Reviewer's report
Title:Increased proton pump inhibitor and NSAID exposure in irritable bowel
syndrome: results from a case-control study
Version: 2Date:25 June 2012
Reviewer: saurabh mukewar
Reviewer's report:
The authors have conducted an interesting study to compare use of NSAIDs,
PPIs, SSRIs between IBS patients and controls. The authors have concluded
that given nature of the study a causal relationship between exposure of these
medication and development of IBS cannot be established. However, there was
a significant difference between IBS and controls with regards to exposure of
these medications.
I have one major concern regarding criteria used for exposure of medications:
All patients having had at least one prescription for a period of four weeks for a
PPI/NSAID in the 180 days prior to the time of the index visit were considered
exposed – Were the patients included had exposure to PPIs/NSAIDs 6 months
before onset of symptoms or 6 months before the time of visit ? Since diagnosis
of IBS requires, history of 6 months of symptoms and as mentioned by the
authors many patients who were seen were referred to gastroenterologist. These
patients may have been exposed to PPIs/NSAIDs after onset of symptoms.
Authors need to clarify this and clearly state that patients with exposure of these
medications prior to onset of symptoms were included and not prior to their first
visit. Being a tertiary center many patients may have had symptoms for many
months prior to being seen in the clinic.
If patients with use of PPIs/NSAIDs after onset of symptoms were included than
this study merely shows association between IBS, dyspepsia, chronic pain
conditions and medications used for treatment of the same. Based on effects of
NSAIDs and PPIs on gastrointestinal permeability and microflora: a better to
study would be to compare severity of IBS symptoms between IBS patients
taking PPIs/NSAIDs and IBS patients not taking PPIs/NSAIDs.
Other comments:
ABSTRACT
Results: Should add a statement that PPI use was not significantly correlated
after controlling for dyspepsia.
METHODS
“In other cases, diagnosis according to Rome III criteria (symptoms for at
least 6 months) was confirmed using questionnaires sent to patients to assess
symptom duration
following initial symptom onset.” – Unclear what this means. Were these cases
with <6 month history of IBS symptoms.
“The control group consisted of 408 individuals randomly selected from the
general population in
Maastricht, the Netherlands” – Were there 287 controls or 408 controls?
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Reviewer's report
Title:Increased proton pump inhibitor and NSAID exposure in irritable bowel
syndrome: results from a case-control study
Version: 2Date:25 June 2012
Reviewer: saurabh mukewar
Reviewer's report:
The authors have conducted an interesting study to compare use of NSAIDs,
PPIs, SSRIs between IBS patients and controls. The authors have concluded
that given nature of the study a causal relationship between exposure of these
medication and development of IBS cannot be established. However, there was
a significant difference between IBS and controls with regards to exposure of
these medications.
I have one major concern regarding criteria used for exposure of medications:
All patients having had at least one prescription for a period of four weeks for a
PPI/NSAID in the 180 days prior to the time of the index visit were considered
exposed – Were the patients included had exposure to PPIs/NSAIDs 6 months
before onset of symptoms or 6 months before the time of visit ? Since diagnosis
of IBS requires, history of 6 months of symptoms and as mentioned by the
authors many patients who were seen were referred to gastroenterologist. These
patients may have been exposed to PPIs/NSAIDs after onset of symptoms.
Authors need to clarify this and clearly state that patients with exposure of these
medications prior to onset of symptoms were included and not prior to their first
visit. Being a tertiary center many patients may have had symptoms for many
months prior to being seen in the clinic.
If patients with use of PPIs/NSAIDs after onset of symptoms were included than
this study merely shows association between IBS, dyspepsia, chronic pain
conditions and medications used for treatment of the same. Based on effects of
NSAIDs and PPIs on gastrointestinal permeability and microflora: a better to
study would be to compare severity of IBS symptoms between IBS patients
taking PPIs/NSAIDs and IBS patients not taking PPIs/NSAIDs.
Other comments:
ABSTRACT
Results: Should add a statement that PPI use was not significantly correlated
after controlling for dyspepsia.
METHODS
“In other cases, diagnosis according to Rome III criteria (symptoms for at
least 6 months) was confirmed using questionnaires sent to patients to assess
symptom duration
following initial symptom onset.” – Unclear what this means. Were these cases
with <6 month history of IBS symptoms.
“The control group consisted of 408 individuals randomly selected from the
general population in
Maastricht, the Netherlands” – Were there 287 controls or 408 controls?
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Please review this paper.
user
Reviewer's report
Title:Increased proton pump inhibitor and NSAID exposure in irritable bowel
syndrome: results from a case-control study
Version: 2Date:25 June 2012
Reviewer: saurabh mukewar
Reviewer's report:
The authors have conducted an interesting study to compare use of NSAIDs,
PPIs, SSRIs between IBS patients and controls. The authors have concluded
that given nature of the study a causal relationship between exposure of these
medication and development of IBS cannot be established. However, there was
a significant difference between IBS and controls with regards to exposure of
these medications.
I have one major concern regarding criteria used for exposure of medications:
All patients having had at least one prescription for a period of four weeks for a
PPI/NSAID in the 180 days prior to the time of the index visit were considered
exposed – Were the patients included had exposure to PPIs/NSAIDs 6 months
before onset of symptoms or 6 months before the time of visit ? Since diagnosis
of IBS requires, history of 6 months of symptoms and as mentioned by the
authors many patients who were seen were referred to gastroenterologist. These
patients may have been exposed to PPIs/NSAIDs after onset of symptoms.
Authors need to clarify this and clearly state that patients with exposure of these
medications prior to onset of symptoms were included and not prior to their first
visit. Being a tertiary center many patients may have had symptoms for many
months prior to being seen in the clinic.
If patients with use of PPIs/NSAIDs after onset of symptoms were included than
this study merely shows association between IBS, dyspepsia, chronic pain
conditions and medications used for treatment of the same. Based on effects of
NSAIDs and PPIs on gastrointestinal permeability and microflora: a better to
study would be to compare severity of IBS symptoms between IBS patients
taking PPIs/NSAIDs and IBS patients not taking PPIs/NSAIDs.
Other comments:
ABSTRACT
Results: Should add a statement that PPI use was not significantly correlated
after controlling for dyspepsia.
METHODS
“In other cases, diagnosis according to Rome III criteria (symptoms for at
least 6 months) was confirmed using questionnaires sent to patients to assess
symptom duration
following initial symptom onset.” – Unclear what this means. Were these cases
with <6 month history of IBS symptoms.
“The control group consisted of 408 individuals randomly selected from the
general population in
Maastricht, the Netherlands” – Were there 287 controls or 408 controls?
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
assistant