Reviewer's report
Title:Prediction of response to PPI therapy and factors influencing treatment
outcome in patients with GORD: a prospective pragmatic trial
Version: 1Date:10 January 2011
Reviewer: Frank Zerbib
Reviewer's report:
This is a very interesting study that involved a huge number of patients with
GERD symptoms in which the factors associated to response to PPIs were
determined. The authors defined the response to PPIs by the means of the
Request questionnaire which has been validated previously. The authors report
that poor response was associated with low BMI, female gender, nonerosive
disease, IBS and anxiety.
This well done study allows identifying the main factors associated with poor
response to PPI. No pH or pH-impedance study was done but it is easy to
understand regarding the number of patients invoved worldwide. Most of the
identified factors associated with poor response were expected.
- Major Compulsory Revisions
1- It is not very clear to me whether the statistical analysis is univariate or
multivariate. If I understand well it is an univariate analysis and a multivariate
analysis is mandatory since many factors may be associated (i.e. gender, BMI,
and IBS).
2- The role of IBS was expected but the problem of functional dyspepsia is even
more important in the context of GERD. Why were dyspeptic symptoms not
assessed? Many dyspeptic symptoms are taken into account by the Request
questionnaire (as well as IBS symptoms) and may account for the absence of
response defined by the Request scores.
- Minor Essential Revisions
1- Endoscopy data were missing for only 12/1888 patients which is a very
impressive results and quite hard to understand. What was the actual "screen
failure" rate (i.e. patients not included because the refused to be scoped)? How
many patients where scoped while on or juste after one or several courses of
PPIs? This may have affected the results regarding the grade of esophagitis.
2- The role of low BMI was unexpected but this is the second study showing
similar results (Fletcher et al, Gut 2011 published online). This may be added to
the discussion as well as potential mechanisms involved to explain this result
(symptoms more likely related to GERD with increased BMI?).
- Discretionary Revisions
I would delete figures 2 and 4
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
'I declare that I have no competing interests'
Reviewer's report
Title:Prediction of response to PPI therapy and factors influencing treatment
outcome in patients with GORD: a prospective pragmatic trial
Version: 1Date:10 January 2011
Reviewer: Frank Zerbib
Reviewer's report:
This is a very interesting study that involved a huge number of patients with
GERD symptoms in which the factors associated to response to PPIs were
determined. The authors defined the response to PPIs by the means of the
Request questionnaire which has been validated previously. The authors report
that poor response was associated with low BMI, female gender, nonerosive
disease, IBS and anxiety.
This well done study allows identifying the main factors associated with poor
response to PPI. No pH or pH-impedance study was done but it is easy to
understand regarding the number of patients invoved worldwide. Most of the
identified factors associated with poor response were expected.
- Major Compulsory Revisions
1- It is not very clear to me whether the statistical analysis is univariate or
multivariate. If I understand well it is an univariate analysis and a multivariate
analysis is mandatory since many factors may be associated (i.e. gender, BMI,
and IBS).
2- The role of IBS was expected but the problem of functional dyspepsia is even
more important in the context of GERD. Why were dyspeptic symptoms not
assessed? Many dyspeptic symptoms are taken into account by the Request
questionnaire (as well as IBS symptoms) and may account for the absence of
response defined by the Request scores.
- Minor Essential Revisions
1- Endoscopy data were missing for only 12/1888 patients which is a very
impressive results and quite hard to understand. What was the actual "screen
failure" rate (i.e. patients not included because the refused to be scoped)? How
many patients where scoped while on or juste after one or several courses of
PPIs? This may have affected the results regarding the grade of esophagitis.
2- The role of low BMI was unexpected but this is the second study showing
similar results (Fletcher et al, Gut 2011 published online). This may be added to
the discussion as well as potential mechanisms involved to explain this result
(symptoms more likely related to GERD with increased BMI?).
- Discretionary Revisions
I would delete figures 2 and 4
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
'I declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:Prediction of response to PPI therapy and factors influencing treatment
outcome in patients with GORD: a prospective pragmatic trial
Version: 1Date:10 January 2011
Reviewer: Frank Zerbib
Reviewer's report:
This is a very interesting study that involved a huge number of patients with
GERD symptoms in which the factors associated to response to PPIs were
determined. The authors defined the response to PPIs by the means of the
Request questionnaire which has been validated previously. The authors report
that poor response was associated with low BMI, female gender, nonerosive
disease, IBS and anxiety.
This well done study allows identifying the main factors associated with poor
response to PPI. No pH or pH-impedance study was done but it is easy to
understand regarding the number of patients invoved worldwide. Most of the
identified factors associated with poor response were expected.
- Major Compulsory Revisions
1- It is not very clear to me whether the statistical analysis is univariate or
multivariate. If I understand well it is an univariate analysis and a multivariate
analysis is mandatory since many factors may be associated (i.e. gender, BMI,
and IBS).
2- The role of IBS was expected but the problem of functional dyspepsia is even
more important in the context of GERD. Why were dyspeptic symptoms not
assessed? Many dyspeptic symptoms are taken into account by the Request
questionnaire (as well as IBS symptoms) and may account for the absence of
response defined by the Request scores.
- Minor Essential Revisions
1- Endoscopy data were missing for only 12/1888 patients which is a very
impressive results and quite hard to understand. What was the actual "screen
failure" rate (i.e. patients not included because the refused to be scoped)? How
many patients where scoped while on or juste after one or several courses of
PPIs? This may have affected the results regarding the grade of esophagitis.
2- The role of low BMI was unexpected but this is the second study showing
similar results (Fletcher et al, Gut 2011 published online). This may be added to
the discussion as well as potential mechanisms involved to explain this result
(symptoms more likely related to GERD with increased BMI?).
- Discretionary Revisions
I would delete figures 2 and 4
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
'I declare that I have no competing interests'
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