Reviewer’s report
Title: Functional constipation masked as irritable bowel syndrome
Version: 0 Date: 29 Jan 2020
Reviewer: Francesca Galeazzi
Reviewer's report:
RE: Manuscript  BMGE-D-19-01142
Author: Monica Tosto et al
TITLE: Functional constipation masked as irritable bowel syndrome
The present paper addresses the management of IBS-D and IBS-M in children, aiming to verify the
hypothesis of an underlying functional constipation in these patients. The topic is interesting and could
lead to a different work up and management of these young patients. 
However, some important issues need to be clarified: 
1. The sample is very limited (10 patients in IBS D and 16 in IBS M) and imbalanced in gender (9
males vs 1 female in IBS-D) and age distribution (9.5 - 18 yrs in IBS-D). 
It is well known the IBS is more prevalent in the female population, and hormonal and psychological
factors play a pivotal role in the pathophysiology; as well, the placebo effect cannot be ruled out in
such a small population. 
2. The authors do not describe a control group (patients with IBS-D / IBS-M and suspected occult
constipation untreated) 
3. Symptoms have been investigate using a validated questionnaire? 
4. Diet habits have been investigated? Diet may substantially vary between 9 yrs and 18 yrs of age 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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 for 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.
No conflict of interest
I agree to the open peer review policy of the journal. I understand that my name will be included
on my report to the authors 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: Functional constipation masked as irritable bowel syndrome
Version: 0 Date: 29 Jan 2020
Reviewer: Francesca Galeazzi
Reviewer's report:
RE: Manuscript  BMGE-D-19-01142
Author: Monica Tosto et al
TITLE: Functional constipation masked as irritable bowel syndrome
The present paper addresses the management of IBS-D and IBS-M in children, aiming to verify the
hypothesis of an underlying functional constipation in these patients. The topic is interesting and could
lead to a different work up and management of these young patients. 
However, some important issues need to be clarified: 
1. The sample is very limited (10 patients in IBS D and 16 in IBS M) and imbalanced in gender (9
males vs 1 female in IBS-D) and age distribution (9.5 - 18 yrs in IBS-D). 
It is well known the IBS is more prevalent in the female population, and hormonal and psychological
factors play a pivotal role in the pathophysiology; as well, the placebo effect cannot be ruled out in
such a small population. 
2. The authors do not describe a control group (patients with IBS-D / IBS-M and suspected occult
constipation untreated) 
3. Symptoms have been investigate using a validated questionnaire? 
4. Diet habits have been investigated? Diet may substantially vary between 9 yrs and 18 yrs of age 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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 for 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.
No conflict of interest
I agree to the open peer review policy of the journal. I understand that my name will be included
on my report to the authors 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: Functional constipation masked as irritable bowel syndrome
Version: 0 Date: 29 Jan 2020
Reviewer: Francesca Galeazzi
Reviewer's report:
RE: Manuscript  BMGE-D-19-01142
Author: Monica Tosto et al
TITLE: Functional constipation masked as irritable bowel syndrome
The present paper addresses the management of IBS-D and IBS-M in children, aiming to verify the
hypothesis of an underlying functional constipation in these patients. The topic is interesting and could
lead to a different work up and management of these young patients. 
However, some important issues need to be clarified: 
1. The sample is very limited (10 patients in IBS D and 16 in IBS M) and imbalanced in gender (9
males vs 1 female in IBS-D) and age distribution (9.5 - 18 yrs in IBS-D). 
It is well known the IBS is more prevalent in the female population, and hormonal and psychological
factors play a pivotal role in the pathophysiology; as well, the placebo effect cannot be ruled out in
such a small population. 
2. The authors do not describe a control group (patients with IBS-D / IBS-M and suspected occult
constipation untreated) 
3. Symptoms have been investigate using a validated questionnaire? 
4. Diet habits have been investigated? Diet may substantially vary between 9 yrs and 18 yrs of age 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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 for 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.
No conflict of interest
I agree to the open peer review policy of the journal. I understand that my name will be included
on my report to the authors 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