Title: Acute idiopathic pancreatitis is associated with more aggressive disease course in Crohn’s
disease but not in ulcerative colitis
Version: 3 Date: 26 Mar 2023
Reviewer:  Saurabh Dawra
Reviewer's report:
A very  well brought out thought provoking study. However, a few queries remain
1. It would be interesting to analyze as to how many patients of Acute pancreatitis were admitted
at your centre over a course of 09 years(2011-2020). You have mentioned   7231  patients of
IBD out of which you could find only 53 who match your research criteria(IBD+ AP).  Is it
disease association or ‘collider bias’ that a few people may have both diseases.
2. In the CD cohort, two patients had a complicated course of AP, including one episode of
acute idiopathic pancreatitis complicated by pseudocyst and necrotizing pancreatitis, and one
episode of endoscopic retrograde cholangiopancreatography (ERCP)-induced pancreatitis with
pseudocyst formation. Was this patient with Post  ERCP AP included? If yes how is it idiopathic?
3. It is interesting to note that 26.42% (14/53) had ‘recurrent AP’. Do you have follow up data
on this subset of ‘recurrent AP’?  What is the diagnostic criteria of recurrent AP followed in
your study? This is prudent as these patients of  ‘recurrent AP’ might actually be those who have
developed chronic pancreatitis and these pain episodes were attributable to Acute pancreatitis
in the first place
4. Again you have mentioned that ‘one patient with CD who had an episode of gallstone
pancreatitis followed by an episode of ERCP-induced pancreatitis 6 years later’. Was this patient
included in analysis? How is it idiopathic if he/ she has had both gall stone related and post
ERCP pancreatitis?
5. The discussion part may be modified to justify the statement as to how the occurrence of AP in
0.73 % of patients with IBD qualifies to be termed as ‘ extra intestinal manifestation’? while the
occurrence of the same disease(API) in general population is ‘10 -35 %’. In the same discussion
the authors urge the readers to interpret the results with ‘caution’
Title: Acute idiopathic pancreatitis is associated with more aggressive disease course in Crohn’s
disease but not in ulcerative colitis
Version: 3 Date: 26 Mar 2023
Reviewer:  Saurabh Dawra
Reviewer's report:
A very  well brought out thought provoking study. However, a few queries remain
1. It would be interesting to analyze as to how many patients of Acute pancreatitis were admitted
at your centre over a course of 09 years(2011-2020). You have mentioned   7231  patients of
IBD out of which you could find only 53 who match your research criteria(IBD+ AP).  Is it
disease association or ‘collider bias’ that a few people may have both diseases.
2. In the CD cohort, two patients had a complicated course of AP, including one episode of
acute idiopathic pancreatitis complicated by pseudocyst and necrotizing pancreatitis, and one
episode of endoscopic retrograde cholangiopancreatography (ERCP)-induced pancreatitis with
pseudocyst formation. Was this patient with Post  ERCP AP included? If yes how is it idiopathic?
3. It is interesting to note that 26.42% (14/53) had ‘recurrent AP’. Do you have follow up data
on this subset of ‘recurrent AP’?  What is the diagnostic criteria of recurrent AP followed in
your study? This is prudent as these patients of  ‘recurrent AP’ might actually be those who have
developed chronic pancreatitis and these pain episodes were attributable to Acute pancreatitis
in the first place
4. Again you have mentioned that ‘one patient with CD who had an episode of gallstone
pancreatitis followed by an episode of ERCP-induced pancreatitis 6 years later’. Was this patient
included in analysis? How is it idiopathic if he/ she has had both gall stone related and post
ERCP pancreatitis?
5. The discussion part may be modified to justify the statement as to how the occurrence of AP in
0.73 % of patients with IBD qualifies to be termed as ‘ extra intestinal manifestation’? while the
occurrence of the same disease(API) in general population is ‘10 -35 %’. In the same discussion
the authors urge the readers to interpret the results with ‘caution’
Please review this paper.
user
Title: Acute idiopathic pancreatitis is associated with more aggressive disease course in Crohn’s
disease but not in ulcerative colitis
Version: 3 Date: 26 Mar 2023
Reviewer:  Saurabh Dawra
Reviewer's report:
A very  well brought out thought provoking study. However, a few queries remain
1. It would be interesting to analyze as to how many patients of Acute pancreatitis were admitted
at your centre over a course of 09 years(2011-2020). You have mentioned   7231  patients of
IBD out of which you could find only 53 who match your research criteria(IBD+ AP).  Is it
disease association or ‘collider bias’ that a few people may have both diseases.
2. In the CD cohort, two patients had a complicated course of AP, including one episode of
acute idiopathic pancreatitis complicated by pseudocyst and necrotizing pancreatitis, and one
episode of endoscopic retrograde cholangiopancreatography (ERCP)-induced pancreatitis with
pseudocyst formation. Was this patient with Post  ERCP AP included? If yes how is it idiopathic?
3. It is interesting to note that 26.42% (14/53) had ‘recurrent AP’. Do you have follow up data
on this subset of ‘recurrent AP’?  What is the diagnostic criteria of recurrent AP followed in
your study? This is prudent as these patients of  ‘recurrent AP’ might actually be those who have
developed chronic pancreatitis and these pain episodes were attributable to Acute pancreatitis
in the first place
4. Again you have mentioned that ‘one patient with CD who had an episode of gallstone
pancreatitis followed by an episode of ERCP-induced pancreatitis 6 years later’. Was this patient
included in analysis? How is it idiopathic if he/ she has had both gall stone related and post
ERCP pancreatitis?
5. The discussion part may be modified to justify the statement as to how the occurrence of AP in
0.73 % of patients with IBD qualifies to be termed as ‘ extra intestinal manifestation’? while the
occurrence of the same disease(API) in general population is ‘10 -35 %’. In the same discussion
the authors urge the readers to interpret the results with ‘caution’
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