Reviewer's report 
 A National Survey on the Patterns of Treatment of Inflammatory Bowel Disease in Canada Title: 
Authors: 
Dr Robert J Hilsden ( rhilsden@ucalgary.ca )
Dr Marja J Verhoef ( mverhoef@ucalgary.ca )
Allan Best ( abest@vanhosp.bc.ca )
Gaia Pocobelli ( gpocobel@ucalgary.ca )
 1  16 Apr 2003 Version: Date: 
 Edward V Loftus Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Unable to decide on acceptance or rejection until the authors have Advice on publication: 
responded to the compulsory revisions 
Hilsden and colleagues present the results of a survey of over 2700 members of the Crohn's and 
Colitis Foundation of Canada regarding the use of therapies for inflammatory bowel disease. They 
noted regional differences in the prevalence of colorectal surgery for ulcerative colitis. Roughly one 
quarter of patients with Crohn's had taken purine analogs in the past 12 months, versus approximately one eighth of UC patients. Infliximab use was relatively uncommon. Rates of medical 
therapy did not vary based on region or socioeconomic status, although purine analog use was more 
common in younger patients. 
1. The paper is well written and contains quite a bit of interesting data on this large group of patients. 
My biggest concern is that the authors seem to be overemphasizing the representativeness of this 
sample (e.g., 2nd paragraph of the Background, first 2.5 pages of Discussion). I would argue that 
members of a patient support organization are in fact not at all representative of the IBD population as a whole. The patients who do well after surgery (and population-based studies tell us there are more of these folks than we think) are usually not represented in such a sample. Members of these 
organizations tend to have more severe or more chronically active disease, and they tend to have 
better educations and higher socioeconomic status (see below). As an example of the skewed nature of the populaton, 2/3 of respondents were Crohn's patients, not the 50% expected. I would strongly recommend that the authors further highlight this weakness. I agree this is important data 
and should be published, but readers need to understand the lack of representativeness of this 
sample. 
2. Table 1 could be improved by adding a column and showing demographic characteristics of 
Canadians as a whole. I am sure most of these data are available on the Statistics Canada website. 
This will likely point out that this sample of patients is not necessarily representative of the population 
in terms of education and socioeconomic status. 
3. Throughout the manuscript, the term "Remicade" is used to describe infliximab, while other 
medications are called by generic name. In addition, the manufacturer of infliximab is mentioned but 
other manufacturers are not. I would substitute "infliximab" every place "Remicade" or "remicade" 
appears (of course, Remicade could be mentioned parenthetically the first time). I would also drop 
the manufacturer, or else mention the manufacturers of all drugs mentioned. 
4. "likert" should be "Likert" 
5. Later same page, "We French translation" should be "The French translation" 
6. Table 4 last word of title of table missing, should be "colitis" 
Competing interests: 
DECLARATION 
Reviewer's report 
 A National Survey on the Patterns of Treatment of Inflammatory Bowel Disease in Canada Title: 
Authors: 
Dr Robert J Hilsden ( rhilsden@ucalgary.ca )
Dr Marja J Verhoef ( mverhoef@ucalgary.ca )
Allan Best ( abest@vanhosp.bc.ca )
Gaia Pocobelli ( gpocobel@ucalgary.ca )
 1  16 Apr 2003 Version: Date: 
 Edward V Loftus Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Unable to decide on acceptance or rejection until the authors have Advice on publication: 
responded to the compulsory revisions 
Hilsden and colleagues present the results of a survey of over 2700 members of the Crohn's and 
Colitis Foundation of Canada regarding the use of therapies for inflammatory bowel disease. They 
noted regional differences in the prevalence of colorectal surgery for ulcerative colitis. Roughly one 
quarter of patients with Crohn's had taken purine analogs in the past 12 months, versus approximately one eighth of UC patients. Infliximab use was relatively uncommon. Rates of medical 
therapy did not vary based on region or socioeconomic status, although purine analog use was more 
common in younger patients. 
