Title: Intestinal fatty acid binding protein is a disease biomarker in paediatric coeliac disease
and Crohn’s disease
Version: 2 Date: 17 Aug 2021
Reviewer's report:
In this paper Logan et al. aim to evaluate the role of intestinal fatty acid binding protein (iFABP)
as a non invasive biomarker (serum+urine samples tested) of celiac disease and Crohn’s disease
in children. The control group included healthy children. Patients with ulcerative colitis were
also enrolled. The paper deals with an interesting topic. However, there are substantial concerns
regarding the definitions of the enrolled patients and the methods for assessing adherence to a
gluten-free diet in celiac patients.
Major concerns
1. The definition of controls should be better clarified. Some children were recruited for
measurement of serum iFABP among those “admitted to hospital…for acute diagnostic
investigations” (page 6, line 133), whereas urinary analysis was conducted on children recruited
from the local community. More details on the baseline clinical features of these children must
be provided, particularly for those admitted to hospital. Did they suffer from gastrointestinal
symptoms? Moroeover, it is not stated whether controls were matched according to age and
gender. This can influence the homogeneity of the populations under investigation.
2. Diagnosis of celiac disease was made by means of a duodenal biopsy (diagnoses predate the
ESPGHAN 2012 criteria). Were antibodies for celiac disease tested?
3. It is not entirely clear to me why the Authors decided to measure iFABP levels also in patients
affected by ulcerative colitis, which by definitions does not involve the small-bowel. Were
patients affected by ulcerative colitis considered as controls?
4. Evaluation of adherence to a gluten-free diet cannot be solely measured by relying on gluten
immunogenic peptides. Although they may represent a promising tool in the follow-up of celiac
patients, assessment of adherence by a skilled dietician and follow-up duodenal biopsy still
remains the best methods to evaluate adherence in celiac patients.
5. I am very sceptical that on the basis of the results provided by this study iFABP can be used
for the non-invasive diagnosis of celiac disease, at least at this stage
Minor concerns:
1. I would suggest adopting different abbreviations, such as CeD for celiac disease and CrD for
Crohn’s disease.
Title: Intestinal fatty acid binding protein is a disease biomarker in paediatric coeliac disease
and Crohn’s disease
Version: 2 Date: 17 Aug 2021
Reviewer's report:
In this paper Logan et al. aim to evaluate the role of intestinal fatty acid binding protein (iFABP)
as a non invasive biomarker (serum+urine samples tested) of celiac disease and Crohn’s disease
in children. The control group included healthy children. Patients with ulcerative colitis were
also enrolled. The paper deals with an interesting topic. However, there are substantial concerns
regarding the definitions of the enrolled patients and the methods for assessing adherence to a
gluten-free diet in celiac patients.
Major concerns
1. The definition of controls should be better clarified. Some children were recruited for
measurement of serum iFABP among those “admitted to hospital…for acute diagnostic
investigations” (page 6, line 133), whereas urinary analysis was conducted on children recruited
from the local community. More details on the baseline clinical features of these children must
be provided, particularly for those admitted to hospital. Did they suffer from gastrointestinal
symptoms? Moroeover, it is not stated whether controls were matched according to age and
gender. This can influence the homogeneity of the populations under investigation.
2. Diagnosis of celiac disease was made by means of a duodenal biopsy (diagnoses predate the
ESPGHAN 2012 criteria). Were antibodies for celiac disease tested?
3. It is not entirely clear to me why the Authors decided to measure iFABP levels also in patients
affected by ulcerative colitis, which by definitions does not involve the small-bowel. Were
patients affected by ulcerative colitis considered as controls?
4. Evaluation of adherence to a gluten-free diet cannot be solely measured by relying on gluten
immunogenic peptides. Although they may represent a promising tool in the follow-up of celiac
patients, assessment of adherence by a skilled dietician and follow-up duodenal biopsy still
remains the best methods to evaluate adherence in celiac patients.
5. I am very sceptical that on the basis of the results provided by this study iFABP can be used
for the non-invasive diagnosis of celiac disease, at least at this stage
Minor concerns:
1. I would suggest adopting different abbreviations, such as CeD for celiac disease and CrD for
Crohn’s disease.
Please review this paper.
user
Title: Intestinal fatty acid binding protein is a disease biomarker in paediatric coeliac disease
and Crohn’s disease
Version: 2 Date: 17 Aug 2021
Reviewer's report:
In this paper Logan et al. aim to evaluate the role of intestinal fatty acid binding protein (iFABP)
as a non invasive biomarker (serum+urine samples tested) of celiac disease and Crohn’s disease
in children. The control group included healthy children. Patients with ulcerative colitis were
also enrolled. The paper deals with an interesting topic. However, there are substantial concerns
regarding the definitions of the enrolled patients and the methods for assessing adherence to a
gluten-free diet in celiac patients.
Major concerns
1. The definition of controls should be better clarified. Some children were recruited for
measurement of serum iFABP among those “admitted to hospital…for acute diagnostic
investigations” (page 6, line 133), whereas urinary analysis was conducted on children recruited
from the local community. More details on the baseline clinical features of these children must
be provided, particularly for those admitted to hospital. Did they suffer from gastrointestinal
symptoms? Moroeover, it is not stated whether controls were matched according to age and
gender. This can influence the homogeneity of the populations under investigation.
2. Diagnosis of celiac disease was made by means of a duodenal biopsy (diagnoses predate the
ESPGHAN 2012 criteria). Were antibodies for celiac disease tested?
3. It is not entirely clear to me why the Authors decided to measure iFABP levels also in patients
affected by ulcerative colitis, which by definitions does not involve the small-bowel. Were
patients affected by ulcerative colitis considered as controls?
4. Evaluation of adherence to a gluten-free diet cannot be solely measured by relying on gluten
immunogenic peptides. Although they may represent a promising tool in the follow-up of celiac
patients, assessment of adherence by a skilled dietician and follow-up duodenal biopsy still
remains the best methods to evaluate adherence in celiac patients.
5. I am very sceptical that on the basis of the results provided by this study iFABP can be used
for the non-invasive diagnosis of celiac disease, at least at this stage
Minor concerns:
1. I would suggest adopting different abbreviations, such as CeD for celiac disease and CrD for
Crohn’s disease.
assistant