Title: Better diagnostic accuracy for GERD observed with the new MNBI cutoff: An
observational study in Vietnam
Version: 3 Date: 29 Mar 2025
Reviewer's report:
Dear Authors,
I have read with great interest your work entitled “Better diagnostic accuracy for GERD observed
with the new MNBI cutoff: An observational study in Vietnam”. An important strong point is
that the study is the first study in Vietnam in which 24-hour esophageal pH monitoring was used
to diagnose GERD.
In your study you underline the diagnostic usefulness of the novel MNBI thresholds in
identifying GERD. It is known that MNBI thresholds in identifying GERD are variable in the
different populations. It varies across studies and may be lower in Asia than in Europe, but
your study confirms the data literature thresholds in Vietnam population: the MNBI value is
significantly lower in patients with abnormal AET and the percentage of MNBI >2500 Ohms
was 2.9% in patients with abnormal AET. In fact, you confirm that the new cutoff value of 1500
Ohms has high sensitivity and specificity in diagnosing GERD.
1. Why did you use Chicago classification version 3? You have excluded patients with EGJ-
OO but the manometric diagnostic criteria differ from Chicago 3 to Chicago 4 classification. I
suggest re-evaluating your study population using Chicago classification version 4 or excluding
only patients with EGJ-OO diagnosis if they have a confirming radiogram. Your choice must be
explained in the text and the Chicago classification version 4 must be added in the bibliography.
2. In your study’s population, 80 patients (60.2%) had erosive esophagitis, predominantly LA
grade A (93.8%). Did patients undergo endoscopic examination off PPI therapy? This data must
be added to the text.
3. You use the term “hypomotility”. Is it possible to use a more specific terminology?
4. You haven’t described EGJ types. Can you put them on your table?
5. I don’t understand in your text if, in the inconclusive group, MNBI thresholds are useful to
rule on or off GERD diagnosis.
6. Did patients undergo pH-impedance examination off PPI therapy?
7. In the figure 1 (part b), I would put patients with LA grade A esophagitis with NERD group,
considering that LA grade B, C and D esophagitis are diagnostic for GERD (Lyon consensus
v.2).
Title: Better diagnostic accuracy for GERD observed with the new MNBI cutoff: An
observational study in Vietnam
Version: 3 Date: 29 Mar 2025
Reviewer's report:
Dear Authors,
I have read with great interest your work entitled “Better diagnostic accuracy for GERD observed
with the new MNBI cutoff: An observational study in Vietnam”. An important strong point is
that the study is the first study in Vietnam in which 24-hour esophageal pH monitoring was used
to diagnose GERD.
In your study you underline the diagnostic usefulness of the novel MNBI thresholds in
identifying GERD. It is known that MNBI thresholds in identifying GERD are variable in the
different populations. It varies across studies and may be lower in Asia than in Europe, but
your study confirms the data literature thresholds in Vietnam population: the MNBI value is
significantly lower in patients with abnormal AET and the percentage of MNBI >2500 Ohms
was 2.9% in patients with abnormal AET. In fact, you confirm that the new cutoff value of 1500
Ohms has high sensitivity and specificity in diagnosing GERD.
1. Why did you use Chicago classification version 3? You have excluded patients with EGJ-
OO but the manometric diagnostic criteria differ from Chicago 3 to Chicago 4 classification. I
suggest re-evaluating your study population using Chicago classification version 4 or excluding
only patients with EGJ-OO diagnosis if they have a confirming radiogram. Your choice must be
explained in the text and the Chicago classification version 4 must be added in the bibliography.
2. In your study’s population, 80 patients (60.2%) had erosive esophagitis, predominantly LA
grade A (93.8%). Did patients undergo endoscopic examination off PPI therapy? This data must
be added to the text.
3. You use the term “hypomotility”. Is it possible to use a more specific terminology?
4. You haven’t described EGJ types. Can you put them on your table?
5. I don’t understand in your text if, in the inconclusive group, MNBI thresholds are useful to
rule on or off GERD diagnosis.
6. Did patients undergo pH-impedance examination off PPI therapy?
7. In the figure 1 (part b), I would put patients with LA grade A esophagitis with NERD group,
considering that LA grade B, C and D esophagitis are diagnostic for GERD (Lyon consensus
v.2).
Please review this paper.
user
Title: Better diagnostic accuracy for GERD observed with the new MNBI cutoff: An
observational study in Vietnam
Version: 3 Date: 29 Mar 2025
Reviewer's report:
Dear Authors,
I have read with great interest your work entitled “Better diagnostic accuracy for GERD observed
with the new MNBI cutoff: An observational study in Vietnam”. An important strong point is
that the study is the first study in Vietnam in which 24-hour esophageal pH monitoring was used
to diagnose GERD.
In your study you underline the diagnostic usefulness of the novel MNBI thresholds in
identifying GERD. It is known that MNBI thresholds in identifying GERD are variable in the
different populations. It varies across studies and may be lower in Asia than in Europe, but
your study confirms the data literature thresholds in Vietnam population: the MNBI value is
significantly lower in patients with abnormal AET and the percentage of MNBI >2500 Ohms
was 2.9% in patients with abnormal AET. In fact, you confirm that the new cutoff value of 1500
Ohms has high sensitivity and specificity in diagnosing GERD.
1. Why did you use Chicago classification version 3? You have excluded patients with EGJ-
OO but the manometric diagnostic criteria differ from Chicago 3 to Chicago 4 classification. I
suggest re-evaluating your study population using Chicago classification version 4 or excluding
only patients with EGJ-OO diagnosis if they have a confirming radiogram. Your choice must be
explained in the text and the Chicago classification version 4 must be added in the bibliography.
2. In your study’s population, 80 patients (60.2%) had erosive esophagitis, predominantly LA
grade A (93.8%). Did patients undergo endoscopic examination off PPI therapy? This data must
be added to the text.
3. You use the term “hypomotility”. Is it possible to use a more specific terminology?
4. You haven’t described EGJ types. Can you put them on your table?
5. I don’t understand in your text if, in the inconclusive group, MNBI thresholds are useful to
rule on or off GERD diagnosis.
6. Did patients undergo pH-impedance examination off PPI therapy?
7. In the figure 1 (part b), I would put patients with LA grade A esophagitis with NERD group,
considering that LA grade B, C and D esophagitis are diagnostic for GERD (Lyon consensus
v.2).
assistant