Title: Exclusive Enteral Nutrition Remodels the Intestinal Flora in Patients with Active Crohn's
Disease
Version: 3 Date: 04 Apr 2022
Reviewer:  Gilles R.g. Monif
Reviewer's report:
The authors have done a nice job in focusing on the relevance of their data{ the exorbitant cost of
biologics and the fact that  biologics will never induce a permanent remission. Even though the
number of subjects is small, the observations are well done. What is missing is an explanation
as to why and as such, the work is  a measurement paper.
There is still concern , not about the technology, but their understanding of the events that
combine to produce disease. There is still a need to modify the first sentence . Inflammatory
bowel disease does involve the entire gastrointestinal tract. Not so for Crohn's disease. Initial
disease involves the ileocecum and remains so until the site of fecal stasis is altered by
surgery. As to pathogenesis, Crohn's disease is not an autoimmune disease but rather an
immune-mediated disease whose mechanism of action is initiated by Mycobacterium avium
subspecies paratuberculosis (MAP) and whose disease induction is due to intense cytokine/MAP
interactions. The authors should have focused on why dietary manipulations produce superior
result in terms of temporary remissions compared to the 40% achieved with biologics. Their
data fits into that niche and is the reason their paper merits publication.
Title: Exclusive Enteral Nutrition Remodels the Intestinal Flora in Patients with Active Crohn's
Disease
Version: 3 Date: 04 Apr 2022
Reviewer:  Gilles R.g. Monif
Reviewer's report:
The authors have done a nice job in focusing on the relevance of their data{ the exorbitant cost of
biologics and the fact that  biologics will never induce a permanent remission. Even though the
number of subjects is small, the observations are well done. What is missing is an explanation
as to why and as such, the work is  a measurement paper.
There is still concern , not about the technology, but their understanding of the events that
combine to produce disease. There is still a need to modify the first sentence . Inflammatory
bowel disease does involve the entire gastrointestinal tract. Not so for Crohn's disease. Initial
disease involves the ileocecum and remains so until the site of fecal stasis is altered by
surgery. As to pathogenesis, Crohn's disease is not an autoimmune disease but rather an
immune-mediated disease whose mechanism of action is initiated by Mycobacterium avium
subspecies paratuberculosis (MAP) and whose disease induction is due to intense cytokine/MAP
interactions. The authors should have focused on why dietary manipulations produce superior
result in terms of temporary remissions compared to the 40% achieved with biologics. Their
data fits into that niche and is the reason their paper merits publication.
Please review this paper.
user
Title: Exclusive Enteral Nutrition Remodels the Intestinal Flora in Patients with Active Crohn's
Disease
Version: 3 Date: 04 Apr 2022
Reviewer:  Gilles R.g. Monif
Reviewer's report:
The authors have done a nice job in focusing on the relevance of their data{ the exorbitant cost of
biologics and the fact that  biologics will never induce a permanent remission. Even though the
number of subjects is small, the observations are well done. What is missing is an explanation
as to why and as such, the work is  a measurement paper.
There is still concern , not about the technology, but their understanding of the events that
combine to produce disease. There is still a need to modify the first sentence . Inflammatory
bowel disease does involve the entire gastrointestinal tract. Not so for Crohn's disease. Initial
disease involves the ileocecum and remains so until the site of fecal stasis is altered by
surgery. As to pathogenesis, Crohn's disease is not an autoimmune disease but rather an
immune-mediated disease whose mechanism of action is initiated by Mycobacterium avium
subspecies paratuberculosis (MAP) and whose disease induction is due to intense cytokine/MAP
interactions. The authors should have focused on why dietary manipulations produce superior
result in terms of temporary remissions compared to the 40% achieved with biologics. Their
data fits into that niche and is the reason their paper merits publication.
assistant