Title: Characterizing Reflux on High Resolution Esophageal Manometry with Impedance
Version: 1 Date: 22 Dec 2021
Reviewer's report:
The author tried to characterize reflux on high resolution esophageal manometry with Impedance
(HREMI). The idea of reflux on HREMI is novel and several issues are needed to be clarified:
1.The study population included non-obstructive upper gastrointestinal (GI) symptoms, lung
transplant evaluation, bariatric surgery evaluation or health volunteers. The population are so
heterogeneous. The diagnosis of esophageal motility disease or GERD was not clearly presented.
It is too hard to answer the issue that the prevalence of HREMI in GERD, obesity patients or
health subjects. The GERD is defined according to Lyon consensus. However, the subjects did
not receive any endoscopy and possible GERD with endoscopic erosive esophagitis may be
overlooked.
2. The questionnaire was PAGI-SYM but not common GERD self-reported questionaries such
as GERDQ, RDQ, RSI…etc. We cannot know the detailed reflux associated symptoms and
the correlation between reflux on HREMI. We also cannot know the proportion of GERD like
symptoms (ex: GERDQ>=8…etc) in patients with or without reflux on HREMI.
3.The method of HRMI was not described in detail. The discontinuation of medications and
prokinetics were not mentioned.
4. The MII-PH and ambulatory PH were not described in detailed. The discontinuation of PPI
or H2 were noted explained clearly. Some subjects were on PPI and some were off. We cannot
interpret and analyze the diagnosis of GERD together.
5. Why student’s t-test (parametric) and Mann Whitney U test (non-parametric) were both used?
What is the rationale?
6.The authors presented data in mean ± standard error of mean (SEM). SEM is hard for us to
know the outliners. I suggested to presented AET in proportion (like: AET>6%, 4-6% and <4%).
7.”The results of this study were previously presented in abstract form at the 2020 American
College of Gastroenterology Annual Meeting and discussed in more detail here”. I suggest to
delete this.
8. “If esophageal shortening was seen post-swallow, reflux on HREMI was defined as retrograde
movement of bolus detected in 2 impedance sensors above the proximal LES border of the
shortened esophagus.” Is the definition defined by another research? What is the possible
physiology meaning of this? Please discuss in discussion.
Title: Characterizing Reflux on High Resolution Esophageal Manometry with Impedance
Version: 1 Date: 22 Dec 2021
Reviewer's report:
The author tried to characterize reflux on high resolution esophageal manometry with Impedance
(HREMI). The idea of reflux on HREMI is novel and several issues are needed to be clarified:
1.The study population included non-obstructive upper gastrointestinal (GI) symptoms, lung
transplant evaluation, bariatric surgery evaluation or health volunteers. The population are so
heterogeneous. The diagnosis of esophageal motility disease or GERD was not clearly presented.
It is too hard to answer the issue that the prevalence of HREMI in GERD, obesity patients or
health subjects. The GERD is defined according to Lyon consensus. However, the subjects did
not receive any endoscopy and possible GERD with endoscopic erosive esophagitis may be
overlooked.
2. The questionnaire was PAGI-SYM but not common GERD self-reported questionaries such
as GERDQ, RDQ, RSI…etc. We cannot know the detailed reflux associated symptoms and
the correlation between reflux on HREMI. We also cannot know the proportion of GERD like
symptoms (ex: GERDQ>=8…etc) in patients with or without reflux on HREMI.
3.The method of HRMI was not described in detail. The discontinuation of medications and
prokinetics were not mentioned.
4. The MII-PH and ambulatory PH were not described in detailed. The discontinuation of PPI
or H2 were noted explained clearly. Some subjects were on PPI and some were off. We cannot
interpret and analyze the diagnosis of GERD together.
5. Why student’s t-test (parametric) and Mann Whitney U test (non-parametric) were both used?
What is the rationale?
6.The authors presented data in mean ± standard error of mean (SEM). SEM is hard for us to
know the outliners. I suggested to presented AET in proportion (like: AET>6%, 4-6% and <4%).
7.”The results of this study were previously presented in abstract form at the 2020 American
College of Gastroenterology Annual Meeting and discussed in more detail here”. I suggest to
delete this.
8. “If esophageal shortening was seen post-swallow, reflux on HREMI was defined as retrograde
movement of bolus detected in 2 impedance sensors above the proximal LES border of the
shortened esophagus.” Is the definition defined by another research? What is the possible
physiology meaning of this? Please discuss in discussion.
Please review this paper.
user
Title: Characterizing Reflux on High Resolution Esophageal Manometry with Impedance
Version: 1 Date: 22 Dec 2021
Reviewer's report:
The author tried to characterize reflux on high resolution esophageal manometry with Impedance
(HREMI). The idea of reflux on HREMI is novel and several issues are needed to be clarified:
1.The study population included non-obstructive upper gastrointestinal (GI) symptoms, lung
transplant evaluation, bariatric surgery evaluation or health volunteers. The population are so
heterogeneous. The diagnosis of esophageal motility disease or GERD was not clearly presented.
It is too hard to answer the issue that the prevalence of HREMI in GERD, obesity patients or
health subjects. The GERD is defined according to Lyon consensus. However, the subjects did
not receive any endoscopy and possible GERD with endoscopic erosive esophagitis may be
overlooked.
2. The questionnaire was PAGI-SYM but not common GERD self-reported questionaries such
as GERDQ, RDQ, RSI…etc. We cannot know the detailed reflux associated symptoms and
the correlation between reflux on HREMI. We also cannot know the proportion of GERD like
symptoms (ex: GERDQ>=8…etc) in patients with or without reflux on HREMI.
3.The method of HRMI was not described in detail. The discontinuation of medications and
prokinetics were not mentioned.
4. The MII-PH and ambulatory PH were not described in detailed. The discontinuation of PPI
or H2 were noted explained clearly. Some subjects were on PPI and some were off. We cannot
interpret and analyze the diagnosis of GERD together.
5. Why student’s t-test (parametric) and Mann Whitney U test (non-parametric) were both used?
What is the rationale?
6.The authors presented data in mean ± standard error of mean (SEM). SEM is hard for us to
know the outliners. I suggested to presented AET in proportion (like: AET>6%, 4-6% and <4%).
7.”The results of this study were previously presented in abstract form at the 2020 American
College of Gastroenterology Annual Meeting and discussed in more detail here”. I suggest to
delete this.
8. “If esophageal shortening was seen post-swallow, reflux on HREMI was defined as retrograde
movement of bolus detected in 2 impedance sensors above the proximal LES border of the
shortened esophagus.” Is the definition defined by another research? What is the possible
physiology meaning of this? Please discuss in discussion.
assistant