Reviewer ’s report  
 
Title:  The Role of Small Intestinal Bacterial Overgrowth (SIBO) in Non -alcoholic Fatty Liver 
Disease (NAFLD) Patients evaluated using Controlled Attenuation Parameter (CAP) Transient 
Elastography (TE): A Tertiary Referral Center Experience  
 
Version: 0 Date: 12 Dec 2018 
 
Reviewer:  Masahide  Hamaguchi  
 
Reviewer’s report:  
 
Major comments  
 
C Rinaldi A Lesmana et. al. performed a cross -sectional study in an university hospital in Jakarta 
to examine the relationship of SIBO with NAFLD.  
 
This study encompasses an interesting topic, but some problems are involved in this manuscript.  
 
 
Major comments  
 
1. Authors claimed that there is no influence of SIBO in NAFLD development, although the 
study design was a cross -sectional study. Authors cann ot claim the causal relationship of 
SIBO.  
 
2. Authors claimed that SIBO plays an important role more in NAFLD patients with 
obesity. But authors didn't present the role of SIBO in NAFLD.  
 
3. Authors examined SIBO in this study. But, they didn't present the d efinition of SIBO in 
this study. They just explained as follows; The presence of SIBO if there is an increase of 
hydrogen concentration ≥20 ppm from baseline within the first 120 minutes. General 
readers wants to know the detail of measurements.  
 
4. Authors  quantified Bifidobacteria, Lactobacillus, Bacteroides using SYBR Green Real 
time PCR. Authors should present the primer information. Moreover, authors should be 
clearly indicate the method that they set the reference for their Real time PCR, and how 
they quantify the targets.  
 
5. Authors should provide the validation data for their quantification. General readers like to 
know the rate of concordance, when authors quantify target species two or more times in 
the same stool.  
 
6. The study subjects are patients  in the university hospital. I guess that many of them 
receive medication and the medication can effect SIBO. However, authors didn't examine 
the relationship of SIBO with medication.  
Are the methods appropriate and well described?  
If not, please specify what  is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete  a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
None.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any  attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creative commons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title:  The Role of Small Intestinal Bacterial Overgrowth (SIBO) in Non -alcoholic Fatty Liver 
Disease (NAFLD) Patients evaluated using Controlled Attenuation Parameter (CAP) Transient 
Elastography (TE): A Tertiary Referral Center Experience  
 
Version: 0 Date: 12 Dec 2018 
 
Reviewer:  Masahide  Hamaguchi  
 
Reviewer’s report:  
 
Major comments  
 
C Rinaldi A Lesmana et. al. performed a cross -sectional study in an university hospital in Jakarta 
to examine the relationship of SIBO with NAFLD.  
 
This study encompasses an interesting topic, but some problems are involved in this manuscript.  
 
 
Major comments  
 
1. Authors claimed that there is no influence of SIBO in NAFLD development, although the 
study design was a cross -sectional study. Authors cann ot claim the causal relationship of 
SIBO.  
 
2. Authors claimed that SIBO plays an important role more in NAFLD patients with 
obesity. But authors didn't present the role of SIBO in NAFLD.  
 
3. Authors examined SIBO in this study. But, they didn't present the d efinition of SIBO in 
this study. They just explained as follows; The presence of SIBO if there is an increase of 
hydrogen concentration ≥20 ppm from baseline within the first 120 minutes. General 
readers wants to know the detail of measurements.  
 
4. Authors  quantified Bifidobacteria, Lactobacillus, Bacteroides using SYBR Green Real 
time PCR. Authors should present the primer information. Moreover, authors should be 
clearly indicate the method that they set the reference for their Real time PCR, and how 
they quantify the targets.  
 
5. Authors should provide the validation data for their quantification. General readers like to 
know the rate of concordance, when authors quantify target species two or more times in 
the same stool.  
 
6. The study subjects are patients  in the university hospital. I guess that many of them 
receive medication and the medication can effect SIBO. However, authors didn't examine 
the relationship of SIBO with medication.  
Are the methods appropriate and well described?  
If not, please specify what  is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete  a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
None.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any  attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creative commons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title:  The Role of Small Intestinal Bacterial Overgrowth (SIBO) in Non -alcoholic Fatty Liver 
Disease (NAFLD) Patients evaluated using Controlled Attenuation Parameter (CAP) Transient 
Elastography (TE): A Tertiary Referral Center Experience  
 
Version: 0 Date: 12 Dec 2018 
 
Reviewer:  Masahide  Hamaguchi  
 
Reviewer’s report:  
 
Major comments  
 
C Rinaldi A Lesmana et. al. performed a cross -sectional study in an university hospital in Jakarta 
to examine the relationship of SIBO with NAFLD.  
 
This study encompasses an interesting topic, but some problems are involved in this manuscript.  
 
 
Major comments  
 
1. Authors claimed that there is no influence of SIBO in NAFLD development, although the 
study design was a cross -sectional study. Authors cann ot claim the causal relationship of 
SIBO.  
 
2. Authors claimed that SIBO plays an important role more in NAFLD patients with 
obesity. But authors didn't present the role of SIBO in NAFLD.  
 
3. Authors examined SIBO in this study. But, they didn't present the d efinition of SIBO in 
this study. They just explained as follows; The presence of SIBO if there is an increase of 
hydrogen concentration ≥20 ppm from baseline within the first 120 minutes. General 
readers wants to know the detail of measurements.  
 
4. Authors  quantified Bifidobacteria, Lactobacillus, Bacteroides using SYBR Green Real 
time PCR. Authors should present the primer information. Moreover, authors should be 
clearly indicate the method that they set the reference for their Real time PCR, and how 
they quantify the targets.  
 
5. Authors should provide the validation data for their quantification. General readers like to 
know the rate of concordance, when authors quantify target species two or more times in 
the same stool.  
 
6. The study subjects are patients  in the university hospital. I guess that many of them 
receive medication and the medication can effect SIBO. However, authors didn't examine 
the relationship of SIBO with medication.  
Are the methods appropriate and well described?  
If not, please specify what  is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete  a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
None.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any  attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creative commons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant