Reviewer's report 
 Spectrum and antibiotic sensitivity of bacteria contaminating upper gut in patients with Title: 
malabsorption syndrome from the tropics 
Authors: 
Dr Ujjala Ghoshal ( ujjala@sgpgi.ac.in )
Uday CHAND Ghoshal ( ghoshal@sgpgi.ac.in )
Piyush Ranjan ( pranjan@sgpgi.ac.in )
Subhash R Naik ( ghoshal@sgpgi.ac.in )
Archana Ayyagari ( archana@sgpgi.ac.in )
 1  4 Mar 2003 Version: Date: 
 Mark Pimentel Reviewer: 
 not specified Level of interest: 
 Other (see below) Advice on publication: 
Major comments. 
The authors of this paper try to emphasize the relevance of newer 
antibiotics in tropical sprue/bacterial overgrowth. From a gastroenterology standpoint the importance of this paper is the fact that very few researchers study tropical sprue. However, I have some concerns about the 
paper. 
First, the introduction lacks a clear hypothesis. The hypothesis 
(hypotheses) need to be more clearly stated. 
An important methodologic problem is the identification of response. I did 
not get the feeling that there was a systematic approach to evaluating and 
following up on clinical symptoms. The authors defined a clinical response, 
but I am not sure how many of the patients got all the testing and follow up 
that they refer to (ie. Did all the patients get a repeat D-xylose). This also translates into clinical improvement. In the results do not indicate in detail what were the clinical improvements seen. Did stool reduce from 5 a 
day to 2 a day? 
I think the main thrust of the paper is the culture and sensitivity. If the 
authors have more detailed data on clinical response than they already 
discuss, it would be helpful....If not, just exclude the clinical outcomes. 
Minor comments. 
First paragraph of methods (last sentence) there is no "(b)". 
Competing interests: 
None declared. 
Reviewer's report 
 Spectrum and antibiotic sensitivity of bacteria contaminating upper gut in patients with Title: 
malabsorption syndrome from the tropics 
Authors: 
Dr Ujjala Ghoshal ( ujjala@sgpgi.ac.in )
Uday CHAND Ghoshal ( ghoshal@sgpgi.ac.in )
Piyush Ranjan ( pranjan@sgpgi.ac.in )
Subhash R Naik ( ghoshal@sgpgi.ac.in )
Archana Ayyagari ( archana@sgpgi.ac.in )
 1  4 Mar 2003 Version: Date: 
 Mark Pimentel Reviewer: 
 not specified Level of interest: 
 Other (see below) Advice on publication: 
Major comments. 
The authors of this paper try to emphasize the relevance of newer 
antibiotics in tropical sprue/bacterial overgrowth. From a gastroenterology standpoint the importance of this paper is the fact that very few researchers study tropical sprue. However, I have some concerns about the 
paper. 
First, the introduction lacks a clear hypothesis. The hypothesis 
(hypotheses) need to be more clearly stated. 
An important methodologic problem is the identification of response. I did 
not get the feeling that there was a systematic approach to evaluating and 
following up on clinical symptoms. The authors defined a clinical response, 
but I am not sure how many of the patients got all the testing and follow up 
that they refer to (ie. Did all the patients get a repeat D-xylose). This also translates into clinical improvement. In the results do not indicate in detail what were the clinical improvements seen. Did stool reduce from 5 a 
day to 2 a day? 
I think the main thrust of the paper is the culture and sensitivity. If the 
authors have more detailed data on clinical response than they already 
discuss, it would be helpful....If not, just exclude the clinical outcomes. 
Minor comments. 
First paragraph of methods (last sentence) there is no "(b)". 
Competing interests: 
None declared. 
Please review this paper.
user
Reviewer's report 
 Spectrum and antibiotic sensitivity of bacteria contaminating upper gut in patients with Title: 
malabsorption syndrome from the tropics 
Authors: 
Dr Ujjala Ghoshal ( ujjala@sgpgi.ac.in )
Uday CHAND Ghoshal ( ghoshal@sgpgi.ac.in )
Piyush Ranjan ( pranjan@sgpgi.ac.in )
Subhash R Naik ( ghoshal@sgpgi.ac.in )
Archana Ayyagari ( archana@sgpgi.ac.in )
 1  4 Mar 2003 Version: Date: 
 Mark Pimentel Reviewer: 
 not specified Level of interest: 
 Other (see below) Advice on publication: 
Major comments. 
The authors of this paper try to emphasize the relevance of newer 
antibiotics in tropical sprue/bacterial overgrowth. From a gastroenterology standpoint the importance of this paper is the fact that very few researchers study tropical sprue. However, I have some concerns about the 
paper. 
First, the introduction lacks a clear hypothesis. The hypothesis 
(hypotheses) need to be more clearly stated. 
An important methodologic problem is the identification of response. I did 
not get the feeling that there was a systematic approach to evaluating and 
following up on clinical symptoms. The authors defined a clinical response, 
but I am not sure how many of the patients got all the testing and follow up 
that they refer to (ie. Did all the patients get a repeat D-xylose). This also translates into clinical improvement. In the results do not indicate in detail what were the clinical improvements seen. Did stool reduce from 5 a 
day to 2 a day? 
I think the main thrust of the paper is the culture and sensitivity. If the 
authors have more detailed data on clinical response than they already 
discuss, it would be helpful....If not, just exclude the clinical outcomes. 
Minor comments. 
First paragraph of methods (last sentence) there is no "(b)". 
Competing interests: 
None declared. 
assistant