Title: Symptoms and biomarkers associated with undiagnosed celiac seropositivity
Version: 1 Date: 23 Nov 2020
Reviewer's report:
The aim of the study was to investigate whether undiagnosed CD patients have more symptoms
or affected biomarkers compared with non-CD subjects. This was accomplished by identifying
CD antibody positivity without a known diagnosis of CD in eight population-based cohort
studies comprising 16,776 participants and comparing them to matched controls.
Below are my comments:
-the CD patients are the same individuals than in the previous article by Kårhus et al Am J
Gastroenterol. Moreover the controls are a subset of controls in the same study. Therefore, I
would urge the authors to openly state this on page "materials". For the same reason, I would
suggest to present table 1 as background data (as the CD patients have already been published in
Am J Gastroenterol) refer to the table already in materials and remove it from the result section.
-I would suggest to somehow highligh (for instance bolded font or equivalent) the significant
findings.
-the authors defined CD as IgG-DGP #10.0 U/mL and/or IgA-TTG or IgG-TTG #7.0 U/mL .
However, in TTG negative individuals the positive predictive value of IgG DGP antibodies is
only 18.2% (Hoerter et al. Digestive Diseases and Sciences 2017; 62: 1272–1276). As 59 of the
identified CD cases were only IgG-DGP positive (vaailable in Am J Gastro article), not all of
them are likely true celiac disease patients. I would encourage the authors to discuss this as a
possible limitation.
Title: Symptoms and biomarkers associated with undiagnosed celiac seropositivity
Version: 1 Date: 23 Nov 2020
Reviewer's report:
The aim of the study was to investigate whether undiagnosed CD patients have more symptoms
or affected biomarkers compared with non-CD subjects. This was accomplished by identifying
CD antibody positivity without a known diagnosis of CD in eight population-based cohort
studies comprising 16,776 participants and comparing them to matched controls.
Below are my comments:
-the CD patients are the same individuals than in the previous article by Kårhus et al Am J
Gastroenterol. Moreover the controls are a subset of controls in the same study. Therefore, I
would urge the authors to openly state this on page "materials". For the same reason, I would
suggest to present table 1 as background data (as the CD patients have already been published in
Am J Gastroenterol) refer to the table already in materials and remove it from the result section.
-I would suggest to somehow highligh (for instance bolded font or equivalent) the significant
findings.
-the authors defined CD as IgG-DGP #10.0 U/mL and/or IgA-TTG or IgG-TTG #7.0 U/mL .
However, in TTG negative individuals the positive predictive value of IgG DGP antibodies is
only 18.2% (Hoerter et al. Digestive Diseases and Sciences 2017; 62: 1272–1276). As 59 of the
identified CD cases were only IgG-DGP positive (vaailable in Am J Gastro article), not all of
them are likely true celiac disease patients. I would encourage the authors to discuss this as a
possible limitation.
Please review this paper.
user
Title: Symptoms and biomarkers associated with undiagnosed celiac seropositivity
Version: 1 Date: 23 Nov 2020
Reviewer's report:
The aim of the study was to investigate whether undiagnosed CD patients have more symptoms
or affected biomarkers compared with non-CD subjects. This was accomplished by identifying
CD antibody positivity without a known diagnosis of CD in eight population-based cohort
studies comprising 16,776 participants and comparing them to matched controls.
Below are my comments:
-the CD patients are the same individuals than in the previous article by Kårhus et al Am J
Gastroenterol. Moreover the controls are a subset of controls in the same study. Therefore, I
would urge the authors to openly state this on page "materials". For the same reason, I would
suggest to present table 1 as background data (as the CD patients have already been published in
Am J Gastroenterol) refer to the table already in materials and remove it from the result section.
-I would suggest to somehow highligh (for instance bolded font or equivalent) the significant
findings.
-the authors defined CD as IgG-DGP #10.0 U/mL and/or IgA-TTG or IgG-TTG #7.0 U/mL .
However, in TTG negative individuals the positive predictive value of IgG DGP antibodies is
only 18.2% (Hoerter et al. Digestive Diseases and Sciences 2017; 62: 1272–1276). As 59 of the
identified CD cases were only IgG-DGP positive (vaailable in Am J Gastro article), not all of
them are likely true celiac disease patients. I would encourage the authors to discuss this as a
possible limitation.
assistant