Title: Associations and gastrointestinal symptoms in women with endometriosis in comparison
to women with irritable bowel syndrome: A  study based on a population cohort
Version: 1 Date: 04 May 2023
Reviewer's report:
Overall, the article was informative  of key overlaps between endometriosis and IBS. Starting
from the beginning, it would be helpful to make it clearer that there are two separate research
aims - one being exploring associations and the other relating to gastrointestinal symptoms.
Making this clearer within the background and abstract will avoid confusion - initially I was
interpreting the main aim of the article is exploring misdiagnosis of either disease/differential
diagnosis. However, it seems that the misdiagnosis between the two diseases is a subsequential
finding due to an overlap of gastrointestinal symptoms and associations rather than differential
diagnosis.
Also, mentioning why these associations were chosen in the background with peer reviewed
articles referenced would also help to justify the associations. Giving the reader a reason as
to why BMI, alcohol and smoking was chosen to explore associations with and between both
diseases would be useful to know, and how they interact with both diseases could be more clearly
and explicitly explained - for example, alcohol impacts endometriosis by etc and IBS by, etc,
leading to gastrointestinal symptoms including etc.
Also - was there also any ethics approvals/processes necessary to obtain this data?
The analysis did account for some confounding factors, however it would have been useful to
account for additional including stress/anxiety and other conditions such as Crohns, allergies
and intolerances. These play a significant role in not only the physical manifestation of
gastrointestinal symptoms, but the patients perception of the existence and severity of symptoms.
I agree that exploring  associations between definitively diagnosed endometriosis and IBS be
difficult as laparoscopy of the gold standard of diagnosis and side effects from this invasive
surgery can cause/have symptoms that mimic IBS/gastrointestinal symptoms. This was great to
mention as you did in the end of the article as a limitation. It would be useful to investigate
further the stages of endometriosis and adjust for severity in correlation with gastrointestinal
symptoms. It was touched in in terms of lesion position, which is a determining factor of stage,
however, this would be another analysis that could be explored in the future.
Overall, the article is very informative in discussing the association between these two diseases
in relation to gastrointestinal symptoms. With limitations mentioned, there has been thorough
exploration of these associations and provides the reader with an insight into the common overlap
of two very different diseases, which can lead to mis diagnosis and impact on quality of life.
In the future, it would be useful to explore deeper confounding factors including adjusting for
stage, other diseases over a long period of time. Great work.
Title: Associations and gastrointestinal symptoms in women with endometriosis in comparison
to women with irritable bowel syndrome: A  study based on a population cohort
Version: 1 Date: 04 May 2023
Reviewer's report:
Overall, the article was informative  of key overlaps between endometriosis and IBS. Starting
from the beginning, it would be helpful to make it clearer that there are two separate research
aims - one being exploring associations and the other relating to gastrointestinal symptoms.
Making this clearer within the background and abstract will avoid confusion - initially I was
interpreting the main aim of the article is exploring misdiagnosis of either disease/differential
diagnosis. However, it seems that the misdiagnosis between the two diseases is a subsequential
finding due to an overlap of gastrointestinal symptoms and associations rather than differential
diagnosis.
Also, mentioning why these associations were chosen in the background with peer reviewed
articles referenced would also help to justify the associations. Giving the reader a reason as
to why BMI, alcohol and smoking was chosen to explore associations with and between both
diseases would be useful to know, and how they interact with both diseases could be more clearly
and explicitly explained - for example, alcohol impacts endometriosis by etc and IBS by, etc,
leading to gastrointestinal symptoms including etc.
Also - was there also any ethics approvals/processes necessary to obtain this data?
The analysis did account for some confounding factors, however it would have been useful to
account for additional including stress/anxiety and other conditions such as Crohns, allergies
and intolerances. These play a significant role in not only the physical manifestation of
gastrointestinal symptoms, but the patients perception of the existence and severity of symptoms.
I agree that exploring  associations between definitively diagnosed endometriosis and IBS be
difficult as laparoscopy of the gold standard of diagnosis and side effects from this invasive
surgery can cause/have symptoms that mimic IBS/gastrointestinal symptoms. This was great to
mention as you did in the end of the article as a limitation. It would be useful to investigate
further the stages of endometriosis and adjust for severity in correlation with gastrointestinal
symptoms. It was touched in in terms of lesion position, which is a determining factor of stage,
however, this would be another analysis that could be explored in the future.
Overall, the article is very informative in discussing the association between these two diseases
in relation to gastrointestinal symptoms. With limitations mentioned, there has been thorough
exploration of these associations and provides the reader with an insight into the common overlap
of two very different diseases, which can lead to mis diagnosis and impact on quality of life.
In the future, it would be useful to explore deeper confounding factors including adjusting for
stage, other diseases over a long period of time. Great work.
Please review this paper.
user
Title: Associations and gastrointestinal symptoms in women with endometriosis in comparison
to women with irritable bowel syndrome: A  study based on a population cohort
Version: 1 Date: 04 May 2023
Reviewer's report:
Overall, the article was informative  of key overlaps between endometriosis and IBS. Starting
from the beginning, it would be helpful to make it clearer that there are two separate research
aims - one being exploring associations and the other relating to gastrointestinal symptoms.
Making this clearer within the background and abstract will avoid confusion - initially I was
interpreting the main aim of the article is exploring misdiagnosis of either disease/differential
diagnosis. However, it seems that the misdiagnosis between the two diseases is a subsequential
finding due to an overlap of gastrointestinal symptoms and associations rather than differential
diagnosis.
Also, mentioning why these associations were chosen in the background with peer reviewed
articles referenced would also help to justify the associations. Giving the reader a reason as
to why BMI, alcohol and smoking was chosen to explore associations with and between both
diseases would be useful to know, and how they interact with both diseases could be more clearly
and explicitly explained - for example, alcohol impacts endometriosis by etc and IBS by, etc,
leading to gastrointestinal symptoms including etc.
Also - was there also any ethics approvals/processes necessary to obtain this data?
The analysis did account for some confounding factors, however it would have been useful to
account for additional including stress/anxiety and other conditions such as Crohns, allergies
and intolerances. These play a significant role in not only the physical manifestation of
gastrointestinal symptoms, but the patients perception of the existence and severity of symptoms.
I agree that exploring  associations between definitively diagnosed endometriosis and IBS be
difficult as laparoscopy of the gold standard of diagnosis and side effects from this invasive
surgery can cause/have symptoms that mimic IBS/gastrointestinal symptoms. This was great to
mention as you did in the end of the article as a limitation. It would be useful to investigate
further the stages of endometriosis and adjust for severity in correlation with gastrointestinal
symptoms. It was touched in in terms of lesion position, which is a determining factor of stage,
however, this would be another analysis that could be explored in the future.
Overall, the article is very informative in discussing the association between these two diseases
in relation to gastrointestinal symptoms. With limitations mentioned, there has been thorough
exploration of these associations and provides the reader with an insight into the common overlap
of two very different diseases, which can lead to mis diagnosis and impact on quality of life.
In the future, it would be useful to explore deeper confounding factors including adjusting for
stage, other diseases over a long period of time. Great work.
assistant