Title: Symptoms and symptom clusters in patients newly diagnosed with Inflammatory Bowel
Disease: results from the IBSEN III Study
Version: 1 Date: 13 May 2023
Reviewer:  Stefano Festa
Reviewer's report:
Dear editor,
I read with interest the paper by Johansen and colleagues entitled “Symptoms and symptom
clusters in patients newly diagnosed with Inflammatory Bowel Disease: results from the
IBSEN III Study” that is a prospective population-based inception cohort study of patients
with inflammatory bowel disease (IBD).  The main aim of the present study is to explore the
prevalence of symptoms and symptom clusters and to find possible associations with socio-
demographic and clinical variables in a cohort of newly diagnosed IBD patients. The paper has
definitely different merits:
- The strict methodology and clear study design on the wake of the previous pivotal IBSEN
studies: large population-based cohorts prospectively followed, strict entry criteria for diagnosis,
well-defined catchment area.
- The poorly explored topic (Symptom clusters in IBD)
- Clear presentation and a well-explained statistical approach
I agree with the all the limitations pointed out by the authors in the discussion especially with
that regarding MSAS questionnaire used in this study. MSAS is a generic assessment tool not
validated in IBD patients  thta may have potentially limited the identification of disease-specific
symptoms.
Only some considerations to possibly ameliorate the research:
- Please specify, if explored and analyzed in your research, the prevalence of concomitant
psychiatric/psychological disorders as well as other GI conditions (IBD, coeliac disease etc).
This may potentially affect the results of the study (you need to maximize the characterization
of your population)
- Please specify the reasons why about 40% of patients did not respond to the questionnaire (is it
possible that an elderly subgroup or a subgroup with mild disease did not take part in the survey?
It is possible that a selection bias could have occurred?)
- Please expand in the section method the study design and details of IBSEN III (“Further details
on study design and patient inclusion are described elsewhere…”) .It could be helpful for the
reader to have a bried synthesis on the methodology without the need to read the reference article.
- Could you please better clarify how this research would impact the future clinical practice?
Title: Symptoms and symptom clusters in patients newly diagnosed with Inflammatory Bowel
Disease: results from the IBSEN III Study
Version: 1 Date: 13 May 2023
Reviewer:  Stefano Festa
Reviewer's report:
Dear editor,
I read with interest the paper by Johansen and colleagues entitled “Symptoms and symptom
clusters in patients newly diagnosed with Inflammatory Bowel Disease: results from the
IBSEN III Study” that is a prospective population-based inception cohort study of patients
with inflammatory bowel disease (IBD).  The main aim of the present study is to explore the
prevalence of symptoms and symptom clusters and to find possible associations with socio-
demographic and clinical variables in a cohort of newly diagnosed IBD patients. The paper has
definitely different merits:
- The strict methodology and clear study design on the wake of the previous pivotal IBSEN
studies: large population-based cohorts prospectively followed, strict entry criteria for diagnosis,
well-defined catchment area.
- The poorly explored topic (Symptom clusters in IBD)
- Clear presentation and a well-explained statistical approach
I agree with the all the limitations pointed out by the authors in the discussion especially with
that regarding MSAS questionnaire used in this study. MSAS is a generic assessment tool not
validated in IBD patients  thta may have potentially limited the identification of disease-specific
symptoms.
Only some considerations to possibly ameliorate the research:
- Please specify, if explored and analyzed in your research, the prevalence of concomitant
psychiatric/psychological disorders as well as other GI conditions (IBD, coeliac disease etc).
This may potentially affect the results of the study (you need to maximize the characterization
of your population)
- Please specify the reasons why about 40% of patients did not respond to the questionnaire (is it
possible that an elderly subgroup or a subgroup with mild disease did not take part in the survey?
It is possible that a selection bias could have occurred?)
- Please expand in the section method the study design and details of IBSEN III (“Further details
on study design and patient inclusion are described elsewhere…”) .It could be helpful for the
reader to have a bried synthesis on the methodology without the need to read the reference article.
- Could you please better clarify how this research would impact the future clinical practice?
Please review this paper.
user
Title: Symptoms and symptom clusters in patients newly diagnosed with Inflammatory Bowel
Disease: results from the IBSEN III Study
Version: 1 Date: 13 May 2023
Reviewer:  Stefano Festa
Reviewer's report:
Dear editor,
I read with interest the paper by Johansen and colleagues entitled “Symptoms and symptom
clusters in patients newly diagnosed with Inflammatory Bowel Disease: results from the
IBSEN III Study” that is a prospective population-based inception cohort study of patients
with inflammatory bowel disease (IBD).  The main aim of the present study is to explore the
prevalence of symptoms and symptom clusters and to find possible associations with socio-
demographic and clinical variables in a cohort of newly diagnosed IBD patients. The paper has
definitely different merits:
- The strict methodology and clear study design on the wake of the previous pivotal IBSEN
studies: large population-based cohorts prospectively followed, strict entry criteria for diagnosis,
well-defined catchment area.
- The poorly explored topic (Symptom clusters in IBD)
- Clear presentation and a well-explained statistical approach
I agree with the all the limitations pointed out by the authors in the discussion especially with
that regarding MSAS questionnaire used in this study. MSAS is a generic assessment tool not
validated in IBD patients  thta may have potentially limited the identification of disease-specific
symptoms.
Only some considerations to possibly ameliorate the research:
- Please specify, if explored and analyzed in your research, the prevalence of concomitant
psychiatric/psychological disorders as well as other GI conditions (IBD, coeliac disease etc).
This may potentially affect the results of the study (you need to maximize the characterization
of your population)
- Please specify the reasons why about 40% of patients did not respond to the questionnaire (is it
possible that an elderly subgroup or a subgroup with mild disease did not take part in the survey?
It is possible that a selection bias could have occurred?)
- Please expand in the section method the study design and details of IBSEN III (“Further details
on study design and patient inclusion are described elsewhere…”) .It could be helpful for the
reader to have a bried synthesis on the methodology without the need to read the reference article.
- Could you please better clarify how this research would impact the future clinical practice?
assistant