Reviewer ’s report  
 
Title: A Rare Cause of Dysphagia Due to Esophageal Intramural Pseudodiverticulosis: A Case  
Report and Review of Li terature  
 
Version: 2 Date: 11 Dec 2019  
 
Reviewer: Yasu hiko Abe  
 
Reviewer's report:  
 
As described in the reply to the reviews' comments, the author highlighted as a new finding in 
this present case report that our patient improved substantially after only 2 sequential dilatational 
sessions during the same hospital stay and the addi tion of an H2 blocker for GERD management. 
However, according to the additional description by the author as follows;  "However, in regard 
to the long -term effects of dilatation, an observational study revealed symptom recurrence 
requiring multiple repeat dilations in 12 of the 21 cases on follow up."(page 8, line 150 -152), the 
remaining 9 of 21 cases would show no symptomatic recurrence without repeated dilatation. 
Therefore, symptomatic improvement might be not uncommon by only 2 sequential dilatational 
sessions.  
 
 
 In addition, the author highlighted the alternative useful of H2 blocker as acid suppressive 
therapy for GERD management because of adverse effect with PPI administration. However, the 
tolerance of H2 blocker during continuous administration, le ading to reduction of acid 
suppressive effect, have been shown by many previous reports (Lachman L et al. Twenty -four-
hour intragastric pH: tolerance within 5 days of continuous ranitidine administration. Am J 
Gastroenterol. 2000 Jan;95(1):57 -61, Komazawa Y, et al. Tolerance to famotidine and ranitidine 
treatment after 14 days of administration in healthy subjects without Helicobacter pylori 
infection. J Gastroenterol Hepatol. 2003 Jun;18(6):678 -82., Furuta K, et al. Tolerance to H2 
receptor antagonist corr elates well with the decline in efficacy against gastroesophageal reflux in 
patients with gastroesophageal reflux disease. J Gastroenterol Hepatol. 2006 Oct;21(10):1581 -5.) 
 
 
The author finally concluded in page 8 that "In conclusion, we report a case of a  patient with EIP 
whose dysphagia of several years was successfully treated after only 2 simultaneous sessions of 
dilation therapy during hospitalization and has remained symptom free while on maintenance 
H2-receptor blocker therapy." Ambulatory pH monitor ing of esophagus or stomach was not also 
performed in this patient. It is questionable whether H2 blocker was useful enough to highlight.  
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, pleas e 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.  
 
Unable to assess  
 
Are the conclusions drawn adequately suppo rted by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an a dditional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publi cation 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 future?  
 
3. Do you hold or are you curr ently 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 have no conflict of interest.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named repo rt 
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 understan d 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: A Rare Cause of Dysphagia Due to Esophageal Intramural Pseudodiverticulosis: A Case  
Report and Review of Li terature  
 
Version: 2 Date: 11 Dec 2019  
 
Reviewer: Yasu hiko Abe  
 
Reviewer's report:  
 
As described in the reply to the reviews' comments, the author highlighted as a new finding in 
this present case report that our patient improved substantially after only 2 sequential dilatational 
sessions during the same hospital stay and the addi tion of an H2 blocker for GERD management. 
However, according to the additional description by the author as follows;  "However, in regard 
to the long -term effects of dilatation, an observational study revealed symptom recurrence 
requiring multiple repeat dilations in 12 of the 21 cases on follow up."(page 8, line 150 -152), the 
remaining 9 of 21 cases would show no symptomatic recurrence without repeated dilatation. 
Therefore, symptomatic improvement might be not uncommon by only 2 sequential dilatational 
sessions.  
 
