Reviewer ’s report  
 
Title: Diagnosis of celiac disease and applicability of ESPGHAN guidelines in Mediterranean  
countries: a real life prospective study  
 
Version: 0 Date: 06 Jul 2016  
 
Reviewer: Lars Stenhammar  
 
Reviewer's  report:  
 
BMC Gastroenterology  
Ms no. BMGE -D-16-00211  
 
 
 
Smarrazzo A et al. Diagnosis of celiac disease and applicability of ESPGHAN guidelines in 
Mediterranean countries: a real life prospective study.  
 
 
 
This paper presents the result of a large multi -center study on the diagnostics of celiac disease 
(CD) in 14 pediatric centers of 13 Mediterranean countries. A CD diagnosis was established in 
511 out of 1,974 (26%) enrolled patients.  
 
 
 
1). A major problem with this study is the heterogeneous patient material.  This is clearly 
illustrated in Table 3. There is a huge difference between the cente rs included, e.g. the 5 
largest centers included 1,415 (72%) of the patients; "diagnostic accuracy " (=no. of CD 
patients / no. Of children investigated with small bowel bi opsy) varies betw een 3% 
(5/200) and 61%(11/18);  "diagnostic activity" (= no. of patients investigated with sm all 
bowel biopsy / total no. Of patients) varies between 11% (21/200) and 100% (46/46).  
 
 
 
2). The paper lacks information on how the different cent ers performed small bowel 
biopsy. This is important, since CD patients with enteropathy strictly located to the 
bulbus duodeni can be diagnosed only by endoscopic biopsy.  
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If no t, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
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 co nclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistica l review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the  statistics  
 
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, fu nding, 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 fro m 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 th at 
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 b e 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: Diagnosis of celiac disease and applicability of ESPGHAN guidelines in Mediterranean  
countries: a real life prospective study  
 
Version: 0 Date: 06 Jul 2016  
 
Reviewer: Lars Stenhammar  
 
Reviewer's  report:  
 
BMC Gastroenterology  
Ms no. BMGE -D-16-00211  
 
 
 
Smarrazzo A et al. Diagnosis of celiac disease and applicability of ESPGHAN guidelines in 
Mediterranean countries: a real life prospective study.  
 
 
 
This paper presents the result of a large multi -center study on the diagnostics of celiac disease 
(CD) in 14 pediatric centers of 13 Mediterranean countries. A CD diagnosis was established in 
511 out of 1,974 (26%) enrolled patients.  
 
 
 
1). A major problem with this study is the heterogeneous patient material.  This is clearly 
illustrated in Table 3. There is a huge difference between the cente rs included, e.g. the 5 
largest centers included 1,415 (72%) of the patients; "diagnostic accuracy " (=no. of CD 
patients / no. Of children investigated with small bowel bi opsy) varies betw een 3% 
(5/200) and 61%(11/18);  "diagnostic activity" (= no. of patients investigated with sm all 
bowel biopsy / total no. Of patients) varies between 11% (21/200) and 100% (46/46).  
 
 
 
2). The paper lacks information on how the different cent ers performed small bowel 
biopsy. This is important, since CD patients with enteropathy strictly located to the 
bulbus duodeni can be diagnosed only by endoscopic biopsy.  
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If no t, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
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 co nclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistica l review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the  statistics  
 
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, fu nding, 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 fro m 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 th at 
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 b e 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: Diagnosis of celiac disease and applicability of ESPGHAN guidelines in Mediterranean  
countries: a real life prospective study  
 
Version: 0 Date: 06 Jul 2016  
 
Reviewer: Lars Stenhammar  
 
Reviewer's  report:  
 
BMC Gastroenterology  
Ms no. BMGE -D-16-00211  
 
 
 
Smarrazzo A et al. Diagnosis of celiac disease and applicability of ESPGHAN guidelines in 
Mediterranean countries: a real life prospective study.  
 
 
 
This paper presents the result of a large multi -center study on the diagnostics of celiac disease 
(CD) in 14 pediatric centers of 13 Mediterranean countries. A CD diagnosis was established in 
511 out of 1,974 (26%) enrolled patients.  
 
 
 
1). A major problem with this study is the heterogeneous patient material.  This is clearly 
illustrated in Table 3. There is a huge difference between the cente rs included, e.g. the 5 
largest centers included 1,415 (72%) of the patients; "diagnostic accuracy " (=no. of CD 
patients / no. Of children investigated with small bowel bi opsy) varies betw een 3% 
(5/200) and 61%(11/18);  "diagnostic activity" (= no. of patients investigated with sm all 
bowel biopsy / total no. Of patients) varies between 11% (21/200) and 100% (46/46).  
 
 
 
2). The paper lacks information on how the different cent ers performed small bowel 
biopsy. This is important, since CD patients with enteropathy strictly located to the 
bulbus duodeni can be diagnosed only by endoscopic biopsy.  
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If no t, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
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 co nclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistica l review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the  statistics  
 
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, fu nding, 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 fro m 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 th at 
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 b e 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