Title: Quality of life, functional impairment and healthcare experiences of patients with irritable
bowel syndrome in Norway: An online survey
Version: 4 Date: 31 Jan 2025
Reviewer's report:
Thank you for this survey, which adds to our knowledge of IBS in Norway  with real-life data.
I have just a few comments:
1- I'm not convinced by the relevance of the responses from people under the age of 18, i.e.
25 persons (according to question 2) and  38 persons according to the ‘school pupil’ category
(question 4). We are not sure that they are capable of understanding and answering the questions.
If it wasn't the parents who answered for them, I suggest that these questionnaires should not
be included in the analysis.
2- You rightly excluded 327 questionnaires from the analysis because the diagnosis had not been
made by a doctor. I am surprised to find results for n= 2727 (in figure 5 ). These questionnaires
should be excluded from the analysis.
I would go further and also exclude the 158 questionnaires where people answered question
7:  "Yes, it was diagnosed by another doctor (not a GP or gastrointestinal specialist)". In my
opinion, only a GP or gastroenterologist can correctly diagnose IBS.
It would also have been better to cross this with the response ‘I haven't been diagnosed by a
doctor 249’ in question 10.
3- There seems to be a percentage error in figure 4a. In fact, there are 158 people who were not
seen either by a GP or by the gastroenterologist according to question 7.
4- In Table 1, you were able to classify people according to their type of IBS, i.e. IBS-C, IBS-
D or IBS-M. Did you get this information directly from the people or did you deduce it?  In my
opinion, question 8 doesn't allow you to classify patients with any certainty because it doesn't
meet the definition. For example, an IBS patient with constipation predominance must have hard
stools > 25% of the time and soft stools < 25% of the time.
To be correct, these should be indicated in the same way as the other symptoms (as for headache
and fatigue) in the table.
5- We do not understand how the ‘unemployed’ category is calculated.
Table 1 shows 1035 (38%) “unemployed”. In the discussion section, it says: ‘The present survey
revealed that the unemployment rate among IBS patients was 29%, which is therefore more than
8-fold that of the general population.’
I think there may be some confusion about the term “unemployed”. At times in your article it
refers to all the categories in question 4 without the ‘employed’ category, and at other times it
refers to ‘people of working age who are looking for work’.
Please clarify these points.
6- It would have been interesting to have information on income brackets or socio-professional
categories.
Title: Quality of life, functional impairment and healthcare experiences of patients with irritable
bowel syndrome in Norway: An online survey
Version: 4 Date: 31 Jan 2025
Reviewer's report:
Thank you for this survey, which adds to our knowledge of IBS in Norway  with real-life data.
I have just a few comments:
1- I'm not convinced by the relevance of the responses from people under the age of 18, i.e.
25 persons (according to question 2) and  38 persons according to the ‘school pupil’ category
(question 4). We are not sure that they are capable of understanding and answering the questions.
If it wasn't the parents who answered for them, I suggest that these questionnaires should not
be included in the analysis.
2- You rightly excluded 327 questionnaires from the analysis because the diagnosis had not been
made by a doctor. I am surprised to find results for n= 2727 (in figure 5 ). These questionnaires
should be excluded from the analysis.
I would go further and also exclude the 158 questionnaires where people answered question
7:  "Yes, it was diagnosed by another doctor (not a GP or gastrointestinal specialist)". In my
opinion, only a GP or gastroenterologist can correctly diagnose IBS.
It would also have been better to cross this with the response ‘I haven't been diagnosed by a
doctor 249’ in question 10.
3- There seems to be a percentage error in figure 4a. In fact, there are 158 people who were not
seen either by a GP or by the gastroenterologist according to question 7.
4- In Table 1, you were able to classify people according to their type of IBS, i.e. IBS-C, IBS-
D or IBS-M. Did you get this information directly from the people or did you deduce it?  In my
opinion, question 8 doesn't allow you to classify patients with any certainty because it doesn't
meet the definition. For example, an IBS patient with constipation predominance must have hard
stools > 25% of the time and soft stools < 25% of the time.
To be correct, these should be indicated in the same way as the other symptoms (as for headache
and fatigue) in the table.
5- We do not understand how the ‘unemployed’ category is calculated.
Table 1 shows 1035 (38%) “unemployed”. In the discussion section, it says: ‘The present survey
revealed that the unemployment rate among IBS patients was 29%, which is therefore more than
8-fold that of the general population.’
I think there may be some confusion about the term “unemployed”. At times in your article it
refers to all the categories in question 4 without the ‘employed’ category, and at other times it
refers to ‘people of working age who are looking for work’.
Please clarify these points.
6- It would have been interesting to have information on income brackets or socio-professional
categories.
Please review this paper.
user
Title: Quality of life, functional impairment and healthcare experiences of patients with irritable
bowel syndrome in Norway: An online survey
Version: 4 Date: 31 Jan 2025
Reviewer's report:
Thank you for this survey, which adds to our knowledge of IBS in Norway  with real-life data.
I have just a few comments:
1- I'm not convinced by the relevance of the responses from people under the age of 18, i.e.
25 persons (according to question 2) and  38 persons according to the ‘school pupil’ category
(question 4). We are not sure that they are capable of understanding and answering the questions.
If it wasn't the parents who answered for them, I suggest that these questionnaires should not
be included in the analysis.
2- You rightly excluded 327 questionnaires from the analysis because the diagnosis had not been
made by a doctor. I am surprised to find results for n= 2727 (in figure 5 ). These questionnaires
should be excluded from the analysis.
I would go further and also exclude the 158 questionnaires where people answered question
7:  "Yes, it was diagnosed by another doctor (not a GP or gastrointestinal specialist)". In my
opinion, only a GP or gastroenterologist can correctly diagnose IBS.
It would also have been better to cross this with the response ‘I haven't been diagnosed by a
doctor 249’ in question 10.
3- There seems to be a percentage error in figure 4a. In fact, there are 158 people who were not
seen either by a GP or by the gastroenterologist according to question 7.
4- In Table 1, you were able to classify people according to their type of IBS, i.e. IBS-C, IBS-
D or IBS-M. Did you get this information directly from the people or did you deduce it?  In my
opinion, question 8 doesn't allow you to classify patients with any certainty because it doesn't
meet the definition. For example, an IBS patient with constipation predominance must have hard
stools > 25% of the time and soft stools < 25% of the time.
To be correct, these should be indicated in the same way as the other symptoms (as for headache
and fatigue) in the table.
5- We do not understand how the ‘unemployed’ category is calculated.
Table 1 shows 1035 (38%) “unemployed”. In the discussion section, it says: ‘The present survey
revealed that the unemployment rate among IBS patients was 29%, which is therefore more than
8-fold that of the general population.’
I think there may be some confusion about the term “unemployed”. At times in your article it
refers to all the categories in question 4 without the ‘employed’ category, and at other times it
refers to ‘people of working age who are looking for work’.
Please clarify these points.
6- It would have been interesting to have information on income brackets or socio-professional
categories.
assistant