Reviewer's report
Title:Interprovider Variation of Celiac Disease Testing in Childhood Chronic
Abdominal Pain
Version: 2Date:25 January 2013
Reviewer: steven L werlin
Reviewer's report:
Background:
I do not think there is a definition for chronic functional abdominal pain. The term
functional abdominal pain by itself is chronic abdominal pain. The authors should
use the Rome criteria
Methods:
‘Children who were subsequently diagnosed with a potential organic etiology as
determined by the pediatric gastroenterologist’; should instead be ‘Children who
were subsequently diagnosed with an (potential) organic etiology as determined
by the pediatric gastroenterologist’
In the second paragraph- >10 % weight loss would disqualify a patient being
labeled with functional abdominal pain and almost always qualify to be
investigated for celiac disease
Results:
First paragraph:
• 114 out of 160 is 71.3% and not 63.3%
• Can you stratify the results based on how many of these patients who had
celiac disease testing had weight loss
• Do any of the patients who got work-up for celiac disease testing have any
laboratory abnormalities (majority of the patients who get referred to
sub-specialties will have baseline labs like CBC and/or CMP) that initiated the
testing for celiac disease
Third paragraph
• Do the patients with celiac disease had any red flags like weight loss, lab
abnormalities
Discussion
Second paragraph:
• For reference 7 on racial predilection for celiac disease(7)only talks about celiac
disease in African Americans and does not compare different races. A more
appropriate reference would be an article by Rubio-Tapia et al. (Am J
Gastroenterol. 2012 Oct;107(10):1538-44; quiz 1537, 1545. doi:
10.1038/ajg.2012.219. Epub 2012 Jul 31)
Third paragraph:
• The authors should comment on frequency of celiac disease testing in
functional abdominal pain when 10% of children form their cohort has >10%
weight loss which by itself would disqualify them from being called functional
abdominal pain
• The study by Dhroove et al. included only patients with functional abdominal
pain and that is the reason they excluded the patients who do the fit with this
definition (chronic diarrhea, abdominal pain in certain locations and weight loss)
Fourth paragraph:
• The authors should not comment on prevalence of celiac disease in certain
population group since the study cohort does not fit with any particular group
(neither with FAP nor with chronic abdominal pain presenting to GI clinic as they
excluded the patients who had celiac testing by their primary physician)
Conclusions
• The conclusion to consider celiac disease testing in functional abdominal pain
patients could not be substantiated based on their patient cohort (see the above
comments in results and discussion)
Level of interest: An article of insufficient interest to warrant publication in a
scientific/medical journal
Quality of written English: Needs some language corrections before being
published
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:Interprovider Variation of Celiac Disease Testing in Childhood Chronic
Abdominal Pain
Version: 2Date:25 January 2013
Reviewer: steven L werlin
Reviewer's report:
Background:
I do not think there is a definition for chronic functional abdominal pain. The term
functional abdominal pain by itself is chronic abdominal pain. The authors should
use the Rome criteria
Methods:
‘Children who were subsequently diagnosed with a potential organic etiology as
determined by the pediatric gastroenterologist’; should instead be ‘Children who
were subsequently diagnosed with an (potential) organic etiology as determined
by the pediatric gastroenterologist’
In the second paragraph- >10 % weight loss would disqualify a patient being
labeled with functional abdominal pain and almost always qualify to be
investigated for celiac disease
Results:
First paragraph:
• 114 out of 160 is 71.3% and not 63.3%
• Can you stratify the results based on how many of these patients who had
celiac disease testing had weight loss
• Do any of the patients who got work-up for celiac disease testing have any
laboratory abnormalities (majority of the patients who get referred to
sub-specialties will have baseline labs like CBC and/or CMP) that initiated the
testing for celiac disease
Third paragraph
• Do the patients with celiac disease had any red flags like weight loss, lab
abnormalities
Discussion
Second paragraph:
• For reference 7 on racial predilection for celiac disease(7)only talks about celiac
