Reviewer’s report
Title: 
Gastric amyloidosis presenting as acute upper gastrointestinal bleeding: a
case report
Version: 
2 
Date: 
10 May 2021
Reviewer's report:
In this case reports, the Authors present the case of a gastrointestinal bleeding
leading to the diagnosis of AL Amyloidosis and Multiple Myeloma. 
I find both the case and the topic interesting and worthy of publication. 
There are some issues, though, that need to be addressed. 
1. Case presentation: I find the going back and forth with the timeline of the case
creates confusion (eg: introducing the patient at his second bleeding episode and
then stating that it had been the second one; presenting the results of "previous
endoscopies" and then the current ones, all in past tense...). I found difficult to
understand when what exactly happened and had to read the case more than
once. I suggest to start the case presentation from the beginning and list
successive events/exams in order. 
2. The Congo red staining for the diagnosis: Lines 67-68 state: "Case discussion
between treating gastroenterologist and pathologist prompted staining for the
presence of an infiltrative process" and afterwards the result of the Congo red
staining is mentioned. I think this concept needs to be clarified because it is
crucial for the work of gastoenterologists/clinicians and their collaboration with
pathologists: is the Congo red staining a standard staining when "looking for
infiltrative processes"? Do pathologists perform it always when the question is
"suspected tumor infiltration (or other unspecific infiltration)" or did some other
biochemical data prompted the clinician to ask for - or the pathologist to perform
- that specific staining? 
3. Discussion and review of the Literature: There is a shift around line 109-110
where the Authors switch from presenting of data on AL Amyloidosis to talking
abut GI Amyloid in general. I suggest to either add more specific data on AL
Amyloid in the GI System (after Line 120) or change the order of data
presentation starting from general (Amyloidosis) and going into specific (AL
Type)
4. Language: I suggest a revision by an expert native English speaker
Minor issues: 
- Explanations of Abbreviations should be put in the main text even though the
abbreviation already 
appears in the abstract
- I think "Cardiac" 
(abstract, line 20) does not apply to the cardia region, I would
substitute with cardial/e.
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No
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.
I declare that I have no competing interests
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Gastric amyloidosis presenting as acute upper gastrointestinal bleeding: a
case report
Version: 
2 
Date: 
10 May 2021
Reviewer's report:
In this case reports, the Authors present the case of a gastrointestinal bleeding
leading to the diagnosis of AL Amyloidosis and Multiple Myeloma. 
I find both the case and the topic interesting and worthy of publication. 
There are some issues, though, that need to be addressed. 
1. Case presentation: I find the going back and forth with the timeline of the case
creates confusion (eg: introducing the patient at his second bleeding episode and
then stating that it had been the second one; presenting the results of "previous
endoscopies" and then the current ones, all in past tense...). I found difficult to
understand when what exactly happened and had to read the case more than
once. I suggest to start the case presentation from the beginning and list
successive events/exams in order. 
2. The Congo red staining for the diagnosis: Lines 67-68 state: "Case discussion
between treating gastroenterologist and pathologist prompted staining for the
presence of an infiltrative process" and afterwards the result of the Congo red
staining is mentioned. I think this concept needs to be clarified because it is
crucial for the work of gastoenterologists/clinicians and their collaboration with
pathologists: is the Congo red staining a standard staining when "looking for
infiltrative processes"? Do pathologists perform it always when the question is
"suspected tumor infiltration (or other unspecific infiltration)" or did some other
biochemical data prompted the clinician to ask for - or the pathologist to perform
- that specific staining? 
3. Discussion and review of the Literature: There is a shift around line 109-110
where the Authors switch from presenting of data on AL Amyloidosis to talking
abut GI Amyloid in general. I suggest to either add more specific data on AL
Amyloid in the GI System (after Line 120) or change the order of data
presentation starting from general (Amyloidosis) and going into specific (AL
Type)
4. Language: I suggest a revision by an expert native English speaker
Minor issues: 
- Explanations of Abbreviations should be put in the main text even though the
abbreviation already 
appears in the abstract
- I think "Cardiac" 
(abstract, line 20) does not apply to the cardia region, I would
substitute with cardial/e.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
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.
I declare that I have no competing interests
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Gastric amyloidosis presenting as acute upper gastrointestinal bleeding: a
case report
Version: 
2 
Date: 
10 May 2021
Reviewer's report:
In this case reports, the Authors present the case of a gastrointestinal bleeding
leading to the diagnosis of AL Amyloidosis and Multiple Myeloma. 
I find both the case and the topic interesting and worthy of publication. 
There are some issues, though, that need to be addressed. 
1. Case presentation: I find the going back and forth with the timeline of the case
creates confusion (eg: introducing the patient at his second bleeding episode and
then stating that it had been the second one; presenting the results of "previous
endoscopies" and then the current ones, all in past tense...). I found difficult to
understand when what exactly happened and had to read the case more than
once. I suggest to start the case presentation from the beginning and list
successive events/exams in order. 
2. The Congo red staining for the diagnosis: Lines 67-68 state: "Case discussion
between treating gastroenterologist and pathologist prompted staining for the
presence of an infiltrative process" and afterwards the result of the Congo red
staining is mentioned. I think this concept needs to be clarified because it is
crucial for the work of gastoenterologists/clinicians and their collaboration with
pathologists: is the Congo red staining a standard staining when "looking for
infiltrative processes"? Do pathologists perform it always when the question is
"suspected tumor infiltration (or other unspecific infiltration)" or did some other
biochemical data prompted the clinician to ask for - or the pathologist to perform
- that specific staining? 
3. Discussion and review of the Literature: There is a shift around line 109-110
where the Authors switch from presenting of data on AL Amyloidosis to talking
abut GI Amyloid in general. I suggest to either add more specific data on AL
Amyloid in the GI System (after Line 120) or change the order of data
presentation starting from general (Amyloidosis) and going into specific (AL
Type)
4. Language: I suggest a revision by an expert native English speaker
Minor issues: 
- Explanations of Abbreviations should be put in the main text even though the
abbreviation already 
appears in the abstract
- I think "Cardiac" 
(abstract, line 20) does not apply to the cardia region, I would
substitute with cardial/e.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
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.
I declare that I have no competing interests
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
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