Title: The Impact of Treatment with Bile Acid Sequestrants on Quality of Life in Patients with
Bile Acid Diarrhoea
Version: 1 Date: 29 Jan 2022
Reviewer:  Tadashi Ikegami
Reviewer's report:
This is a study examining whether administration of drugs such as cholestyramine, which is
used to treat BAD, improves the patient's quality of life. The authors evaluated QOL before
and after treatment using three different QOL evaluation questionnaires. No correlation was
found between drug responsiveness and quality of life improvement, but treatment improved
quality of life, especially in the BAD and CD cohorts. On the other hand, in the PC cohort (after
cholecystectomy), the QOL was rather decreased by the administration of the drug.  The authors
evaluate which factors that make up QOL are improving in each of the pathological conditions
that cause BAD, but the number of cases in each is small and it cannot be concluded that it is
definitive, unfortunately.
Comment:
1. SeHCAT, which is used to diagnose bile acid malabsorption, is an established assay for that
purpose, but still not common in many countries, so please add a brief description about this
assay to the background or M & M section.
2. Since authors discussed that the degree of improvement in QOL differs depending on the
disease group (BAD, CD, PC, CG), please summarize the patient backgrounds of the four groups
used in this analysis on a table.
3. It was stated that the CD group, which had a high degree of improvement in clinical efficacy
and QOL, had a lower SeHCAT score, which means severe BAD. On the other hand, patients
with indeterminate was also included in this study. Is there a difference in QOL improvement by
drug administration depending on the degree of bile acid absorption disorder? In other words,
isn't it less effective for patients with mild bile acid malabsorption?
Title: The Impact of Treatment with Bile Acid Sequestrants on Quality of Life in Patients with
Bile Acid Diarrhoea
Version: 1 Date: 29 Jan 2022
Reviewer:  Tadashi Ikegami
Reviewer's report:
This is a study examining whether administration of drugs such as cholestyramine, which is
used to treat BAD, improves the patient's quality of life. The authors evaluated QOL before
and after treatment using three different QOL evaluation questionnaires. No correlation was
found between drug responsiveness and quality of life improvement, but treatment improved
quality of life, especially in the BAD and CD cohorts. On the other hand, in the PC cohort (after
cholecystectomy), the QOL was rather decreased by the administration of the drug.  The authors
evaluate which factors that make up QOL are improving in each of the pathological conditions
that cause BAD, but the number of cases in each is small and it cannot be concluded that it is
definitive, unfortunately.
Comment:
1. SeHCAT, which is used to diagnose bile acid malabsorption, is an established assay for that
purpose, but still not common in many countries, so please add a brief description about this
assay to the background or M & M section.
2. Since authors discussed that the degree of improvement in QOL differs depending on the
disease group (BAD, CD, PC, CG), please summarize the patient backgrounds of the four groups
used in this analysis on a table.
3. It was stated that the CD group, which had a high degree of improvement in clinical efficacy
and QOL, had a lower SeHCAT score, which means severe BAD. On the other hand, patients
with indeterminate was also included in this study. Is there a difference in QOL improvement by
drug administration depending on the degree of bile acid absorption disorder? In other words,
isn't it less effective for patients with mild bile acid malabsorption?
Please review this paper.
user
Title: The Impact of Treatment with Bile Acid Sequestrants on Quality of Life in Patients with
Bile Acid Diarrhoea
Version: 1 Date: 29 Jan 2022
Reviewer:  Tadashi Ikegami
Reviewer's report:
This is a study examining whether administration of drugs such as cholestyramine, which is
used to treat BAD, improves the patient's quality of life. The authors evaluated QOL before
and after treatment using three different QOL evaluation questionnaires. No correlation was
found between drug responsiveness and quality of life improvement, but treatment improved
quality of life, especially in the BAD and CD cohorts. On the other hand, in the PC cohort (after
cholecystectomy), the QOL was rather decreased by the administration of the drug.  The authors
evaluate which factors that make up QOL are improving in each of the pathological conditions
that cause BAD, but the number of cases in each is small and it cannot be concluded that it is
definitive, unfortunately.
Comment:
1. SeHCAT, which is used to diagnose bile acid malabsorption, is an established assay for that
purpose, but still not common in many countries, so please add a brief description about this
assay to the background or M & M section.
2. Since authors discussed that the degree of improvement in QOL differs depending on the
disease group (BAD, CD, PC, CG), please summarize the patient backgrounds of the four groups
used in this analysis on a table.
3. It was stated that the CD group, which had a high degree of improvement in clinical efficacy
and QOL, had a lower SeHCAT score, which means severe BAD. On the other hand, patients
with indeterminate was also included in this study. Is there a difference in QOL improvement by
drug administration depending on the degree of bile acid absorption disorder? In other words,
isn't it less effective for patients with mild bile acid malabsorption?
assistant