disease in African Americans and does not compare different races. A more
appropriate reference would be an article by Rubio-Tapia et al. (Am J
Gastroenterol. 2012 Oct;107(10):1538-44; quiz 1537, 1545. doi:
10.1038/ajg.2012.219. Epub 2012 Jul 31)
Third paragraph:
• The authors should comment on frequency of celiac disease testing in
functional abdominal pain when 10% of children form their cohort has >10%
weight loss which by itself would disqualify them from being called functional
abdominal pain
• The study by Dhroove et al. included only patients with functional abdominal
pain and that is the reason they excluded the patients who do the fit with this
definition (chronic diarrhea, abdominal pain in certain locations and weight loss)
Fourth paragraph:
• The authors should not comment on prevalence of celiac disease in certain
population group since the study cohort does not fit with any particular group
(neither with FAP nor with chronic abdominal pain presenting to GI clinic as they
excluded the patients who had celiac testing by their primary physician)
Conclusions
• The conclusion to consider celiac disease testing in functional abdominal pain
patients could not be substantiated based on their patient cohort (see the above
comments in results and discussion)
Level of interest: An article of insufficient interest to warrant publication in a
scientific/medical journal
Quality of written English: Needs some language corrections before being
published
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:Interprovider Variation of Celiac Disease Testing in Childhood Chronic
Abdominal Pain
Version: 2Date:25 January 2013
Reviewer: steven L werlin
Reviewer's report:
Background:
I do not think there is a definition for chronic functional abdominal pain. The term
functional abdominal pain by itself is chronic abdominal pain. The authors should
use the Rome criteria
Methods:
‘Children who were subsequently diagnosed with a potential organic etiology as
determined by the pediatric gastroenterologist’; should instead be ‘Children who
were subsequently diagnosed with an (potential) organic etiology as determined
by the pediatric gastroenterologist’
In the second paragraph- >10 % weight loss would disqualify a patient being
labeled with functional abdominal pain and almost always qualify to be
investigated for celiac disease
Results:
First paragraph:
• 114 out of 160 is 71.3% and not 63.3%
• Can you stratify the results based on how many of these patients who had
celiac disease testing had weight loss
• Do any of the patients who got work-up for celiac disease testing have any
laboratory abnormalities (majority of the patients who get referred to
sub-specialties will have baseline labs like CBC and/or CMP) that initiated the
testing for celiac disease
Third paragraph
• Do the patients with celiac disease had any red flags like weight loss, lab
abnormalities
Discussion
Second paragraph:
• For reference 7 on racial predilection for celiac disease(7)only talks about celiac
disease in African Americans and does not compare different races. A more
appropriate reference would be an article by Rubio-Tapia et al. (Am J
Gastroenterol. 2012 Oct;107(10):1538-44; quiz 1537, 1545. doi:
10.1038/ajg.2012.219. Epub 2012 Jul 31)
Third paragraph:
• The authors should comment on frequency of celiac disease testing in
functional abdominal pain when 10% of children form their cohort has >10%
weight loss which by itself would disqualify them from being called functional
abdominal pain
• The study by Dhroove et al. included only patients with functional abdominal
pain and that is the reason they excluded the patients who do the fit with this
definition (chronic diarrhea, abdominal pain in certain locations and weight loss)
Fourth paragraph:
• The authors should not comment on prevalence of celiac disease in certain
population group since the study cohort does not fit with any particular group
(neither with FAP nor with chronic abdominal pain presenting to GI clinic as they
excluded the patients who had celiac testing by their primary physician)
Conclusions
• The conclusion to consider celiac disease testing in functional abdominal pain
patients could not be substantiated based on their patient cohort (see the above
comments in results and discussion)
Level of interest: An article of insufficient interest to warrant publication in a
scientific/medical journal
Quality of written English: Needs some language corrections before being
published
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
assistant