Reviewer ’s report  
 
Title: Eosinophilic esophagitis (EoE); a disease that must not be neglected  
 
Version: 1 Date: 29 Mar 2020  
 
Reviewer: Giusi Sciumè  
 
Reviewer's report:  
 
Dear Authors, it's a pleasure for me to contribute to your case report. I appreciate your work in 
highlighting to the scientific community this condition as rare as severe.  
 
Overall this case report is well done describing the management from d iagnosis to treatment's 
outcome.  
 
I suggest some minor revision to the text in order to adhere closer to the current guidelines:  
 
1- At line 32 -33 in the abstract the patient once discharged from the hospital was placed on a six 
weeks course of topical treat ment with budesonide. This choice should be motivated considering 
that the guidelines after 2018 already suggest the continuation of therapy indefinitely.  
 
2- In the background I personally suggest to start the descriprion with the proper definition of 
EoE:  "EoE is a chronic, local, immuno -mediated esophageal disease, characterized clinically by 
symptoms related to esophageal dysfunction and histologically by eosinophil -predominand 
inflammation".  
 
3- Line 52 -53 According to your reference number 7, there is s ignificant association between 
food bolus and perforation, as it represents an indipendent risk factor.  
 
4- In the case presentation the patients was given mometasone furoate for 2 months period and 
then he followed a therapy "on demand" based on symptoms u ntil the perforation. According to 
the current guidelines symptoms cannot guide the therapy as it doesn't correlate with histologic 
activity(Lucendo et al.). Does it mean that the patient did not have any follow -up? And if he had, 
con you please specify wh at type? (clinical, endoscopic, histologic).  
 
5- At line 115 -117 is stressed a crucial point "today there is no lincensed manteinancel therapy". 
In 2017 Lucendo et al. propose diet, topical steroids and PPI as good options for long term 
treatment.  
 
6- Line 1 17-118: We consider for long term therapy all patients with EoE. Moreover the 
possibile strategies (the above -mentioned) are to decide according to the clinical case, 
considering the patient's preferences.  
 
7- Line 124 Current literature still can't say if therapies like dietary and/or steroids can lead to 
resolution of fibrosis. They surely have a role in the prevention of the fibrotization, but once in 
the "fibrosis stage" it could be irreversible or hardly reversible. (Jennifer Armbruster -Lee).  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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.  
 
Not rel evant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript : 
 
Acceptable  
 
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, writ e 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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://creativecommons.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: Eosinophilic esophagitis (EoE); a disease that must not be neglected  
 
Version: 1 Date: 29 Mar 2020  
 
Reviewer: Giusi Sciumè  
 
Reviewer's report:  
 
Dear Authors, it's a pleasure for me to contribute to your case report. I appreciate your work in 
highlighting to the scientific community this condition as rare as severe.  
 
Overall this case report is well done describing the management from d iagnosis to treatment's 
outcome.  
 
I suggest some minor revision to the text in order to adhere closer to the current guidelines:  
 
1- At line 32 -33 in the abstract the patient once discharged from the hospital was placed on a six 
weeks course of topical treat ment with budesonide. This choice should be motivated considering 
that the guidelines after 2018 already suggest the continuation of therapy indefinitely.  
 
2- In the background I personally suggest to start the descriprion with the proper definition of 
EoE:  "EoE is a chronic, local, immuno -mediated esophageal disease, characterized clinically by 
symptoms related to esophageal dysfunction and histologically by eosinophil -predominand 
inflammation".  
 
3- Line 52 -53 According to your reference number 7, there is s ignificant association between 
food bolus and perforation, as it represents an indipendent risk factor.  
 
4- In the case presentation the patients was given mometasone furoate for 2 months period and 
then he followed a therapy "on demand" based on symptoms u ntil the perforation. According to 
the current guidelines symptoms cannot guide the therapy as it doesn't correlate with histologic 
activity(Lucendo et al.). Does it mean that the patient did not have any follow -up? And if he had, 
con you please specify wh at type? (clinical, endoscopic, histologic).  
 
5- At line 115 -117 is stressed a crucial point "today there is no lincensed manteinancel therapy". 
In 2017 Lucendo et al. propose diet, topical steroids and PPI as good options for long term 
treatment.  
 
6- Line 1 17-118: We consider for long term therapy all patients with EoE. Moreover the 
possibile strategies (the above -mentioned) are to decide according to the clinical case, 
considering the patient's preferences.  
 
7- Line 124 Current literature still can't say if therapies like dietary and/or steroids can lead to 
resolution of fibrosis. They surely have a role in the prevention of the fibrotization, but once in 
the "fibrosis stage" it could be irreversible or hardly reversible. (Jennifer Armbruster -Lee).  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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.  
 
Not rel evant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript : 
 
Acceptable  
 
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, writ e 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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://creativecommons.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: Eosinophilic esophagitis (EoE); a disease that must not be neglected  
 
Version: 1 Date: 29 Mar 2020  
 
Reviewer: Giusi Sciumè  
 
Reviewer's report:  
 
Dear Authors, it's a pleasure for me to contribute to your case report. I appreciate your work in 
highlighting to the scientific community this condition as rare as severe.  
 
Overall this case report is well done describing the management from d iagnosis to treatment's 
outcome.  
 
I suggest some minor revision to the text in order to adhere closer to the current guidelines:  
 
1- At line 32 -33 in the abstract the patient once discharged from the hospital was placed on a six 
weeks course of topical treat ment with budesonide. This choice should be motivated considering 
that the guidelines after 2018 already suggest the continuation of therapy indefinitely.  
 
2- In the background I personally suggest to start the descriprion with the proper definition of 
EoE:  "EoE is a chronic, local, immuno -mediated esophageal disease, characterized clinically by 
symptoms related to esophageal dysfunction and histologically by eosinophil -predominand 
inflammation".  
 
3- Line 52 -53 According to your reference number 7, there is s ignificant association between 
food bolus and perforation, as it represents an indipendent risk factor.  
 
4- In the case presentation the patients was given mometasone furoate for 2 months period and 
then he followed a therapy "on demand" based on symptoms u ntil the perforation. According to 
the current guidelines symptoms cannot guide the therapy as it doesn't correlate with histologic 
activity(Lucendo et al.). Does it mean that the patient did not have any follow -up? And if he had, 
con you please specify wh at type? (clinical, endoscopic, histologic).  
 
5- At line 115 -117 is stressed a crucial point "today there is no lincensed manteinancel therapy". 
In 2017 Lucendo et al. propose diet, topical steroids and PPI as good options for long term 
treatment.  
 
6- Line 1 17-118: We consider for long term therapy all patients with EoE. Moreover the 
possibile strategies (the above -mentioned) are to decide according to the clinical case, 
considering the patient's preferences.  
 
7- Line 124 Current literature still can't say if therapies like dietary and/or steroids can lead to 
resolution of fibrosis. They surely have a role in the prevention of the fibrotization, but once in 
the "fibrosis stage" it could be irreversible or hardly reversible. (Jennifer Armbruster -Lee).  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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.  
 
Not rel evant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript : 
 
Acceptable  
 
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, writ e 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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://creativecommons.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