Reviewer's report
Title:Nationwide Epidemiological Study of Severe Gallstone Disease in Taiwan
Version: 1Date:19 April 2009
Reviewer: Monica Acalovschi
Reviewer's report:
The manuscript presents a large epidemiological study on gallstone disease in
Taiwan, focusing the severe disease (complicated and requiring emergency
therapy).
It is an interesting study on a 9-year period including 155,322 cases. The
conclusion is that there was an increase in hospital admission rate for severe
gallstone disease in younger patients, and of pancreatitis and cholangitis in
patients older than 60 years.
Comments
The study was well conducted and is welcome due to the scarcity of the data
regarding this aspect of gallstone disease. The authors correctly identify the
limits of their study, especially the possibility to include under the code of acute
cholecystitis patients presenting with biliary colic, which means symptomatic
lithiasis but not necessarily complicated.
The causes of this increase in incidence of severe cases are being analyzed. It
seems to be related in part to the increased adressability of the patients to
hospitals after changing the insurance system in the country. It would be
interesting to know whether the increase in severity paralleled an increased
incidence of gallstones in this population? There are published studies showing
an increasing incidence of gallstone diseases in 10-years intervals.
Regarding the higher rate of acute cholecystitis in men, this can not be entirely
explained by the lower rate of elective cholecytsectomy rates in men versus
women, because the change in cholecystectomy rates were almost parallel in
both genders during the period studied (Fig.3).
Regarding the increased incidence of complications in those aged > 60 years, is
this not related to an increased segment of the population in this age-group in
this period? It would be interesting to know if the mean age of the patients with
complications after 60 years increased in this period.
Minor comments
Introduction: reference 6 is cited without mentioning the country where these
figures were published.
Approval of the Study by the Ethics Committee should be mentioned in Methods.
English language revision is necessary.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare I have no competing interests.
Reviewer's report
Title:Nationwide Epidemiological Study of Severe Gallstone Disease in Taiwan
Version: 1Date:19 April 2009
Reviewer: Monica Acalovschi
Reviewer's report:
The manuscript presents a large epidemiological study on gallstone disease in
Taiwan, focusing the severe disease (complicated and requiring emergency
therapy).
It is an interesting study on a 9-year period including 155,322 cases. The
conclusion is that there was an increase in hospital admission rate for severe
gallstone disease in younger patients, and of pancreatitis and cholangitis in
patients older than 60 years.
Comments
The study was well conducted and is welcome due to the scarcity of the data
regarding this aspect of gallstone disease. The authors correctly identify the
limits of their study, especially the possibility to include under the code of acute
cholecystitis patients presenting with biliary colic, which means symptomatic
lithiasis but not necessarily complicated.
The causes of this increase in incidence of severe cases are being analyzed. It
seems to be related in part to the increased adressability of the patients to
hospitals after changing the insurance system in the country. It would be
interesting to know whether the increase in severity paralleled an increased
incidence of gallstones in this population? There are published studies showing
an increasing incidence of gallstone diseases in 10-years intervals.
Regarding the higher rate of acute cholecystitis in men, this can not be entirely
explained by the lower rate of elective cholecytsectomy rates in men versus
women, because the change in cholecystectomy rates were almost parallel in
both genders during the period studied (Fig.3).
Regarding the increased incidence of complications in those aged > 60 years, is
this not related to an increased segment of the population in this age-group in
this period? It would be interesting to know if the mean age of the patients with
complications after 60 years increased in this period.
Minor comments
Introduction: reference 6 is cited without mentioning the country where these
figures were published.
Approval of the Study by the Ethics Committee should be mentioned in Methods.
English language revision is necessary.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Nationwide Epidemiological Study of Severe Gallstone Disease in Taiwan
Version: 1Date:19 April 2009
Reviewer: Monica Acalovschi
Reviewer's report:
The manuscript presents a large epidemiological study on gallstone disease in
Taiwan, focusing the severe disease (complicated and requiring emergency
therapy).
It is an interesting study on a 9-year period including 155,322 cases. The
conclusion is that there was an increase in hospital admission rate for severe
gallstone disease in younger patients, and of pancreatitis and cholangitis in
patients older than 60 years.
Comments
The study was well conducted and is welcome due to the scarcity of the data
regarding this aspect of gallstone disease. The authors correctly identify the
limits of their study, especially the possibility to include under the code of acute
cholecystitis patients presenting with biliary colic, which means symptomatic
lithiasis but not necessarily complicated.
The causes of this increase in incidence of severe cases are being analyzed. It
seems to be related in part to the increased adressability of the patients to
hospitals after changing the insurance system in the country. It would be
interesting to know whether the increase in severity paralleled an increased
incidence of gallstones in this population? There are published studies showing
an increasing incidence of gallstone diseases in 10-years intervals.
Regarding the higher rate of acute cholecystitis in men, this can not be entirely
explained by the lower rate of elective cholecytsectomy rates in men versus
women, because the change in cholecystectomy rates were almost parallel in
both genders during the period studied (Fig.3).
Regarding the increased incidence of complications in those aged > 60 years, is
this not related to an increased segment of the population in this age-group in
this period? It would be interesting to know if the mean age of the patients with
complications after 60 years increased in this period.
Minor comments
Introduction: reference 6 is cited without mentioning the country where these
figures were published.
Approval of the Study by the Ethics Committee should be mentioned in Methods.
English language revision is necessary.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare I have no competing interests.
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