1. The paper is well written and contains quite a bit of interesting data on this large group of patients. 
My biggest concern is that the authors seem to be overemphasizing the representativeness of this 
sample (e.g., 2nd paragraph of the Background, first 2.5 pages of Discussion). I would argue that 
members of a patient support organization are in fact not at all representative of the IBD population as a whole. The patients who do well after surgery (and population-based studies tell us there are more of these folks than we think) are usually not represented in such a sample. Members of these 
organizations tend to have more severe or more chronically active disease, and they tend to have 
better educations and higher socioeconomic status (see below). As an example of the skewed nature of the populaton, 2/3 of respondents were Crohn's patients, not the 50% expected. I would strongly recommend that the authors further highlight this weakness. I agree this is important data 
and should be published, but readers need to understand the lack of representativeness of this 
sample. 
2. Table 1 could be improved by adding a column and showing demographic characteristics of 
Canadians as a whole. I am sure most of these data are available on the Statistics Canada website. 
This will likely point out that this sample of patients is not necessarily representative of the population 
in terms of education and socioeconomic status. 
3. Throughout the manuscript, the term "Remicade" is used to describe infliximab, while other 
medications are called by generic name. In addition, the manufacturer of infliximab is mentioned but 
other manufacturers are not. I would substitute "infliximab" every place "Remicade" or "remicade" 
appears (of course, Remicade could be mentioned parenthetically the first time). I would also drop 
the manufacturer, or else mention the manufacturers of all drugs mentioned. 
4. "likert" should be "Likert" 
5. Later same page, "We French translation" should be "The French translation" 
6. Table 4 last word of title of table missing, should be "colitis" 
Competing interests: 
DECLARATION 
Please review this paper.
user
Reviewer's report 
 A National Survey on the Patterns of Treatment of Inflammatory Bowel Disease in Canada Title: 
Authors: 
Dr Robert J Hilsden ( rhilsden@ucalgary.ca )
Dr Marja J Verhoef ( mverhoef@ucalgary.ca )
Allan Best ( abest@vanhosp.bc.ca )
Gaia Pocobelli ( gpocobel@ucalgary.ca )
 1  16 Apr 2003 Version: Date: 
 Edward V Loftus Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Unable to decide on acceptance or rejection until the authors have Advice on publication: 
responded to the compulsory revisions 
Hilsden and colleagues present the results of a survey of over 2700 members of the Crohn's and 
Colitis Foundation of Canada regarding the use of therapies for inflammatory bowel disease. They 
noted regional differences in the prevalence of colorectal surgery for ulcerative colitis. Roughly one 
quarter of patients with Crohn's had taken purine analogs in the past 12 months, versus approximately one eighth of UC patients. Infliximab use was relatively uncommon. Rates of medical 
therapy did not vary based on region or socioeconomic status, although purine analog use was more 
common in younger patients. 
1. The paper is well written and contains quite a bit of interesting data on this large group of patients. 
My biggest concern is that the authors seem to be overemphasizing the representativeness of this 
sample (e.g., 2nd paragraph of the Background, first 2.5 pages of Discussion). I would argue that 
members of a patient support organization are in fact not at all representative of the IBD population as a whole. The patients who do well after surgery (and population-based studies tell us there are more of these folks than we think) are usually not represented in such a sample. Members of these 
organizations tend to have more severe or more chronically active disease, and they tend to have 
better educations and higher socioeconomic status (see below). As an example of the skewed nature of the populaton, 2/3 of respondents were Crohn's patients, not the 50% expected. I would strongly recommend that the authors further highlight this weakness. I agree this is important data 
and should be published, but readers need to understand the lack of representativeness of this 
sample. 
2. Table 1 could be improved by adding a column and showing demographic characteristics of 
Canadians as a whole. I am sure most of these data are available on the Statistics Canada website. 
This will likely point out that this sample of patients is not necessarily representative of the population 
in terms of education and socioeconomic status. 
3. Throughout the manuscript, the term "Remicade" is used to describe infliximab, while other 
medications are called by generic name. In addition, the manufacturer of infliximab is mentioned but 
other manufacturers are not. I would substitute "infliximab" every place "Remicade" or "remicade" 
appears (of course, Remicade could be mentioned parenthetically the first time). I would also drop 
the manufacturer, or else mention the manufacturers of all drugs mentioned. 
4. "likert" should be "Likert" 
5. Later same page, "We French translation" should be "The French translation" 
6. Table 4 last word of title of table missing, should be "colitis" 
Competing interests: 
DECLARATION 
assistant