  
2. Since most outcomes are subjective and were likely measured on an ordinal scalei.e. relief of 
abdominal discomfort, diarrhea etc. and were analyzed as dichotomous outcomes in the meta 
analysis , the authors should clarify whether  definitions for symptom relief were consistent 
across studies. Were subjective outcomes measured using standardized/validated tools in 
different studies? If not, the authors should discuss how this could impact interpretation of 
their study findings in th e limitations section of the paper.  
3. The authors present a subgroup analysis of outcomes according to sex. Was there an 
interaction of sex with treatment allocation for safety and efficacy outcomes?  
Are the methods appropriate and well described?  
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 w hich 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 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 am able to assess the statistics  
 
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 shar es 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 rec eived 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 interest s 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.  
 
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 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://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 included as confidential comme nts 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Ramosetron for the treatment of irritable bowel syndrome with diarrhea: a systematic 
review and meta -analysis of randomized controlled trials  
 
Version: 0 Date: 20 Oct 2016  
 
Reviewer: Nilay Kumar  
 
Reviewer's report:  
 
I have read with interest the systematic review and meta analysis  by Qi et al where the authors 
studied the safety and efficacy of Ramosetron in patients with diarrhea predominant IBS.  
 
1. Introduction may be shortened. Lines 2,3,4 on page 5 can be removed  from the introduction.  
2. Since most outcomes are subjective and were likely measured on an ordinal scalei.e. relief of 
abdominal discomfort, diarrhea etc. and were analyzed as dichotomous outcomes in the meta 
analysis , the authors should clarify whether  definitions for symptom relief were consistent 
across studies. Were subjective outcomes measured using standardized/validated tools in 
different studies? If not, the authors should discuss how this could impact interpretation of 
their study findings in th e limitations section of the paper.  
3. The authors present a subgroup analysis of outcomes according to sex. Was there an 
interaction of sex with treatment allocation for safety and efficacy outcomes?  
Are the methods appropriate and well described?  
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 w hich 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 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 am able to assess the statistics  
 
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 shar es 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 rec eived 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 interest s 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.  
 
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 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://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 included as confidential comme nts 
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: Ramosetron for the treatment of irritable bowel syndrome with diarrhea: a systematic 
review and meta -analysis of randomized controlled trials  
 
Version: 0 Date: 20 Oct 2016  
 
Reviewer: Nilay Kumar  
 
Reviewer's report:  
 
I have read with interest the systematic review and meta analysis  by Qi et al where the authors 
studied the safety and efficacy of Ramosetron in patients with diarrhea predominant IBS.  
 
1. Introduction may be shortened. Lines 2,3,4 on page 5 can be removed  from the introduction.  
2. Since most outcomes are subjective and were likely measured on an ordinal scalei.e. relief of 
abdominal discomfort, diarrhea etc. and were analyzed as dichotomous outcomes in the meta 
analysis , the authors should clarify whether  definitions for symptom relief were consistent 
across studies. Were subjective outcomes measured using standardized/validated tools in 
different studies? If not, the authors should discuss how this could impact interpretation of 
their study findings in th e limitations section of the paper.  
3. The authors present a subgroup analysis of outcomes according to sex. Was there an 
interaction of sex with treatment allocation for safety and efficacy outcomes?  
Are the methods appropriate and well described?  
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 w hich 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 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 am able to assess the statistics  
 
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 shar es 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 rec eived 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 interest s 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.  
 
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 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://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 included as confidential comme nts 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant