Title: Global, Regional, and National Burden of Disease Analysis on Paralytic Ileus and
Intestinal Obstruction in Adults Aged 65 and Over from 1990 to 2021, with Projections for 2030:
A Global Burden of Disease Study 2021 Analysis
Version: 1 Date: 19 Feb 2025
Reviewer's report:
The authors should be commended for a well conducted study. This article contributes to the
global knowledge on a disease area that is less documented and, therefore, warrants publication.
I would like to point out a few areas that need to be included in order to improve the quality
of the work.
1. The possible bias in data capturing from the lower SDI regions needs to be acknowledged in
the discussion. It is well known that data collection and maintenance, which is a high resource-
intensity activity, is less well supported in this region. This needs to be taken into consideration
when interpreting the incidence.
2. The higher incidence of paralytic ileus from the high SDI region may be attributed to the
high use of Opioids in the post-operative periods. It is well recognised that the North Americas,
Australia, and central Europe have a very high rate of post-operative opioid usage compared to
the rest of the world. (Schoenfield et al 2024 & ACoRe survey ; Boutrous et al– preliminary
data ).
3. It would help if you provide a rough breakdown of data contributions  (percentages) from
different regions in the globe. Since there is clearly a difference based on SDI, this information
will be relevant for the readers to get a better perspective.
With these minor corrections the publication can be accepted.
Title: Global, Regional, and National Burden of Disease Analysis on Paralytic Ileus and
Intestinal Obstruction in Adults Aged 65 and Over from 1990 to 2021, with Projections for 2030:
A Global Burden of Disease Study 2021 Analysis
Version: 1 Date: 19 Feb 2025
Reviewer's report:
The authors should be commended for a well conducted study. This article contributes to the
global knowledge on a disease area that is less documented and, therefore, warrants publication.
I would like to point out a few areas that need to be included in order to improve the quality
of the work.
1. The possible bias in data capturing from the lower SDI regions needs to be acknowledged in
the discussion. It is well known that data collection and maintenance, which is a high resource-
intensity activity, is less well supported in this region. This needs to be taken into consideration
when interpreting the incidence.
2. The higher incidence of paralytic ileus from the high SDI region may be attributed to the
high use of Opioids in the post-operative periods. It is well recognised that the North Americas,
Australia, and central Europe have a very high rate of post-operative opioid usage compared to
the rest of the world. (Schoenfield et al 2024 & ACoRe survey ; Boutrous et al– preliminary
data ).
3. It would help if you provide a rough breakdown of data contributions  (percentages) from
different regions in the globe. Since there is clearly a difference based on SDI, this information
will be relevant for the readers to get a better perspective.
With these minor corrections the publication can be accepted.
Please review this paper.
user
Title: Global, Regional, and National Burden of Disease Analysis on Paralytic Ileus and
Intestinal Obstruction in Adults Aged 65 and Over from 1990 to 2021, with Projections for 2030:
A Global Burden of Disease Study 2021 Analysis
Version: 1 Date: 19 Feb 2025
Reviewer's report:
The authors should be commended for a well conducted study. This article contributes to the
global knowledge on a disease area that is less documented and, therefore, warrants publication.
I would like to point out a few areas that need to be included in order to improve the quality
of the work.
1. The possible bias in data capturing from the lower SDI regions needs to be acknowledged in
the discussion. It is well known that data collection and maintenance, which is a high resource-
intensity activity, is less well supported in this region. This needs to be taken into consideration
when interpreting the incidence.
2. The higher incidence of paralytic ileus from the high SDI region may be attributed to the
high use of Opioids in the post-operative periods. It is well recognised that the North Americas,
Australia, and central Europe have a very high rate of post-operative opioid usage compared to
the rest of the world. (Schoenfield et al 2024 & ACoRe survey ; Boutrous et al– preliminary
data ).
3. It would help if you provide a rough breakdown of data contributions  (percentages) from
different regions in the globe. Since there is clearly a difference based on SDI, this information
will be relevant for the readers to get a better perspective.
With these minor corrections the publication can be accepted.
assistant