Reviewer's report
Title:Limited utilization of serologic testing in patients undergoing duodenal
biopsy for celiac disease
Version: 2Date:15 May 2013
Reviewer: PAOLA IOVINO
Reviewer's report:
In this paper, Wiland et al. retrospectively evaluate the use of celiac serology in a
cohort of patients undergoing endoscopy who had been evaluated for duodenal
biopsy. Although authors are aware that guidelines suggest, in presence of a
clinical suspect of celiac disease, to perform sampling after/along with serological
tests, their conclusions were that most duodenal samples has been sent without
a prior evidence of positive tests that is in turn an evaluation of the adherence of
their institution to guidelines
Comments:
There are several missing information on the biopsy sampling. Could the authors
clarified if the biopsies were oriented and how many fragments were taken from
each patient and from which part of duodenum? In order to reduce confounding
factors, I would also suggest to use a standardized classification to categorize
duodenal histology (e.g. modified Marsh or Corazza Villanacci Classifications).
At the end of the introduction (Page 4), the authors state that they
“retrospectively examined the utilization of celiac serology in a cohort of patients
who had been sent for duodenal biopsy”. It is relatively unclear if the authors
focus their work only on the low adherence of their institution to published
guidelines (data that is already known in literature, Parakkal D. et al Do
gastroenterologists adhere to diagnostic and treatment guidelines for celiac
disease? J Clin Gastroenterol. 2012) or also on the presence of other diseases in
non duodenal samples (page 5) regardless of celiac serology.
As they state in the discussion, other non-duodenal histological findings are
common in CD patients, but it’s known that it is not mandatory multiple sampling.
Thus, could the authors better explain the value of those data? are they
suggesting to perform more biopsies in serological positive patients?
Next they examine the importance of “other” duodenal findings (non specific
duodenitis and partial villous atrophy and increased intraepithelial lymphocytes –
PVA IEL-) in serology negative patients. Again, could the authors please clarify
what they mean with “partial villous atrophy and increased intraepithelial
lymphocytes”? A partial villous atrophy can be classified according to Marsh
classification of CD lesions, as modified by Oberhuber et al, as type 3a lesion
(e.g. destructive lesion, characterized by mild villous flattening, with an increase
of IEL greater that 40 per 100 lymphocytes and crypt hyperplasia) or with error
sampling if the biopsies were not oriented.
I would suggest to review the paper according to the suggestions and reevaluate
more specifically their data.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I have no competing interests
Reviewer's report
Title:Limited utilization of serologic testing in patients undergoing duodenal
biopsy for celiac disease
Version: 2Date:15 May 2013
Reviewer: PAOLA IOVINO
Reviewer's report:
In this paper, Wiland et al. retrospectively evaluate the use of celiac serology in a
cohort of patients undergoing endoscopy who had been evaluated for duodenal
biopsy. Although authors are aware that guidelines suggest, in presence of a
clinical suspect of celiac disease, to perform sampling after/along with serological
tests, their conclusions were that most duodenal samples has been sent without
a prior evidence of positive tests that is in turn an evaluation of the adherence of
their institution to guidelines
Comments:
There are several missing information on the biopsy sampling. Could the authors
clarified if the biopsies were oriented and how many fragments were taken from
each patient and from which part of duodenum? In order to reduce confounding
factors, I would also suggest to use a standardized classification to categorize
duodenal histology (e.g. modified Marsh or Corazza Villanacci Classifications).
At the end of the introduction (Page 4), the authors state that they
“retrospectively examined the utilization of celiac serology in a cohort of patients
who had been sent for duodenal biopsy”. It is relatively unclear if the authors
focus their work only on the low adherence of their institution to published
guidelines (data that is already known in literature, Parakkal D. et al Do
gastroenterologists adhere to diagnostic and treatment guidelines for celiac
disease? J Clin Gastroenterol. 2012) or also on the presence of other diseases in
non duodenal samples (page 5) regardless of celiac serology.
As they state in the discussion, other non-duodenal histological findings are
common in CD patients, but it’s known that it is not mandatory multiple sampling.
Thus, could the authors better explain the value of those data? are they
suggesting to perform more biopsies in serological positive patients?
Next they examine the importance of “other” duodenal findings (non specific
duodenitis and partial villous atrophy and increased intraepithelial lymphocytes –
PVA IEL-) in serology negative patients. Again, could the authors please clarify
what they mean with “partial villous atrophy and increased intraepithelial
lymphocytes”? A partial villous atrophy can be classified according to Marsh
classification of CD lesions, as modified by Oberhuber et al, as type 3a lesion
(e.g. destructive lesion, characterized by mild villous flattening, with an increase
of IEL greater that 40 per 100 lymphocytes and crypt hyperplasia) or with error
sampling if the biopsies were not oriented.
I would suggest to review the paper according to the suggestions and reevaluate
more specifically their data.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Limited utilization of serologic testing in patients undergoing duodenal
biopsy for celiac disease
Version: 2Date:15 May 2013
Reviewer: PAOLA IOVINO
Reviewer's report:
In this paper, Wiland et al. retrospectively evaluate the use of celiac serology in a
cohort of patients undergoing endoscopy who had been evaluated for duodenal
biopsy. Although authors are aware that guidelines suggest, in presence of a
clinical suspect of celiac disease, to perform sampling after/along with serological
tests, their conclusions were that most duodenal samples has been sent without
a prior evidence of positive tests that is in turn an evaluation of the adherence of
their institution to guidelines
Comments:
There are several missing information on the biopsy sampling. Could the authors
clarified if the biopsies were oriented and how many fragments were taken from
each patient and from which part of duodenum? In order to reduce confounding
factors, I would also suggest to use a standardized classification to categorize
duodenal histology (e.g. modified Marsh or Corazza Villanacci Classifications).
At the end of the introduction (Page 4), the authors state that they
“retrospectively examined the utilization of celiac serology in a cohort of patients
who had been sent for duodenal biopsy”. It is relatively unclear if the authors
focus their work only on the low adherence of their institution to published
guidelines (data that is already known in literature, Parakkal D. et al Do
gastroenterologists adhere to diagnostic and treatment guidelines for celiac
disease? J Clin Gastroenterol. 2012) or also on the presence of other diseases in
non duodenal samples (page 5) regardless of celiac serology.
As they state in the discussion, other non-duodenal histological findings are
common in CD patients, but it’s known that it is not mandatory multiple sampling.
Thus, could the authors better explain the value of those data? are they
suggesting to perform more biopsies in serological positive patients?
Next they examine the importance of “other” duodenal findings (non specific
duodenitis and partial villous atrophy and increased intraepithelial lymphocytes –
PVA IEL-) in serology negative patients. Again, could the authors please clarify
what they mean with “partial villous atrophy and increased intraepithelial
lymphocytes”? A partial villous atrophy can be classified according to Marsh
classification of CD lesions, as modified by Oberhuber et al, as type 3a lesion
(e.g. destructive lesion, characterized by mild villous flattening, with an increase
of IEL greater that 40 per 100 lymphocytes and crypt hyperplasia) or with error
sampling if the biopsies were not oriented.
I would suggest to review the paper according to the suggestions and reevaluate
more specifically their data.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I have no competing interests
assistant