Reviewer ’s report  
 
Title: GASTROESOPHAGEAL REFLUX DISEASE: PREVALENCE AND EXTRAOESO -
PHAGEAL MANIFESTATIONS AMONG UNDERGRADUATE STUDENTS IN SOUTH  
WEST NIGERIA  
 
Version: 2 Date: 05 Aug 2019  
 
Reviewer: Ivano Biviano  
 
Reviewer's report:  
 
Gastroesophageal reflux disease (GERD) is a chronic disorder associated with a huge economic 
burden in the Western countries and significantly decr eased quality of life.  The occurrence of 
GERD is shaped by marked temporal and geographic variations, suggesting the influence of 
environmental risk factors in the etiology of these diseases. Although several studies have 
suggested that the prevalence of GERD is lower in Africa, over the past decades there has been 
an increasing trend in the prevalence. In this interesting paper Authors evaluate the prevalence of 
typical and atypical GERD symptoms among undergraduate students in south west Nigeria.  
However , some important issues need to be clarified:  
 
*      in the Background section it is necessary to better define the concept of oesophageal 
manifestations of GERD clarifying that GERD can potentially lead to serious medical 
complications such as Barrett's esophagus and esophageal adenocarcinoma;  
 
*      in the methods it is not clear the definition of GERD, the frequency and the intensity of 
typical GERD -related symptoms;  
 
* it is necessary to better explain which validated questionnaire was employed  to the  
assessment of the GERD illustrating the features of the questions;  
 
* the Authors do not report information on lifestyle (for example on coffee consumption) 
and whether the students are smoker or nonsmoker;  
 
* I don't understand the difference between GERD and GERS as reported in the text;  
 
* the Authors don't evaluate the percentage of smokers, dietary characteristics, lifestyle 
modifications, psychosocial stress that can be associated with the prevalence of GERD among 
young students in a private University;  
 
* in the discussion it is necessary to clarify that the selected group of people could be not 
representative of the Nigeria's young population for lifestyle habits, risk factors, etc.  
 
* It is well know that patients with GERD may present with atypical sym ptoms in the 
absence of typical esophageal symptoms, so I am not sure that part C of the study  is applicable  
only to the students who had a score ≥4  
 
* In my opinion Extraesophageal manifestations should be studied in patients with and 
without GERD  
 
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 co ntrols?  
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.  
 
Yes 
 
Are you able to assess any statisti cs 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 rev iew 
 
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 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 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 reimburse ments, 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 t o 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 have no competing interests  
 
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 f or publication, my named r eport 
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 confidentia l comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: GASTROESOPHAGEAL REFLUX DISEASE: PREVALENCE AND EXTRAOESO -
PHAGEAL MANIFESTATIONS AMONG UNDERGRADUATE STUDENTS IN SOUTH  
WEST NIGERIA  
 
Version: 2 Date: 05 Aug 2019  
 
Reviewer: Ivano Biviano  
 
Reviewer's report:  
 
Gastroesophageal reflux disease (GERD) is a chronic disorder associated with a huge economic 
burden in the Western countries and significantly decr eased quality of life.  The occurrence of 
GERD is shaped by marked temporal and geographic variations, suggesting the influence of 
environmental risk factors in the etiology of these diseases. Although several studies have 
suggested that the prevalence of GERD is lower in Africa, over the past decades there has been 
an increasing trend in the prevalence. In this interesting paper Authors evaluate the prevalence of 
typical and atypical GERD symptoms among undergraduate students in south west Nigeria.  
However , some important issues need to be clarified:  
 
*      in the Background section it is necessary to better define the concept of oesophageal 
manifestations of GERD clarifying that GERD can potentially lead to serious medical 
complications such as Barrett's esophagus and esophageal adenocarcinoma;  
 
*      in the methods it is not clear the definition of GERD, the frequency and the intensity of 
typical GERD -related symptoms;  
 
* it is necessary to better explain which validated questionnaire was employed  to the  
assessment of the GERD illustrating the features of the questions;  
 
* the Authors do not report information on lifestyle (for example on coffee consumption) 
and whether the students are smoker or nonsmoker;  
 
* I don't understand the difference between GERD and GERS as reported in the text;  
 
* the Authors don't evaluate the percentage of smokers, dietary characteristics, lifestyle 
modifications, psychosocial stress that can be associated with the prevalence of GERD among 
young students in a private University;  
 
* in the discussion it is necessary to clarify that the selected group of people could be not 
representative of the Nigeria's young population for lifestyle habits, risk factors, etc.  
 
* It is well know that patients with GERD may present with atypical sym ptoms in the 
absence of typical esophageal symptoms, so I am not sure that part C of the study  is applicable  
only to the students who had a score ≥4  
 
* In my opinion Extraesophageal manifestations should be studied in patients with and 
without GERD  
 
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 co ntrols?  
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.  
 
Yes 
 
Are you able to assess any statisti cs 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 rev iew 
 
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 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 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 reimburse ments, 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 t o 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 have no competing interests  
 
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 f or publication, my named r eport 
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 confidentia l 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: GASTROESOPHAGEAL REFLUX DISEASE: PREVALENCE AND EXTRAOESO -
PHAGEAL MANIFESTATIONS AMONG UNDERGRADUATE STUDENTS IN SOUTH  
WEST NIGERIA  
 
Version: 2 Date: 05 Aug 2019  
 
Reviewer: Ivano Biviano  
 
Reviewer's report:  
 
Gastroesophageal reflux disease (GERD) is a chronic disorder associated with a huge economic 
burden in the Western countries and significantly decr eased quality of life.  The occurrence of 
GERD is shaped by marked temporal and geographic variations, suggesting the influence of 
environmental risk factors in the etiology of these diseases. Although several studies have 
suggested that the prevalence of GERD is lower in Africa, over the past decades there has been 
an increasing trend in the prevalence. In this interesting paper Authors evaluate the prevalence of 
typical and atypical GERD symptoms among undergraduate students in south west Nigeria.  
However , some important issues need to be clarified:  
 
*      in the Background section it is necessary to better define the concept of oesophageal 
manifestations of GERD clarifying that GERD can potentially lead to serious medical 
complications such as Barrett's esophagus and esophageal adenocarcinoma;  
 
*      in the methods it is not clear the definition of GERD, the frequency and the intensity of 
typical GERD -related symptoms;  
 
* it is necessary to better explain which validated questionnaire was employed  to the  
assessment of the GERD illustrating the features of the questions;  
 
* the Authors do not report information on lifestyle (for example on coffee consumption) 
and whether the students are smoker or nonsmoker;  
 
* I don't understand the difference between GERD and GERS as reported in the text;  
 
* the Authors don't evaluate the percentage of smokers, dietary characteristics, lifestyle 
modifications, psychosocial stress that can be associated with the prevalence of GERD among 
young students in a private University;  
 
* in the discussion it is necessary to clarify that the selected group of people could be not 
representative of the Nigeria's young population for lifestyle habits, risk factors, etc.  
 
* It is well know that patients with GERD may present with atypical sym ptoms in the 
absence of typical esophageal symptoms, so I am not sure that part C of the study  is applicable  
only to the students who had a score ≥4  
 
* In my opinion Extraesophageal manifestations should be studied in patients with and 
without GERD  
 
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 co ntrols?  
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.  
 
Yes 
 
Are you able to assess any statisti cs 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 rev iew 
 
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 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 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 reimburse ments, 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 t o 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 have no competing interests  
 
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 f or publication, my named r eport 
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 confidentia l comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant