Title: Esophageal motility disorders in symptomatic patients and its relation to age
Version: 4 Date: 25 Feb 2023
Reviewer's report:
This revision is much improved from the initial submission;  the writing is more clear and the
suggestions made by reviewers have largely been incorporated.  There are still a few things that
can be modified to make this paper stronger:
1.  It is not necessary to include any statements about conventional vs. high resolution
manometry in the methods, other than to state that conventional manometry equipment and
definitions of motility disorders were used; the detail about high resolution manometry vs.
conventional manometry should really only be in the discussion.
2.  The full definitions and criteria for motility disorders are helpful, but probably should be
put into a table rather than being detailed in the Methods section as they are now.  It would be
better to state in the Methods that conventional manometry definitions for the various motility
disorders were used (see Table x).
3.  In the Methods there is a statement that patients with inflammatory GERD were not included
in the study.  Does this mean that patients with erosive esophagitis were excluded?  Since many
of the patients did have heartburn it is likely that there were some GERD patients in the study
population.  This would be good to clarify.
4.  The very high incidence of achalasia in this study is still somewhat mysterious, since it is
so much higher than is generally seen among motility laboratories; the authors have added a
statement, per reviewer's suggestion, that this could be due to differences between conventional
manometry and high resolution manometry, however it is usually believed that achalasia is more
likely to be identified on high resolution manometry, rather than  on conventional manometry.
It would be helpful for the authors to included something in the discussion that speculates why
the rate of achalasia is so high in their population (and apparently was high in another study
cited by the authors).
5.  The conclusion at the end of the paper includes, "Possible causes are higher LES resting
pressure, impaired esophageal peristalsis, and incomplete LES relaxation."  What is described
here are the manometric features of achalasia, not the cause of anything, so this conclusion can
be strengthened by removing this sentence.
Title: Esophageal motility disorders in symptomatic patients and its relation to age
Version: 4 Date: 25 Feb 2023
Reviewer's report:
This revision is much improved from the initial submission;  the writing is more clear and the
suggestions made by reviewers have largely been incorporated.  There are still a few things that
can be modified to make this paper stronger:
1.  It is not necessary to include any statements about conventional vs. high resolution
manometry in the methods, other than to state that conventional manometry equipment and
definitions of motility disorders were used; the detail about high resolution manometry vs.
conventional manometry should really only be in the discussion.
2.  The full definitions and criteria for motility disorders are helpful, but probably should be
put into a table rather than being detailed in the Methods section as they are now.  It would be
better to state in the Methods that conventional manometry definitions for the various motility
disorders were used (see Table x).
3.  In the Methods there is a statement that patients with inflammatory GERD were not included
in the study.  Does this mean that patients with erosive esophagitis were excluded?  Since many
of the patients did have heartburn it is likely that there were some GERD patients in the study
population.  This would be good to clarify.
4.  The very high incidence of achalasia in this study is still somewhat mysterious, since it is
so much higher than is generally seen among motility laboratories; the authors have added a
statement, per reviewer's suggestion, that this could be due to differences between conventional
manometry and high resolution manometry, however it is usually believed that achalasia is more
likely to be identified on high resolution manometry, rather than  on conventional manometry.
It would be helpful for the authors to included something in the discussion that speculates why
the rate of achalasia is so high in their population (and apparently was high in another study
cited by the authors).
5.  The conclusion at the end of the paper includes, "Possible causes are higher LES resting
pressure, impaired esophageal peristalsis, and incomplete LES relaxation."  What is described
here are the manometric features of achalasia, not the cause of anything, so this conclusion can
be strengthened by removing this sentence.
Please review this paper.
user
Title: Esophageal motility disorders in symptomatic patients and its relation to age
Version: 4 Date: 25 Feb 2023
Reviewer's report:
This revision is much improved from the initial submission;  the writing is more clear and the
suggestions made by reviewers have largely been incorporated.  There are still a few things that
can be modified to make this paper stronger:
1.  It is not necessary to include any statements about conventional vs. high resolution
manometry in the methods, other than to state that conventional manometry equipment and
definitions of motility disorders were used; the detail about high resolution manometry vs.
conventional manometry should really only be in the discussion.
2.  The full definitions and criteria for motility disorders are helpful, but probably should be
put into a table rather than being detailed in the Methods section as they are now.  It would be
better to state in the Methods that conventional manometry definitions for the various motility
disorders were used (see Table x).
3.  In the Methods there is a statement that patients with inflammatory GERD were not included
in the study.  Does this mean that patients with erosive esophagitis were excluded?  Since many
of the patients did have heartburn it is likely that there were some GERD patients in the study
population.  This would be good to clarify.
4.  The very high incidence of achalasia in this study is still somewhat mysterious, since it is
so much higher than is generally seen among motility laboratories; the authors have added a
statement, per reviewer's suggestion, that this could be due to differences between conventional
manometry and high resolution manometry, however it is usually believed that achalasia is more
likely to be identified on high resolution manometry, rather than  on conventional manometry.
It would be helpful for the authors to included something in the discussion that speculates why
the rate of achalasia is so high in their population (and apparently was high in another study
cited by the authors).
5.  The conclusion at the end of the paper includes, "Possible causes are higher LES resting
pressure, impaired esophageal peristalsis, and incomplete LES relaxation."  What is described
here are the manometric features of achalasia, not the cause of anything, so this conclusion can
be strengthened by removing this sentence.
assistant