Reviewer ’s report  
 
Title:  Improving basic skills in celiac -like disease diagnosis : a case report.  
 
Version: 0 Date: 30 Jul 2018 
 
Reviewer:  Riccardo  Troncone  
 
Reviewer’s report:  
 
In this paper a case report is discussed that highlights the concept that the diagnosis of celiac 
disease (CD) is not exclusively or almost  exclusively based on duodenal histology, rather on the 
combination of clinical features  (mainly the response to gluten -free diet, lacking in this 
particular case), serology (negative in this case),  genetics (HLA) and histology (in this case 
consistent w ith the diagnosis of CD).  
 
The paper is clearly presented  Although of educational value, it is not really innovative, not 
providing any new info.   Giardiasis  is discussed in all textbooks in the differential diagnosis of 
CD. Hovewever it offers a number  of issues that in the discussion could be more expanded on 
the basis of more recent references.  
 
 
Specific issues  
 
In the presentation of this case it would be useful to have:  
 
* HLA typing: being not a classical case because of the negative serology,  the a bsence of 
HLA alleles associated with CD would have immediately led to a diagnosis alternative to 
CD. 
 
* Count of gammadelta IELs : important in the differential diagnosis of villous atrophy.  
 
 
In the discussion useful to expand:  
 
* Rate of false negative in adults with CD  
 
* Non coeliac villous atrophy (several recent papers on this topic)  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in t he future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors ' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title:  Improving basic skills in celiac -like disease diagnosis : a case report.  
 
Version: 0 Date: 30 Jul 2018 
 
Reviewer:  Riccardo  Troncone  
 
Reviewer’s report:  
 
In this paper a case report is discussed that highlights the concept that the diagnosis of celiac 
disease (CD) is not exclusively or almost  exclusively based on duodenal histology, rather on the 
combination of clinical features  (mainly the response to gluten -free diet, lacking in this 
particular case), serology (negative in this case),  genetics (HLA) and histology (in this case 
consistent w ith the diagnosis of CD).  
 
The paper is clearly presented  Although of educational value, it is not really innovative, not 
providing any new info.   Giardiasis  is discussed in all textbooks in the differential diagnosis of 
CD. Hovewever it offers a number  of issues that in the discussion could be more expanded on 
the basis of more recent references.  
 
 
Specific issues  
 
In the presentation of this case it would be useful to have:  
 
* HLA typing: being not a classical case because of the negative serology,  the a bsence of 
HLA alleles associated with CD would have immediately led to a diagnosis alternative to 
CD. 
 
* Count of gammadelta IELs : important in the differential diagnosis of villous atrophy.  
 
 
In the discussion useful to expand:  
 
* Rate of false negative in adults with CD  
 
* Non coeliac villous atrophy (several recent papers on this topic)  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in t he future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors ' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title:  Improving basic skills in celiac -like disease diagnosis : a case report.  
 
Version: 0 Date: 30 Jul 2018 
 
Reviewer:  Riccardo  Troncone  
 
Reviewer’s report:  
 
In this paper a case report is discussed that highlights the concept that the diagnosis of celiac 
disease (CD) is not exclusively or almost  exclusively based on duodenal histology, rather on the 
combination of clinical features  (mainly the response to gluten -free diet, lacking in this 
particular case), serology (negative in this case),  genetics (HLA) and histology (in this case 
consistent w ith the diagnosis of CD).  
 
The paper is clearly presented  Although of educational value, it is not really innovative, not 
providing any new info.   Giardiasis  is discussed in all textbooks in the differential diagnosis of 
CD. Hovewever it offers a number  of issues that in the discussion could be more expanded on 
the basis of more recent references.  
 
 
Specific issues  
 
In the presentation of this case it would be useful to have:  
 
* HLA typing: being not a classical case because of the negative serology,  the a bsence of 
HLA alleles associated with CD would have immediately led to a diagnosis alternative to 
CD. 
 
* Count of gammadelta IELs : important in the differential diagnosis of villous atrophy.  
 
 
In the discussion useful to expand:  
 
* Rate of false negative in adults with CD  
 
* Non coeliac villous atrophy (several recent papers on this topic)  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in t he future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors ' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant