Title: EXTRA-ESOPHAGEAL SYMPTOMS IN INDIVIDUALS WITH AND WITHOUT
EROSIVE ESOPHAGITIS: A CASE-CONTROL STUDY IN ALBANIA
Version: 2 Date: 17 Dec 2020
Reviewer:  Vincenzo Savarino
Reviewer's report:
The Authors have diagnosed reflux esophagitis using the well known Los Angeles classification,
but the majiority of their cases pertained to the mild degrees of this disease (A and B). According
to the recent Lyon Consensus, these degrees do not permit to diagnose reflux esophagitis with
certainty because of great interobserver variability among endoscopists. So, a more precise
diagnosis by means of functional tests should have been made, but there is no mention of this
kind of examinations in this study.
It is well known that reflux esophagitis is present in a small part of patients with extra-esophageal
symptoms (< 30%) and therefore endoscopy has a poor sensitivity to detect GERD in these cases.
Respiratory symptoms can be due to many diseases beyond GERD. Did the Authors exclude
other causes for these extra-esophageal symptoms (e.g. the use of ACE inhibitors for chronic
cough) ?
The majority of GERD patients pertain to the NERD population without erosive esophagitis. It
would have been more interesting to compare the rate of extra-esophageal symptoms between
NERD and erosive patients.
The table comparing findings between the mild and severe forms of esophagitis can be omitted,
because patients with grades C and D were much lower for a meaningful statistical comparison.
The study was carried out more than six years ago. Is there any reason for the delay in the
preparation of this paper ?
Title: EXTRA-ESOPHAGEAL SYMPTOMS IN INDIVIDUALS WITH AND WITHOUT
EROSIVE ESOPHAGITIS: A CASE-CONTROL STUDY IN ALBANIA
Version: 2 Date: 17 Dec 2020
Reviewer:  Vincenzo Savarino
Reviewer's report:
The Authors have diagnosed reflux esophagitis using the well known Los Angeles classification,
but the majiority of their cases pertained to the mild degrees of this disease (A and B). According
to the recent Lyon Consensus, these degrees do not permit to diagnose reflux esophagitis with
certainty because of great interobserver variability among endoscopists. So, a more precise
diagnosis by means of functional tests should have been made, but there is no mention of this
kind of examinations in this study.
It is well known that reflux esophagitis is present in a small part of patients with extra-esophageal
symptoms (< 30%) and therefore endoscopy has a poor sensitivity to detect GERD in these cases.
Respiratory symptoms can be due to many diseases beyond GERD. Did the Authors exclude
other causes for these extra-esophageal symptoms (e.g. the use of ACE inhibitors for chronic
cough) ?
The majority of GERD patients pertain to the NERD population without erosive esophagitis. It
would have been more interesting to compare the rate of extra-esophageal symptoms between
NERD and erosive patients.
The table comparing findings between the mild and severe forms of esophagitis can be omitted,
because patients with grades C and D were much lower for a meaningful statistical comparison.
The study was carried out more than six years ago. Is there any reason for the delay in the
preparation of this paper ?
Please review this paper.
user
Title: EXTRA-ESOPHAGEAL SYMPTOMS IN INDIVIDUALS WITH AND WITHOUT
EROSIVE ESOPHAGITIS: A CASE-CONTROL STUDY IN ALBANIA
Version: 2 Date: 17 Dec 2020
Reviewer:  Vincenzo Savarino
Reviewer's report:
The Authors have diagnosed reflux esophagitis using the well known Los Angeles classification,
but the majiority of their cases pertained to the mild degrees of this disease (A and B). According
to the recent Lyon Consensus, these degrees do not permit to diagnose reflux esophagitis with
certainty because of great interobserver variability among endoscopists. So, a more precise
diagnosis by means of functional tests should have been made, but there is no mention of this
kind of examinations in this study.
It is well known that reflux esophagitis is present in a small part of patients with extra-esophageal
symptoms (< 30%) and therefore endoscopy has a poor sensitivity to detect GERD in these cases.
Respiratory symptoms can be due to many diseases beyond GERD. Did the Authors exclude
other causes for these extra-esophageal symptoms (e.g. the use of ACE inhibitors for chronic
cough) ?
The majority of GERD patients pertain to the NERD population without erosive esophagitis. It
would have been more interesting to compare the rate of extra-esophageal symptoms between
NERD and erosive patients.
The table comparing findings between the mild and severe forms of esophagitis can be omitted,
because patients with grades C and D were much lower for a meaningful statistical comparison.
The study was carried out more than six years ago. Is there any reason for the delay in the
preparation of this paper ?
assistant