Reviewer ’s report  
 
Title: Elobixibat alleviates chronic constipation in hemodialysis patients: A questionnaire -based 
study  
 
Version: 0 Date: 03 Aug 2019  
 
Reviewer: Luigi Brusciano  
 
Reviewer's report:  
 
In this paper the Author s analyze the efficacy of Elobixibat in alleviating chronic constipation in 
hemodialysis patients. It is a debated and interesting topic about a common condition in HD 
patients. A comprehensive and extensive literature review of the NCBI database PubMed wa s 
also carried out. The article was well conducted and it is interesting in its fields. It is a well -
structured paper, written in good English and the References are up dated.   
 
 
Minor issues:  
 
In the "discussion" section I suggest to better analyze the diag nostic process of constipated 
patients. In fact, a proper diagnostic process should combine, in addition to clinical and 
instrumental values, several clinical/physiatric parameters such as puborectalis muscle function, 
perineal defense reflex, agonist and antagonist muscle synergies, and last but not least, postural 
examination (lumbar lordosis) and respiratory function.. Therefore the following papers should 
be considered:  
 
"Clinical and instrumental parameters in patients with constipation and incontinence : their 
potential implications in the functional aspects of these disorders.Brusciano L, Limongelli P, del 
Genio G, Rossetti G, Sansone S, Healey A, Maffettone V, Napolitano V, Pizza F, Tolone S, del 
Genio A. Int J Colorectal Dis. 2009 Aug;24(8):961 -7. doi : 10.1007/s00384 -009-0678 -2. Epub 
2009 Mar 7.."  
 
"An imaginary cuboid: chest, abdomen, vertebral column and perineum, different parts of the 
same whole in the harmonic functioning of the pelvic floor.Brusciano L, Gambardella C, Tolone 
S, Del Genio G, Terra cciano G, Gualtieri G, Schiano di Visconte M, Docimo L. Tech 
Coloproctol. 2019 May 7. doi: 10.1007/s10151 -019-01996 -x." 
 
I consider that the paper could be published in the Journal after these minor revisions.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comme nts to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy 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 qua lity 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 reimbursem ents, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat 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 o rganization 
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.  
 
none  
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the au thors and, if the manuscript is accepted f or 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 in cluded 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: Elobixibat alleviates chronic constipation in hemodialysis patients: A questionnaire -based 
study  
 
Version: 0 Date: 03 Aug 2019  
 
Reviewer: Luigi Brusciano  
 
Reviewer's report:  
 
In this paper the Author s analyze the efficacy of Elobixibat in alleviating chronic constipation in 
hemodialysis patients. It is a debated and interesting topic about a common condition in HD 
patients. A comprehensive and extensive literature review of the NCBI database PubMed wa s 
also carried out. The article was well conducted and it is interesting in its fields. It is a well -
structured paper, written in good English and the References are up dated.   
 
 
Minor issues:  
 
In the "discussion" section I suggest to better analyze the diag nostic process of constipated 
patients. In fact, a proper diagnostic process should combine, in addition to clinical and 
instrumental values, several clinical/physiatric parameters such as puborectalis muscle function, 
perineal defense reflex, agonist and antagonist muscle synergies, and last but not least, postural 
examination (lumbar lordosis) and respiratory function.. Therefore the following papers should 
be considered:  
 
"Clinical and instrumental parameters in patients with constipation and incontinence : their 
potential implications in the functional aspects of these disorders.Brusciano L, Limongelli P, del 
Genio G, Rossetti G, Sansone S, Healey A, Maffettone V, Napolitano V, Pizza F, Tolone S, del 
Genio A. Int J Colorectal Dis. 2009 Aug;24(8):961 -7. doi : 10.1007/s00384 -009-0678 -2. Epub 
2009 Mar 7.."  
 
"An imaginary cuboid: chest, abdomen, vertebral column and perineum, different parts of the 
same whole in the harmonic functioning of the pelvic floor.Brusciano L, Gambardella C, Tolone 
S, Del Genio G, Terra cciano G, Gualtieri G, Schiano di Visconte M, Docimo L. Tech 
Coloproctol. 2019 May 7. doi: 10.1007/s10151 -019-01996 -x." 
 
I consider that the paper could be published in the Journal after these minor revisions.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comme nts to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy 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 qua lity 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 reimbursem ents, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat 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 o rganization 
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.  
 
none  
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the au thors and, if the manuscript is accepted f or 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 in cluded 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: Elobixibat alleviates chronic constipation in hemodialysis patients: A questionnaire -based 
study  
 
Version: 0 Date: 03 Aug 2019  
 
Reviewer: Luigi Brusciano  
 
Reviewer's report:  
 
In this paper the Author s analyze the efficacy of Elobixibat in alleviating chronic constipation in 
hemodialysis patients. It is a debated and interesting topic about a common condition in HD 
patients. A comprehensive and extensive literature review of the NCBI database PubMed wa s 
also carried out. The article was well conducted and it is interesting in its fields. It is a well -
structured paper, written in good English and the References are up dated.   
 
 
Minor issues:  
 
In the "discussion" section I suggest to better analyze the diag nostic process of constipated 
patients. In fact, a proper diagnostic process should combine, in addition to clinical and 
instrumental values, several clinical/physiatric parameters such as puborectalis muscle function, 
perineal defense reflex, agonist and antagonist muscle synergies, and last but not least, postural 
examination (lumbar lordosis) and respiratory function.. Therefore the following papers should 
be considered:  
 
"Clinical and instrumental parameters in patients with constipation and incontinence : their 
potential implications in the functional aspects of these disorders.Brusciano L, Limongelli P, del 
Genio G, Rossetti G, Sansone S, Healey A, Maffettone V, Napolitano V, Pizza F, Tolone S, del 
Genio A. Int J Colorectal Dis. 2009 Aug;24(8):961 -7. doi : 10.1007/s00384 -009-0678 -2. Epub 
2009 Mar 7.."  
 
"An imaginary cuboid: chest, abdomen, vertebral column and perineum, different parts of the 
same whole in the harmonic functioning of the pelvic floor.Brusciano L, Gambardella C, Tolone 
S, Del Genio G, Terra cciano G, Gualtieri G, Schiano di Visconte M, Docimo L. Tech 
Coloproctol. 2019 May 7. doi: 10.1007/s10151 -019-01996 -x." 
 
I consider that the paper could be published in the Journal after these minor revisions.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comme nts to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy 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 qua lity 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 reimbursem ents, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat 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 o rganization 
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.  
 
none  
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the au thors and, if the manuscript is accepted f or 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 in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant