Reviewer ’s report  
 
Title: Risk Factor for Steatorrhea in Pediatric Chronic Pancreatitis Patients  
 
Version: 1 Date: 24 Dec 2017  
 
Reviewer: Amy Tyberg  
 
Reviewer's report:  
 
This is an interesting manuscript looking at the incidence of and risk factors associated with 
pancreatic insufficiency in the pediatric population. I agree with the authors that this is especially 
important as malnutrition fro m steatorrea can have profound effects on growth and development 
in children.  
 
A few comments:  
1. Why were patients with groove pancreatitis and autoimmune pancreatitis excluded?  
 
2. Gallstone pancreatitis is not mentioned under etiology, which is odd bec ause it is one of the 
most common etiologies. Did none of the included patients have gallstone pancreatitis? If so, 
how can you explain that?  
 
3. Was fecal elastase or secretin -MRCP used in the diagnosis of steatorrea? These modalities 
can be more sensitiv e than fecal fat and subjective complaint of foul -smelling diarrhea.  
 
4. Was there any analysis done looking for an association between etiology of pancreatitis and 
development of steatorrea? I would be curious if patients with altered ductal anatomy were 
more likely to develop steatorrhea than other etiologies. Also, was successful endoscopic 
therapy a negative predictor of development of steatorrea? Aka does fixing any underlying 
pathology prevent the development of steatorrhea down the road?  
Are the met hods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statisti cal review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language cor rections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this  manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied f or patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the a uthors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer  review policy of the journal  
Reviewer ’s report  
 
Title: Risk Factor for Steatorrhea in Pediatric Chronic Pancreatitis Patients  
 
Version: 1 Date: 24 Dec 2017  
 
Reviewer: Amy Tyberg  
 
Reviewer's report:  
 
This is an interesting manuscript looking at the incidence of and risk factors associated with 
pancreatic insufficiency in the pediatric population. I agree with the authors that this is especially 
important as malnutrition fro m steatorrea can have profound effects on growth and development 
in children.  
 
A few comments:  
1. Why were patients with groove pancreatitis and autoimmune pancreatitis excluded?  
 
2. Gallstone pancreatitis is not mentioned under etiology, which is odd bec ause it is one of the 
most common etiologies. Did none of the included patients have gallstone pancreatitis? If so, 
how can you explain that?  
 
3. Was fecal elastase or secretin -MRCP used in the diagnosis of steatorrea? These modalities 
can be more sensitiv e than fecal fat and subjective complaint of foul -smelling diarrhea.  
 
4. Was there any analysis done looking for an association between etiology of pancreatitis and 
development of steatorrea? I would be curious if patients with altered ductal anatomy were 
more likely to develop steatorrhea than other etiologies. Also, was successful endoscopic 
therapy a negative predictor of development of steatorrea? Aka does fixing any underlying 
pathology prevent the development of steatorrhea down the road?  
Are the met hods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statisti cal review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language cor rections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this  manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied f or patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the a uthors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer  review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Risk Factor for Steatorrhea in Pediatric Chronic Pancreatitis Patients  
 
Version: 1 Date: 24 Dec 2017  
 
Reviewer: Amy Tyberg  
 
Reviewer's report:  
 
This is an interesting manuscript looking at the incidence of and risk factors associated with 
pancreatic insufficiency in the pediatric population. I agree with the authors that this is especially 
important as malnutrition fro m steatorrea can have profound effects on growth and development 
in children.  
 
A few comments:  
1. Why were patients with groove pancreatitis and autoimmune pancreatitis excluded?  
 
2. Gallstone pancreatitis is not mentioned under etiology, which is odd bec ause it is one of the 
most common etiologies. Did none of the included patients have gallstone pancreatitis? If so, 
how can you explain that?  
 
3. Was fecal elastase or secretin -MRCP used in the diagnosis of steatorrea? These modalities 
can be more sensitiv e than fecal fat and subjective complaint of foul -smelling diarrhea.  
 
4. Was there any analysis done looking for an association between etiology of pancreatitis and 
development of steatorrea? I would be curious if patients with altered ductal anatomy were 
more likely to develop steatorrhea than other etiologies. Also, was successful endoscopic 
therapy a negative predictor of development of steatorrea? Aka does fixing any underlying 
pathology prevent the development of steatorrhea down the road?  
Are the met hods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statisti cal review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language cor rections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this  manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied f or patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the a uthors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer  review policy of the journal  
assistant