Reviewer's report
Title:Complicated coeliac disease: two different patterns of natural history, two
different prognoses. A multicentre case control study
Version:2Date:19 May 2014
Reviewer: Benjamin Lebwohl
Reviewer's report:
In this study, Biagi and colleagues analyze outcomes of 87 patients with
complicated celiac disease (a composite classification including refractory celiac
disease types 1 and 2, ulcerative jejunitis, enteropathy associated T cell
lymphoma, small bowel adenocarcinoma, and collagenous sprue) and 136
patients with uncomplicated celiac disease. They found that those with
complicated celiac disease had lower hemoglobin, albumin, and total cholesterol
at diagnosis than those with uncomplicated celiac disease, and higher
inflammatory markers (ESR and CRP). Moreover, they found that those patients
whose complications developed after an initial improvement had an lower
mortality compared to those who did not have an initial improvement.
Limitations of this study include 1) its relatively short median follow-up (2.9 years
after the onset of complications), though this was driven in part by the mortality
associated with complicated celiac disease; and 2) insufficient power to account
for the relative contributions of each component of the umbrella term of
complicated celiac disease.
Minor essential revisions:
- Abstract: "37 cases died." Specify how many were in group A and how many
were in group B.
- Introduction: "However, due to its retrospective nature, this study cannot
provide
epidemiological data." I am uncertain as to the intent of the authors here. This
paper provides epidemiological data regarding outcomes in complicated celiac
disease. Perhaps the authors are referring to population-based data.
- Methods: Up to how many control patients were matched to each case?
- Do the authors have information on how many patients with complicated CD
had persistently elevated serum TTG levels? On a related note: the authors
report that adherence to the gluten-free diet was inferior among those with
complicated CD. Diagnosing refractory celiac disease requires strict adherence
to the gluten-free diet, and many providers consider those with persistently
elevated TTG levels as having persistent villous atrophy due to gluten exposure
and not true refractory celiac disease.
- Tables 1 and 2: It would be helpful to report percentages.
- Figure 1: the Y axis should be labeled "Complication-Free Survival."
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 that I have no competing interests
Reviewer's report
Title:Complicated coeliac disease: two different patterns of natural history, two
different prognoses. A multicentre case control study
Version:2Date:19 May 2014
Reviewer: Benjamin Lebwohl
Reviewer's report:
In this study, Biagi and colleagues analyze outcomes of 87 patients with
complicated celiac disease (a composite classification including refractory celiac
disease types 1 and 2, ulcerative jejunitis, enteropathy associated T cell
lymphoma, small bowel adenocarcinoma, and collagenous sprue) and 136
patients with uncomplicated celiac disease. They found that those with
complicated celiac disease had lower hemoglobin, albumin, and total cholesterol
at diagnosis than those with uncomplicated celiac disease, and higher
inflammatory markers (ESR and CRP). Moreover, they found that those patients
whose complications developed after an initial improvement had an lower
mortality compared to those who did not have an initial improvement.
Limitations of this study include 1) its relatively short median follow-up (2.9 years
after the onset of complications), though this was driven in part by the mortality
associated with complicated celiac disease; and 2) insufficient power to account
for the relative contributions of each component of the umbrella term of
complicated celiac disease.
Minor essential revisions:
- Abstract: "37 cases died." Specify how many were in group A and how many
were in group B.
- Introduction: "However, due to its retrospective nature, this study cannot
provide
epidemiological data." I am uncertain as to the intent of the authors here. This
paper provides epidemiological data regarding outcomes in complicated celiac
disease. Perhaps the authors are referring to population-based data.
- Methods: Up to how many control patients were matched to each case?
- Do the authors have information on how many patients with complicated CD
had persistently elevated serum TTG levels? On a related note: the authors
report that adherence to the gluten-free diet was inferior among those with
complicated CD. Diagnosing refractory celiac disease requires strict adherence
to the gluten-free diet, and many providers consider those with persistently
elevated TTG levels as having persistent villous atrophy due to gluten exposure
and not true refractory celiac disease.
- Tables 1 and 2: It would be helpful to report percentages.
- Figure 1: the Y axis should be labeled "Complication-Free Survival."
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 that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Complicated coeliac disease: two different patterns of natural history, two
different prognoses. A multicentre case control study
Version:2Date:19 May 2014
Reviewer: Benjamin Lebwohl
Reviewer's report:
In this study, Biagi and colleagues analyze outcomes of 87 patients with
complicated celiac disease (a composite classification including refractory celiac
disease types 1 and 2, ulcerative jejunitis, enteropathy associated T cell
lymphoma, small bowel adenocarcinoma, and collagenous sprue) and 136
patients with uncomplicated celiac disease. They found that those with
complicated celiac disease had lower hemoglobin, albumin, and total cholesterol
at diagnosis than those with uncomplicated celiac disease, and higher
inflammatory markers (ESR and CRP). Moreover, they found that those patients
whose complications developed after an initial improvement had an lower
mortality compared to those who did not have an initial improvement.
Limitations of this study include 1) its relatively short median follow-up (2.9 years
after the onset of complications), though this was driven in part by the mortality
associated with complicated celiac disease; and 2) insufficient power to account
for the relative contributions of each component of the umbrella term of
complicated celiac disease.
Minor essential revisions:
- Abstract: "37 cases died." Specify how many were in group A and how many
were in group B.
- Introduction: "However, due to its retrospective nature, this study cannot
provide
epidemiological data." I am uncertain as to the intent of the authors here. This
paper provides epidemiological data regarding outcomes in complicated celiac
disease. Perhaps the authors are referring to population-based data.
- Methods: Up to how many control patients were matched to each case?
- Do the authors have information on how many patients with complicated CD
had persistently elevated serum TTG levels? On a related note: the authors
report that adherence to the gluten-free diet was inferior among those with
complicated CD. Diagnosing refractory celiac disease requires strict adherence
to the gluten-free diet, and many providers consider those with persistently
elevated TTG levels as having persistent villous atrophy due to gluten exposure
and not true refractory celiac disease.
- Tables 1 and 2: It would be helpful to report percentages.
- Figure 1: the Y axis should be labeled "Complication-Free Survival."
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 that I have no competing interests
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