Reviewer's report
Title:A gluten-free diet effectively reduces symptoms and health care
consumption in a Swedish celiac disease population
Version: 2Date:2 February 2012
Reviewer: joseph murray
Reviewer's report:
This is an interesting paper that, using survey methods, describes the
self-reported benefit of a gluten-free diet. It documents patients’ reports of a
decreased healthcare utilization as well as personal costs in terms of days lost.
Minor Comments:
1. Does the duration of diagnosis of celiac disease affect the apparent response?
If there is no effect of the duration, then it is unlikely that recall bias would have a
major impact on the patient’s perception of improvement.
2. Prior economic studies—the authors should include a reference to the health
economic study carried out by Green PHR et al (J Insurance Medicine 2008).
3. How did the authors handle the actual diagnostic tests for celiac disease?
Were these included or were these likely to have been included in the
assessment of the year prior to diagnosis, initiation of treatment, or not?
4. Is there any available data to compare with natural history of patients without
celiac disease in terms of health care utilization?
5. The introduction, particularly the 3rd paragraph, could be shorted as it does
not appear to be entirely relevant to the topic at hand.
6. The issue of the occurrence of second autoimmune diseases also probably
needs to be carefully evaluated to address the issue of whether a type 2 error
could have occurred due to lack of power.
7. How was celiac disease verified? For example, is membership in the Celiac
Society of Sweden contingent upon diagnosis by biopsy?
8. Is it likely that patients with the most severe outcome may have died after
diagnosis? How many questionnaires were returned because of death of the
individuals?
9. What immune-mediated diseases in the population were used to ascertain
how these frequencies compare?
10. The frequency of GI symptoms reported in the pre-treatment and in the
current time frame examines the difference in frequency as the overall group.
What was the new occurrence of symptoms in subjects who did not report it in
the pre-treatment phase? For example, one study by Murray et al (Am J Clin
Nutr, 2004) documented a new onset of symptoms. It may be helpful to report the
new onset of symptoms in patients previously lacking those symptoms.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:A gluten-free diet effectively reduces symptoms and health care
consumption in a Swedish celiac disease population
Version: 2Date:2 February 2012
Reviewer: joseph murray
Reviewer's report:
This is an interesting paper that, using survey methods, describes the
self-reported benefit of a gluten-free diet. It documents patients’ reports of a
decreased healthcare utilization as well as personal costs in terms of days lost.
Minor Comments:
1. Does the duration of diagnosis of celiac disease affect the apparent response?
If there is no effect of the duration, then it is unlikely that recall bias would have a
major impact on the patient’s perception of improvement.
2. Prior economic studies—the authors should include a reference to the health
economic study carried out by Green PHR et al (J Insurance Medicine 2008).
3. How did the authors handle the actual diagnostic tests for celiac disease?
Were these included or were these likely to have been included in the
assessment of the year prior to diagnosis, initiation of treatment, or not?
4. Is there any available data to compare with natural history of patients without
celiac disease in terms of health care utilization?
5. The introduction, particularly the 3rd paragraph, could be shorted as it does
not appear to be entirely relevant to the topic at hand.
6. The issue of the occurrence of second autoimmune diseases also probably
needs to be carefully evaluated to address the issue of whether a type 2 error
could have occurred due to lack of power.
7. How was celiac disease verified? For example, is membership in the Celiac
Society of Sweden contingent upon diagnosis by biopsy?
8. Is it likely that patients with the most severe outcome may have died after
diagnosis? How many questionnaires were returned because of death of the
individuals?
9. What immune-mediated diseases in the population were used to ascertain
how these frequencies compare?
10. The frequency of GI symptoms reported in the pre-treatment and in the
current time frame examines the difference in frequency as the overall group.
What was the new occurrence of symptoms in subjects who did not report it in
the pre-treatment phase? For example, one study by Murray et al (Am J Clin
Nutr, 2004) documented a new onset of symptoms. It may be helpful to report the
new onset of symptoms in patients previously lacking those symptoms.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:A gluten-free diet effectively reduces symptoms and health care
consumption in a Swedish celiac disease population
Version: 2Date:2 February 2012
Reviewer: joseph murray
Reviewer's report:
This is an interesting paper that, using survey methods, describes the
self-reported benefit of a gluten-free diet. It documents patients’ reports of a
decreased healthcare utilization as well as personal costs in terms of days lost.
Minor Comments:
1. Does the duration of diagnosis of celiac disease affect the apparent response?
If there is no effect of the duration, then it is unlikely that recall bias would have a
major impact on the patient’s perception of improvement.
2. Prior economic studies—the authors should include a reference to the health
economic study carried out by Green PHR et al (J Insurance Medicine 2008).
3. How did the authors handle the actual diagnostic tests for celiac disease?
Were these included or were these likely to have been included in the
assessment of the year prior to diagnosis, initiation of treatment, or not?
4. Is there any available data to compare with natural history of patients without
celiac disease in terms of health care utilization?
5. The introduction, particularly the 3rd paragraph, could be shorted as it does
not appear to be entirely relevant to the topic at hand.
6. The issue of the occurrence of second autoimmune diseases also probably
needs to be carefully evaluated to address the issue of whether a type 2 error
could have occurred due to lack of power.
7. How was celiac disease verified? For example, is membership in the Celiac
Society of Sweden contingent upon diagnosis by biopsy?
8. Is it likely that patients with the most severe outcome may have died after
diagnosis? How many questionnaires were returned because of death of the
individuals?
9. What immune-mediated diseases in the population were used to ascertain
how these frequencies compare?
10. The frequency of GI symptoms reported in the pre-treatment and in the
current time frame examines the difference in frequency as the overall group.
What was the new occurrence of symptoms in subjects who did not report it in
the pre-treatment phase? For example, one study by Murray et al (Am J Clin
Nutr, 2004) documented a new onset of symptoms. It may be helpful to report the
new onset of symptoms in patients previously lacking those symptoms.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
assistant