 
 In addition, the author highlighted the alternative useful of H2 blocker as acid suppressive 
therapy for GERD management because of adverse effect with PPI administration. However, the 
tolerance of H2 blocker during continuous administration, le ading to reduction of acid 
suppressive effect, have been shown by many previous reports (Lachman L et al. Twenty -four-
hour intragastric pH: tolerance within 5 days of continuous ranitidine administration. Am J 
Gastroenterol. 2000 Jan;95(1):57 -61, Komazawa Y, et al. Tolerance to famotidine and ranitidine 
treatment after 14 days of administration in healthy subjects without Helicobacter pylori 
infection. J Gastroenterol Hepatol. 2003 Jun;18(6):678 -82., Furuta K, et al. Tolerance to H2 
receptor antagonist corr elates well with the decline in efficacy against gastroesophageal reflux in 
patients with gastroesophageal reflux disease. J Gastroenterol Hepatol. 2006 Oct;21(10):1581 -5.) 
 
 
The author finally concluded in page 8 that "In conclusion, we report a case of a  patient with EIP 
whose dysphagia of several years was successfully treated after only 2 simultaneous sessions of 
dilation therapy during hospitalization and has remained symptom free while on maintenance 
H2-receptor blocker therapy." Ambulatory pH monitor ing of esophagus or stomach was not also 
performed in this patient. It is questionable whether H2 blocker was useful enough to highlight.  
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, pleas e 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.  
 
Unable to assess  
 
Are the conclusions drawn adequately suppo rted by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an a dditional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publi cation 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 future?  
 
3. Do you hold or are you curr ently 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 have no conflict of interest.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named repo rt 
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 understan d 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: A Rare Cause of Dysphagia Due to Esophageal Intramural Pseudodiverticulosis: A Case  
Report and Review of Li terature  
 
Version: 2 Date: 11 Dec 2019  
 
Reviewer: Yasu hiko Abe  
 
Reviewer's report:  
 
As described in the reply to the reviews' comments, the author highlighted as a new finding in 
this present case report that our patient improved substantially after only 2 sequential dilatational 
sessions during the same hospital stay and the addi tion of an H2 blocker for GERD management. 
However, according to the additional description by the author as follows;  "However, in regard 
to the long -term effects of dilatation, an observational study revealed symptom recurrence 
requiring multiple repeat dilations in 12 of the 21 cases on follow up."(page 8, line 150 -152), the 
remaining 9 of 21 cases would show no symptomatic recurrence without repeated dilatation. 
Therefore, symptomatic improvement might be not uncommon by only 2 sequential dilatational 
sessions.  
 
 
 In addition, the author highlighted the alternative useful of H2 blocker as acid suppressive 
therapy for GERD management because of adverse effect with PPI administration. However, the 
tolerance of H2 blocker during continuous administration, le ading to reduction of acid 
suppressive effect, have been shown by many previous reports (Lachman L et al. Twenty -four-
hour intragastric pH: tolerance within 5 days of continuous ranitidine administration. Am J 
Gastroenterol. 2000 Jan;95(1):57 -61, Komazawa Y, et al. Tolerance to famotidine and ranitidine 
treatment after 14 days of administration in healthy subjects without Helicobacter pylori 
infection. J Gastroenterol Hepatol. 2003 Jun;18(6):678 -82., Furuta K, et al. Tolerance to H2 
receptor antagonist corr elates well with the decline in efficacy against gastroesophageal reflux in 
patients with gastroesophageal reflux disease. J Gastroenterol Hepatol. 2006 Oct;21(10):1581 -5.) 
 
 
The author finally concluded in page 8 that "In conclusion, we report a case of a  patient with EIP 
whose dysphagia of several years was successfully treated after only 2 simultaneous sessions of 
dilation therapy during hospitalization and has remained symptom free while on maintenance 
H2-receptor blocker therapy." Ambulatory pH monitor ing of esophagus or stomach was not also 
performed in this patient. It is questionable whether H2 blocker was useful enough to highlight.  
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, pleas e 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.  
 
Unable to assess  
 
Are the conclusions drawn adequately suppo rted by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an a dditional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publi cation 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 future?  
 
3. Do you hold or are you curr ently 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 have no conflict of interest.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named repo rt 
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 understan d 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