Title: Multicenter epidemiological survey of pneumatosis intestinalis in Japan
Version: 1 Date: 30 Jan 2022
Reviewer:  Paulo Cabrera
Reviewer's report:
Greetings
The aim is clear as the authors claim, to define the clinical features leading to complications and
poor prognosis of PI. Using a multicenter epidemiological survey, they got a standardized data
collection in Japan. 167 patients from 48 intitutions were examined.
The multivariate analysis revealed:
i) two variables were independent predictors of the small-bowel-involved type; older age
(adjusted OR, 1.05 and 95% confidence intervals [CI], 1.02-1.09, P=0.0053) and chronic kidney
disease (adjusted OR, 13.19 and 95% CI, 1.04-167.62, P=0.0468).
ii) Complicating PI was associated with the small-bowel-involved combined type (adjusted OR,
45.49 and 95% CI, 8.34-248.13, P<0.0001), the small-bowel-only type (adjusted OR, 7.90 and
95% CI, 1.92-32.56, P=0.0042), and allopurinol/benzbromaron (adjusted OR, 31.07 and 95%
CI, 1.70-567.28, P=0.0204).
iii) Therapy was as follow: Oxygen therapy was performed in patients with a past history of
bowel obstruction (adjusted OR, 13.77 and 95% CI, 1.31-144.56, 97 P=0.0288) and surgery
was performed in patients with complicating PI (adjusted OR, 8.93 and 98 95% CI, 1.10-72.78,
P=0.0408).
iv) Two variables were associated with exacerbation of PI. Antihypertensives (adjusted OR,
12.28 and 95% CI, 1.07-140.79, 99 P=0.0439) and complicating PI (adjusted OR, 11.77 and
95% CI, 1.053-131.526; P=0.0453)
v) The complicating PI was the only indicator of death (adjusted OR, 14.40 and 95% CI,
1.09-189.48, P=0.0425).
Some patients clinically are asymptomatic while others present severe symptoms of abdominal
pain and diarrhea followed by abdominal distension, nausea, vomit, and bloody or mucous
stool, these is clear in the study. The CT scan is the diagnostic gold standard, and it is
usually used again in patient follow-up. In the study they used other tools for diagnosis as:
endoscopy, endoscopic ultrasonography, CT, plain abdominal roentgenogram, barium enema
roentgenogram, or laparotomy.
The treatment protocol is well clarify in these study.  It has varied  in the last years from a medical
approach to an early surgical intervention. Treatment is often not warranted in asymptomatic
patients as they resolve spontaneously . Symptomatic patients require a medical approach
consisting in: intestinal decompression, parenteral nutrition, fluid and electrolyte repletion, and
in defined cases antibiotics The surgical approach for these patients remains controversial,
especially considering that a delay in the intervention can be harmful.
At the end this study can contribute in important data in a rare pathology, where its etiology is
not that clear. But nevertheless, by methodological type (retrospective) and the way to collect
information generates different biases. The authors list limitations and some biases, these brings
reliability to the study but also opens the door to future prospective studies.
Title: Multicenter epidemiological survey of pneumatosis intestinalis in Japan
Version: 1 Date: 30 Jan 2022
Reviewer:  Paulo Cabrera
Reviewer's report:
Greetings
The aim is clear as the authors claim, to define the clinical features leading to complications and
poor prognosis of PI. Using a multicenter epidemiological survey, they got a standardized data
collection in Japan. 167 patients from 48 intitutions were examined.
The multivariate analysis revealed:
i) two variables were independent predictors of the small-bowel-involved type; older age
(adjusted OR, 1.05 and 95% confidence intervals [CI], 1.02-1.09, P=0.0053) and chronic kidney
disease (adjusted OR, 13.19 and 95% CI, 1.04-167.62, P=0.0468).
ii) Complicating PI was associated with the small-bowel-involved combined type (adjusted OR,
45.49 and 95% CI, 8.34-248.13, P<0.0001), the small-bowel-only type (adjusted OR, 7.90 and
95% CI, 1.92-32.56, P=0.0042), and allopurinol/benzbromaron (adjusted OR, 31.07 and 95%
CI, 1.70-567.28, P=0.0204).
iii) Therapy was as follow: Oxygen therapy was performed in patients with a past history of
bowel obstruction (adjusted OR, 13.77 and 95% CI, 1.31-144.56, 97 P=0.0288) and surgery
was performed in patients with complicating PI (adjusted OR, 8.93 and 98 95% CI, 1.10-72.78,
P=0.0408).
iv) Two variables were associated with exacerbation of PI. Antihypertensives (adjusted OR,
12.28 and 95% CI, 1.07-140.79, 99 P=0.0439) and complicating PI (adjusted OR, 11.77 and
95% CI, 1.053-131.526; P=0.0453)
v) The complicating PI was the only indicator of death (adjusted OR, 14.40 and 95% CI,
1.09-189.48, P=0.0425).
