Title: Symptoms, burden, and unmet needs of patients living with exocrine pancreatic
insufficiency: a narrative review of the patient experience
Version: 0 Date: 25 Jul 2023
Reviewer's report:
Exocrine pancreatic insufficiency (EPI) is a major digestive issue that leads to many long-term
complications from maldigestion and malnutrition. EPI is underdiagnosed and undertreated, so
a focus on EPI is welcome to highlight this, in an effort to improve the treatment of patients.
EPI is present in multiple diseases, however, and therefore a focus on patient experience of
EPI is likely to be confounded by the differences between these multiple diseases and their
symptomatologies. This is analogous to a focus on patient experience of diminished cardiac
output, also from multiple diseases with different symptomatology that would confound attempts
to pinpoint the exact impact on patient experience of diminished cardiac output and its treatment.
The study of Barkin et al identifies pain as the commonest accompaniment of EPI in the studies
identified, which suggests that chronic pancreatitis is a dominant theme in these as this is
typically the most painful condition associated with EPI. The focus on patient experience and
highlighting the need for long-term trials of the treatment of EPI are welcome, the approach
adopted has the major issue of confounding as described. This should be thoroughly and robustly
addressed in the discussion and outlined as a significant limitation of the study. Furthermore,
there are components of the results that would be more appropriate in the discussion, and should
be moved accordingly.
Title: Symptoms, burden, and unmet needs of patients living with exocrine pancreatic
insufficiency: a narrative review of the patient experience
Version: 0 Date: 25 Jul 2023
Reviewer's report:
Exocrine pancreatic insufficiency (EPI) is a major digestive issue that leads to many long-term
complications from maldigestion and malnutrition. EPI is underdiagnosed and undertreated, so
a focus on EPI is welcome to highlight this, in an effort to improve the treatment of patients.
EPI is present in multiple diseases, however, and therefore a focus on patient experience of
EPI is likely to be confounded by the differences between these multiple diseases and their
symptomatologies. This is analogous to a focus on patient experience of diminished cardiac
output, also from multiple diseases with different symptomatology that would confound attempts
to pinpoint the exact impact on patient experience of diminished cardiac output and its treatment.
The study of Barkin et al identifies pain as the commonest accompaniment of EPI in the studies
identified, which suggests that chronic pancreatitis is a dominant theme in these as this is
typically the most painful condition associated with EPI. The focus on patient experience and
highlighting the need for long-term trials of the treatment of EPI are welcome, the approach
adopted has the major issue of confounding as described. This should be thoroughly and robustly
addressed in the discussion and outlined as a significant limitation of the study. Furthermore,
there are components of the results that would be more appropriate in the discussion, and should
be moved accordingly.
Please review this paper.
user
Title: Symptoms, burden, and unmet needs of patients living with exocrine pancreatic
insufficiency: a narrative review of the patient experience
Version: 0 Date: 25 Jul 2023
Reviewer's report:
Exocrine pancreatic insufficiency (EPI) is a major digestive issue that leads to many long-term
complications from maldigestion and malnutrition. EPI is underdiagnosed and undertreated, so
a focus on EPI is welcome to highlight this, in an effort to improve the treatment of patients.
EPI is present in multiple diseases, however, and therefore a focus on patient experience of
EPI is likely to be confounded by the differences between these multiple diseases and their
symptomatologies. This is analogous to a focus on patient experience of diminished cardiac
output, also from multiple diseases with different symptomatology that would confound attempts
to pinpoint the exact impact on patient experience of diminished cardiac output and its treatment.
The study of Barkin et al identifies pain as the commonest accompaniment of EPI in the studies
identified, which suggests that chronic pancreatitis is a dominant theme in these as this is
typically the most painful condition associated with EPI. The focus on patient experience and
highlighting the need for long-term trials of the treatment of EPI are welcome, the approach
adopted has the major issue of confounding as described. This should be thoroughly and robustly
addressed in the discussion and outlined as a significant limitation of the study. Furthermore,
there are components of the results that would be more appropriate in the discussion, and should
be moved accordingly.
assistant