Reviewer’ s report
Title: Gastropathy associated with lanthanum phosphate deposition that was endoscopically
tracked for 3 years. : a case report
Version: 1Date: 04 Apr 2020
Reviewer's report:
In this paper, the authors describe annual chronological change of the endoscopic findings in a
patient with long-term administration of lanthanum carbonate, which seems to be worth reporting.However, several worrisome points below are to be considered.
More detailed histopathologic findings of the biopsy material are needed:
Deposited materials containing lanthanum seem to show more variable findings, not just"eosinophilic granular deposits".The gastric mucosa in Figure 2, which is reportedly a biopsy from the erosive lesion, seems toshow regenerative change in addition to intestinal metaplasia.
Only a biopsy material obtained at the third endoscopy is reported. Were any biopsies obtained at
the first, second, or forth endoscopy? If there are other biopsy materials, their histopathologicfindings should be described in comparison with the biopsy of the third endoscopy, and should bediscussed with the corresponding endoscopic findings.
The authors' discussion about the relationship between the lanthanum deposition and intestinal
metaplasia in Pages 7-8 is insufficient.The authors point that the spread mode of the lanthanum deposition and progressive atrophy of the
gastric mucosa described by Takemoto et al. are similar. Is the lanthanum deposition followed by
intestinalization of the gastric epithelium, or is the intestinal metaplasia caused by the lanthanumdeposition?The relationship between alteration of tight junction proteins such as claudins and the increasedpermeability is not directly studied in the cited references (1, 6, 7), which should be more correctlydiscussed.
The description of "scanning electron microscopy-energy dispersive x-ray spectroscopy (SEM-
EDX)" in the test is not inconsistent and incorrect:"energy dispersive X - ray analysis" in Figure 3 legend, and "energy dispersion type X-rays (SEM-DEX) analysis" in Figure 4 legend. This is the case for the main text in Page 6."SEM-DEX" seems to be "SEM-EDX".
In Keywords, "histrocyte" seems to be "histiocyte".In Reference 5, an author name seems to be described just as an initial "TT".
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes 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.
YesAre 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 furtherassessment in your comments to the editors.
Not relevant to this manuscriptQuality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being publishedDeclaration 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 thismanuscript, 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, write '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 reportincluding 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 commentsto the editors, which will not be published.
I agree to the open peer review policy of the journal
Reviewer’ s report
Title: Gastropathy associated with lanthanum phosphate deposition that was endoscopically
tracked for 3 years. : a case report
Version: 1Date: 04 Apr 2020
Reviewer's report:
In this paper, the authors describe annual chronological change of the endoscopic findings in a
patient with long-term administration of lanthanum carbonate, which seems to be worth reporting.However, several worrisome points below are to be considered.
More detailed histopathologic findings of the biopsy material are needed:
Deposited materials containing lanthanum seem to show more variable findings, not just"eosinophilic granular deposits".The gastric mucosa in Figure 2, which is reportedly a biopsy from the erosive lesion, seems toshow regenerative change in addition to intestinal metaplasia.
Only a biopsy material obtained at the third endoscopy is reported. Were any biopsies obtained at
the first, second, or forth endoscopy? If there are other biopsy materials, their histopathologicfindings should be described in comparison with the biopsy of the third endoscopy, and should bediscussed with the corresponding endoscopic findings.
The authors' discussion about the relationship between the lanthanum deposition and intestinal
metaplasia in Pages 7-8 is insufficient.The authors point that the spread mode of the lanthanum deposition and progressive atrophy of the
gastric mucosa described by Takemoto et al. are similar. Is the lanthanum deposition followed by
intestinalization of the gastric epithelium, or is the intestinal metaplasia caused by the lanthanumdeposition?The relationship between alteration of tight junction proteins such as claudins and the increasedpermeability is not directly studied in the cited references (1, 6, 7), which should be more correctlydiscussed.
The description of "scanning electron microscopy-energy dispersive x-ray spectroscopy (SEM-
EDX)" in the test is not inconsistent and incorrect:"energy dispersive X - ray analysis" in Figure 3 legend, and "energy dispersion type X-rays (SEM-DEX) analysis" in Figure 4 legend. This is the case for the main text in Page 6."SEM-DEX" seems to be "SEM-EDX".
In Keywords, "histrocyte" seems to be "histiocyte".In Reference 5, an author name seems to be described just as an initial "TT".
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes 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.
YesAre 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 furtherassessment in your comments to the editors.
Not relevant to this manuscriptQuality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being publishedDeclaration 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 thismanuscript, 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, write '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 reportincluding 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 commentsto 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: Gastropathy associated with lanthanum phosphate deposition that was endoscopically
tracked for 3 years. : a case report
Version: 1Date: 04 Apr 2020
Reviewer's report:
In this paper, the authors describe annual chronological change of the endoscopic findings in a
patient with long-term administration of lanthanum carbonate, which seems to be worth reporting.However, several worrisome points below are to be considered.
More detailed histopathologic findings of the biopsy material are needed:
Deposited materials containing lanthanum seem to show more variable findings, not just"eosinophilic granular deposits".The gastric mucosa in Figure 2, which is reportedly a biopsy from the erosive lesion, seems toshow regenerative change in addition to intestinal metaplasia.
Only a biopsy material obtained at the third endoscopy is reported. Were any biopsies obtained at
the first, second, or forth endoscopy? If there are other biopsy materials, their histopathologicfindings should be described in comparison with the biopsy of the third endoscopy, and should bediscussed with the corresponding endoscopic findings.
The authors' discussion about the relationship between the lanthanum deposition and intestinal
metaplasia in Pages 7-8 is insufficient.The authors point that the spread mode of the lanthanum deposition and progressive atrophy of the
gastric mucosa described by Takemoto et al. are similar. Is the lanthanum deposition followed by
intestinalization of the gastric epithelium, or is the intestinal metaplasia caused by the lanthanumdeposition?The relationship between alteration of tight junction proteins such as claudins and the increasedpermeability is not directly studied in the cited references (1, 6, 7), which should be more correctlydiscussed.
The description of "scanning electron microscopy-energy dispersive x-ray spectroscopy (SEM-
EDX)" in the test is not inconsistent and incorrect:"energy dispersive X - ray analysis" in Figure 3 legend, and "energy dispersion type X-rays (SEM-DEX) analysis" in Figure 4 legend. This is the case for the main text in Page 6."SEM-DEX" seems to be "SEM-EDX".
In Keywords, "histrocyte" seems to be "histiocyte".In Reference 5, an author name seems to be described just as an initial "TT".
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes 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.
YesAre 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 furtherassessment in your comments to the editors.
Not relevant to this manuscriptQuality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being publishedDeclaration 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 thismanuscript, 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, write '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 reportincluding 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 commentsto the editors, which will not be published.
I agree to the open peer review policy of the journal
assistant