Some patients clinically are asymptomatic while others present severe symptoms of abdominal
pain and diarrhea followed by abdominal distension, nausea, vomit, and bloody or mucous
stool, these is clear in the study. The CT scan is the diagnostic gold standard, and it is
usually used again in patient follow-up. In the study they used other tools for diagnosis as:
endoscopy, endoscopic ultrasonography, CT, plain abdominal roentgenogram, barium enema
roentgenogram, or laparotomy.
The treatment protocol is well clarify in these study.  It has varied  in the last years from a medical
approach to an early surgical intervention. Treatment is often not warranted in asymptomatic
patients as they resolve spontaneously . Symptomatic patients require a medical approach
consisting in: intestinal decompression, parenteral nutrition, fluid and electrolyte repletion, and
in defined cases antibiotics The surgical approach for these patients remains controversial,
especially considering that a delay in the intervention can be harmful.
At the end this study can contribute in important data in a rare pathology, where its etiology is
not that clear. But nevertheless, by methodological type (retrospective) and the way to collect
information generates different biases. The authors list limitations and some biases, these brings
reliability to the study but also opens the door to future prospective studies.
Please review this paper.
user
Title: Multicenter epidemiological survey of pneumatosis intestinalis in Japan
Version: 1 Date: 30 Jan 2022
Reviewer:  Paulo Cabrera
Reviewer's report:
Greetings
The aim is clear as the authors claim, to define the clinical features leading to complications and
poor prognosis of PI. Using a multicenter epidemiological survey, they got a standardized data
collection in Japan. 167 patients from 48 intitutions were examined.
The multivariate analysis revealed:
i) two variables were independent predictors of the small-bowel-involved type; older age
(adjusted OR, 1.05 and 95% confidence intervals [CI], 1.02-1.09, P=0.0053) and chronic kidney
disease (adjusted OR, 13.19 and 95% CI, 1.04-167.62, P=0.0468).
ii) Complicating PI was associated with the small-bowel-involved combined type (adjusted OR,
45.49 and 95% CI, 8.34-248.13, P<0.0001), the small-bowel-only type (adjusted OR, 7.90 and
95% CI, 1.92-32.56, P=0.0042), and allopurinol/benzbromaron (adjusted OR, 31.07 and 95%
CI, 1.70-567.28, P=0.0204).
iii) Therapy was as follow: Oxygen therapy was performed in patients with a past history of
bowel obstruction (adjusted OR, 13.77 and 95% CI, 1.31-144.56, 97 P=0.0288) and surgery
was performed in patients with complicating PI (adjusted OR, 8.93 and 98 95% CI, 1.10-72.78,
P=0.0408).
iv) Two variables were associated with exacerbation of PI. Antihypertensives (adjusted OR,
12.28 and 95% CI, 1.07-140.79, 99 P=0.0439) and complicating PI (adjusted OR, 11.77 and
95% CI, 1.053-131.526; P=0.0453)
v) The complicating PI was the only indicator of death (adjusted OR, 14.40 and 95% CI,
1.09-189.48, P=0.0425).
Some patients clinically are asymptomatic while others present severe symptoms of abdominal
pain and diarrhea followed by abdominal distension, nausea, vomit, and bloody or mucous
stool, these is clear in the study. The CT scan is the diagnostic gold standard, and it is
usually used again in patient follow-up. In the study they used other tools for diagnosis as:
endoscopy, endoscopic ultrasonography, CT, plain abdominal roentgenogram, barium enema
roentgenogram, or laparotomy.
The treatment protocol is well clarify in these study.  It has varied  in the last years from a medical
approach to an early surgical intervention. Treatment is often not warranted in asymptomatic
patients as they resolve spontaneously . Symptomatic patients require a medical approach
consisting in: intestinal decompression, parenteral nutrition, fluid and electrolyte repletion, and
in defined cases antibiotics The surgical approach for these patients remains controversial,
especially considering that a delay in the intervention can be harmful.
At the end this study can contribute in important data in a rare pathology, where its etiology is
not that clear. But nevertheless, by methodological type (retrospective) and the way to collect
information generates different biases. The authors list limitations and some biases, these brings
reliability to the study but also opens the door to future prospective studies.
assistant