Reviewer's report
Title:Increased proton pump inhibitor and NSAID exposure in irritable bowel
syndrome: results from a case-control study
Version: 2Date:14 June 2012
Reviewer: Xianrui Wu
Reviewer's report:
The manuscript by Keszthelyi and colleagues aimed to evaluate the association
between exposures of several certain medications and the development of IBS
symptoms in a large-population-sized case-control study. Major finding was that
NSAIDs and PPIs were more frequently used in IBS patients when compared
with controls. A number of issues need to be discussed and clarified.
Major Compulsory Revisions
1. As noted, comorbidities (rheumatic disorders, GERD, ect) were not adjusted in
the study. This raised the question that the relationship between drug use and
development of IBS symptoms might be a reflection of the true association
between underlying comorbidities and IBS. This could be addressed in either of
the following two ways: 1) run the multivariate analysis with comorbidities
included in the model; 2) select the controls by matching for comorbidities with
the IBS patients.
Minor Essential Revisions
2. Several studies, including a recently published systemic review (Ruepert L, et
al. Cochrane Database Syst Rev. 2011;(8):CD003460.), showed that SSRIs use
could improve the IBS related symptoms. While results from this study indicated
that exposure of SSRIs was positively associated with IBS. Wondering whether
the authors can comment on the controversies.
3. Methods, paragraph 4. The authors mentioned that “The control group
consisted of 408 individuals randomly selected from the general population…”.
What method is applied to select the potential controls from the general
populations?
4. Table 1, which statistical analysis was applied to compare age and BMI
between IBS patients and controls? This was not consistent with what was
described in the methods (statistical analysis).
5. Table 3, OR [95% CI] was calculated for different types of drug use. Was this
the result from the univariate analysis or the result after adjusting for other
potential risk factors? This needed to be clarified.
6. Full name needed to be provided when the abbreviation was used for the first
time in the manuscript.
Discretionary Revisions
7. No significant association between drug use and IBS subtype was found in this
study. Do the authors have the data regarding the relationship between drug use
and severity of the IBS related symptoms?
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Increased proton pump inhibitor and NSAID exposure in irritable bowel
syndrome: results from a case-control study
Version: 2Date:14 June 2012
Reviewer: Xianrui Wu
Reviewer's report:
The manuscript by Keszthelyi and colleagues aimed to evaluate the association
between exposures of several certain medications and the development of IBS
symptoms in a large-population-sized case-control study. Major finding was that
NSAIDs and PPIs were more frequently used in IBS patients when compared
with controls. A number of issues need to be discussed and clarified.
Major Compulsory Revisions
1. As noted, comorbidities (rheumatic disorders, GERD, ect) were not adjusted in
the study. This raised the question that the relationship between drug use and
development of IBS symptoms might be a reflection of the true association
between underlying comorbidities and IBS. This could be addressed in either of
the following two ways: 1) run the multivariate analysis with comorbidities
included in the model; 2) select the controls by matching for comorbidities with
the IBS patients.
Minor Essential Revisions
2. Several studies, including a recently published systemic review (Ruepert L, et
al. Cochrane Database Syst Rev. 2011;(8):CD003460.), showed that SSRIs use
could improve the IBS related symptoms. While results from this study indicated
that exposure of SSRIs was positively associated with IBS. Wondering whether
the authors can comment on the controversies.
3. Methods, paragraph 4. The authors mentioned that “The control group
consisted of 408 individuals randomly selected from the general population…”.
What method is applied to select the potential controls from the general
populations?
4. Table 1, which statistical analysis was applied to compare age and BMI
between IBS patients and controls? This was not consistent with what was
described in the methods (statistical analysis).
5. Table 3, OR [95% CI] was calculated for different types of drug use. Was this
the result from the univariate analysis or the result after adjusting for other
potential risk factors? This needed to be clarified.
6. Full name needed to be provided when the abbreviation was used for the first
time in the manuscript.
Discretionary Revisions
7. No significant association between drug use and IBS subtype was found in this
study. Do the authors have the data regarding the relationship between drug use
and severity of the IBS related symptoms?
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
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:14 June 2012
Reviewer: Xianrui Wu
Reviewer's report:
The manuscript by Keszthelyi and colleagues aimed to evaluate the association
between exposures of several certain medications and the development of IBS
symptoms in a large-population-sized case-control study. Major finding was that
NSAIDs and PPIs were more frequently used in IBS patients when compared
with controls. A number of issues need to be discussed and clarified.
Major Compulsory Revisions
1. As noted, comorbidities (rheumatic disorders, GERD, ect) were not adjusted in
the study. This raised the question that the relationship between drug use and
development of IBS symptoms might be a reflection of the true association
between underlying comorbidities and IBS. This could be addressed in either of
the following two ways: 1) run the multivariate analysis with comorbidities
included in the model; 2) select the controls by matching for comorbidities with
the IBS patients.
Minor Essential Revisions
2. Several studies, including a recently published systemic review (Ruepert L, et
al. Cochrane Database Syst Rev. 2011;(8):CD003460.), showed that SSRIs use
could improve the IBS related symptoms. While results from this study indicated
that exposure of SSRIs was positively associated with IBS. Wondering whether
the authors can comment on the controversies.
3. Methods, paragraph 4. The authors mentioned that “The control group
consisted of 408 individuals randomly selected from the general population…”.
What method is applied to select the potential controls from the general
populations?
4. Table 1, which statistical analysis was applied to compare age and BMI
between IBS patients and controls? This was not consistent with what was
described in the methods (statistical analysis).
5. Table 3, OR [95% CI] was calculated for different types of drug use. Was this
the result from the univariate analysis or the result after adjusting for other
potential risk factors? This needed to be clarified.
6. Full name needed to be provided when the abbreviation was used for the first
time in the manuscript.
Discretionary Revisions
7. No significant association between drug use and IBS subtype was found in this
study. Do the authors have the data regarding the relationship between drug use
and severity of the IBS related symptoms?
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
assistant