Title: Study on the relationship of depression, anxiety, lifestyle and eating habits with the
severity of reflux esophagitis
Version: 4 Date: 20 Dec 2020
Reviewer's report:
This is a case-control study with a sizable number of participants to evaluate the risk factors
of RE and its severity, including anxiety/depression, life style including dietary habits. They
found that low education level, drinking strong tea, preference for sweets and acidic foods,
overeating, short interval between dinner and sleep, anxiety, depression, sleeping on low pillow
and constipation were independent risk factors of RE. Sleeping on low pillow was associated
severity of RE. Depression but not anxiety is positively associated with scores of symptoms and
impaired quality of life. The manuscript is generally well written.
Major concerns:
1. The RE cases were recruited from the department of gastroenterology, but were not well
defined , because the indications for endoscopy, socioeconomic status and other clinical features
including comorbidities and medication of participants were not mentioned and could be
potential confounders.
2. The authors found that sleeping on low pillow was associated the RE severity, however, the
data of RE severity and the prevalence of sleeping on low pillow in patients with different RE
severity were not presented. Besides, sleeping on low pillow was not defined. Was it the same
as “no head-of-the-bed elevation”?
3. The authors found that there were more RE patients having low pillows compared to
asymptomatic controls (44% vs. 14%). Since sleeping on high pillow is a therapeutic strategy
for reflux, why 86% of asymptomatic controls need to take the action?
Minor concerns:
1. Smoking cessation has been recognized to reduce reflux previously. However, the authors
found that smoking was a risk in univariate analysis but was not in multivariate analysis. Was
this finding due to different logistic regression models?
2. Was the questionnaire in the supplementary material self-administered or face-to-face
interviewing?  If it was self-administered, how did the participants know the definition of each
item? What was the response rate of filling out questionnaire?
3. Would the authors explain why depression but not anxiety is associated with symptom severity
and quality of life?
4. Typo: Table 1 alcohol drinking 75 (20.8) in RE group
5. Terminology: The experimental group…..; should it be the “case group”
6. Reference 22 has nothing to do with reflux disease.
Thank you for the opportunity to review your paper.
Title: Study on the relationship of depression, anxiety, lifestyle and eating habits with the
severity of reflux esophagitis
Version: 4 Date: 20 Dec 2020
Reviewer's report:
This is a case-control study with a sizable number of participants to evaluate the risk factors
of RE and its severity, including anxiety/depression, life style including dietary habits. They
found that low education level, drinking strong tea, preference for sweets and acidic foods,
overeating, short interval between dinner and sleep, anxiety, depression, sleeping on low pillow
and constipation were independent risk factors of RE. Sleeping on low pillow was associated
severity of RE. Depression but not anxiety is positively associated with scores of symptoms and
impaired quality of life. The manuscript is generally well written.
Major concerns:
1. The RE cases were recruited from the department of gastroenterology, but were not well
defined , because the indications for endoscopy, socioeconomic status and other clinical features
including comorbidities and medication of participants were not mentioned and could be
potential confounders.
2. The authors found that sleeping on low pillow was associated the RE severity, however, the
data of RE severity and the prevalence of sleeping on low pillow in patients with different RE
severity were not presented. Besides, sleeping on low pillow was not defined. Was it the same
as “no head-of-the-bed elevation”?
3. The authors found that there were more RE patients having low pillows compared to
asymptomatic controls (44% vs. 14%). Since sleeping on high pillow is a therapeutic strategy
for reflux, why 86% of asymptomatic controls need to take the action?
Minor concerns:
1. Smoking cessation has been recognized to reduce reflux previously. However, the authors
found that smoking was a risk in univariate analysis but was not in multivariate analysis. Was
this finding due to different logistic regression models?
2. Was the questionnaire in the supplementary material self-administered or face-to-face
interviewing?  If it was self-administered, how did the participants know the definition of each
item? What was the response rate of filling out questionnaire?
3. Would the authors explain why depression but not anxiety is associated with symptom severity
and quality of life?
4. Typo: Table 1 alcohol drinking 75 (20.8) in RE group
5. Terminology: The experimental group…..; should it be the “case group”
6. Reference 22 has nothing to do with reflux disease.
Thank you for the opportunity to review your paper.
Please review this paper.
user
Title: Study on the relationship of depression, anxiety, lifestyle and eating habits with the
severity of reflux esophagitis
Version: 4 Date: 20 Dec 2020
Reviewer's report:
This is a case-control study with a sizable number of participants to evaluate the risk factors
of RE and its severity, including anxiety/depression, life style including dietary habits. They
found that low education level, drinking strong tea, preference for sweets and acidic foods,
overeating, short interval between dinner and sleep, anxiety, depression, sleeping on low pillow
and constipation were independent risk factors of RE. Sleeping on low pillow was associated
severity of RE. Depression but not anxiety is positively associated with scores of symptoms and
impaired quality of life. The manuscript is generally well written.
Major concerns:
1. The RE cases were recruited from the department of gastroenterology, but were not well
defined , because the indications for endoscopy, socioeconomic status and other clinical features
including comorbidities and medication of participants were not mentioned and could be
potential confounders.
2. The authors found that sleeping on low pillow was associated the RE severity, however, the
data of RE severity and the prevalence of sleeping on low pillow in patients with different RE
severity were not presented. Besides, sleeping on low pillow was not defined. Was it the same
as “no head-of-the-bed elevation”?
3. The authors found that there were more RE patients having low pillows compared to
asymptomatic controls (44% vs. 14%). Since sleeping on high pillow is a therapeutic strategy
for reflux, why 86% of asymptomatic controls need to take the action?
Minor concerns:
1. Smoking cessation has been recognized to reduce reflux previously. However, the authors
found that smoking was a risk in univariate analysis but was not in multivariate analysis. Was
this finding due to different logistic regression models?
2. Was the questionnaire in the supplementary material self-administered or face-to-face
interviewing?  If it was self-administered, how did the participants know the definition of each
item? What was the response rate of filling out questionnaire?
3. Would the authors explain why depression but not anxiety is associated with symptom severity
and quality of life?
4. Typo: Table 1 alcohol drinking 75 (20.8) in RE group
5. Terminology: The experimental group…..; should it be the “case group”
6. Reference 22 has nothing to do with reflux disease.
Thank you for the opportunity to review your paper.
assistant