Title: Patient-reported symptoms and burden of eosinophilic esophagitis: evidence from real-
world clinical practice
Version: 0 Date: 27 Nov 2023
Reviewer:  Jamal O. Hayat
Reviewer's report:
Well written and reads nicely. Large patients numbers from multiple sites.
Is there a breakdown of patients per sites/per country?
1. The dysphagia despite treatment number is high compared to published data on current
therapeutic options eg orodispersible budesonide. This may be due to inadequate access to
licensed medications/cost of prescribing /inappropriate treatment eg PPI's when not effective,
using other formulations of topical  steroids. This should be commented on.
2. Persistent symptoms may be due to concomitant disease eg gastro-oesophageal reflux disease
3. There is a comment in the discussion that patients would prefer dietary modification rather
than medication. I think this needs to be clarified further. I suspect this is for simple dietary
restrictions f they are effective - but unfortunately this will only apply to less than half of patients.
Most dietary exclusion studies have a high drop out rate the longer the study progresses and the
more foods are restricted (eg step up or six food elimination diets)
4. This discussion comment includes standard of care treatment but the wording implies that
elemental diet  is the primary treatment. This is not the case - and should be worded in a more
objective fashion eg therapeutic options include dietary elimination medications including PPIs
ad steroids etc. Treatment options should be determining using efficacy and patient choice....
5. Study reports a difference between patient reported outcomes and physician. Is  there a
statistical difference? Most common reported symptoms ie dysphagia is the same.  suggest may
need to revise this comment
6.  dysphagia despite treatment - is this more common in particular treatment groups eg PPI
vs steroids?
7. In discussion - first paragraph - there is a comment on  need for urgent novel treatment - but
one of the issues  that has been demonstrated  is that the delay  in diagnosis may lead to more
advanced disease, so this statement should be revised - to include this , plus optimising currently
available treatment +/- use of novel treatments.
8. The statement on lack of awareness of physicians on patients fears - i disagree with the use of
this statemnt. It is not clearly demonstrated from the results of that patients and  i would suggest
revise eg 'important to physicians to be aware of patinet fears'...
9. Figure 1 - check spelling of dysphagia on the diagram
Title: Patient-reported symptoms and burden of eosinophilic esophagitis: evidence from real-
world clinical practice
Version: 0 Date: 27 Nov 2023
Reviewer:  Jamal O. Hayat
Reviewer's report:
Well written and reads nicely. Large patients numbers from multiple sites.
Is there a breakdown of patients per sites/per country?
1. The dysphagia despite treatment number is high compared to published data on current
therapeutic options eg orodispersible budesonide. This may be due to inadequate access to
licensed medications/cost of prescribing /inappropriate treatment eg PPI's when not effective,
using other formulations of topical  steroids. This should be commented on.
2. Persistent symptoms may be due to concomitant disease eg gastro-oesophageal reflux disease
3. There is a comment in the discussion that patients would prefer dietary modification rather
than medication. I think this needs to be clarified further. I suspect this is for simple dietary
restrictions f they are effective - but unfortunately this will only apply to less than half of patients.
Most dietary exclusion studies have a high drop out rate the longer the study progresses and the
more foods are restricted (eg step up or six food elimination diets)
4. This discussion comment includes standard of care treatment but the wording implies that
elemental diet  is the primary treatment. This is not the case - and should be worded in a more
objective fashion eg therapeutic options include dietary elimination medications including PPIs
ad steroids etc. Treatment options should be determining using efficacy and patient choice....
5. Study reports a difference between patient reported outcomes and physician. Is  there a
statistical difference? Most common reported symptoms ie dysphagia is the same.  suggest may
need to revise this comment
6.  dysphagia despite treatment - is this more common in particular treatment groups eg PPI
vs steroids?
7. In discussion - first paragraph - there is a comment on  need for urgent novel treatment - but
one of the issues  that has been demonstrated  is that the delay  in diagnosis may lead to more
advanced disease, so this statement should be revised - to include this , plus optimising currently
available treatment +/- use of novel treatments.
8. The statement on lack of awareness of physicians on patients fears - i disagree with the use of
this statemnt. It is not clearly demonstrated from the results of that patients and  i would suggest
revise eg 'important to physicians to be aware of patinet fears'...
9. Figure 1 - check spelling of dysphagia on the diagram
Please review this paper.
user
Title: Patient-reported symptoms and burden of eosinophilic esophagitis: evidence from real-
world clinical practice
Version: 0 Date: 27 Nov 2023
Reviewer:  Jamal O. Hayat
Reviewer's report:
Well written and reads nicely. Large patients numbers from multiple sites.
Is there a breakdown of patients per sites/per country?
1. The dysphagia despite treatment number is high compared to published data on current
therapeutic options eg orodispersible budesonide. This may be due to inadequate access to
licensed medications/cost of prescribing /inappropriate treatment eg PPI's when not effective,
using other formulations of topical  steroids. This should be commented on.
2. Persistent symptoms may be due to concomitant disease eg gastro-oesophageal reflux disease
3. There is a comment in the discussion that patients would prefer dietary modification rather
than medication. I think this needs to be clarified further. I suspect this is for simple dietary
restrictions f they are effective - but unfortunately this will only apply to less than half of patients.
Most dietary exclusion studies have a high drop out rate the longer the study progresses and the
more foods are restricted (eg step up or six food elimination diets)
4. This discussion comment includes standard of care treatment but the wording implies that
elemental diet  is the primary treatment. This is not the case - and should be worded in a more
objective fashion eg therapeutic options include dietary elimination medications including PPIs
ad steroids etc. Treatment options should be determining using efficacy and patient choice....
5. Study reports a difference between patient reported outcomes and physician. Is  there a
statistical difference? Most common reported symptoms ie dysphagia is the same.  suggest may
need to revise this comment
6.  dysphagia despite treatment - is this more common in particular treatment groups eg PPI
vs steroids?
7. In discussion - first paragraph - there is a comment on  need for urgent novel treatment - but
one of the issues  that has been demonstrated  is that the delay  in diagnosis may lead to more
advanced disease, so this statement should be revised - to include this , plus optimising currently
available treatment +/- use of novel treatments.
8. The statement on lack of awareness of physicians on patients fears - i disagree with the use of
this statemnt. It is not clearly demonstrated from the results of that patients and  i would suggest
revise eg 'important to physicians to be aware of patinet fears'...
9. Figure 1 - check spelling of dysphagia on the diagram
assistant