Title: Investigating Neutropenic Enterocolitis: A Systematic Review of Case Reports and
Clinical Insights
Version: 4 Date: 20 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the review mentions broad-spectrum antibiotics and bowel rest as the mainstay of
treatment, a deeper exploration of more recent or advanced management strategies could
strengthen the manuscript. For example, new therapies, such as the use of antifungal agents,
biologics, or surgical interventions in severe cases, could be discussed if these were noted in
the included case reports.
-The manuscript mentions that some cases underwent surgical treatments, but these are not
discussed in depth. Given the serious nature of NE, it would be beneficial to provide more detail
on the role of surgery in the management of NE, such as indications for surgery (e.g., perforation,
bowel necrosis) and outcomes related to surgical interventions.
-While the statistical findings are mentioned (e.g., odds ratios for risk factors), the discussion
could benefit from a more detailed interpretation of these results. For example, while
antibacterial prophylaxis and broad-spectrum antibiotics were associated with a reduced risk
of death, it would be helpful to explain the clinical significance of the adjusted odds ratios
(aOR) and discuss any potential confounders that might explain these associations. A deeper
exploration of non-significant findings, such as the relationship between bowel wall thickening
and mortality, could also add more nuance to the interpretation.
-The association between granulocyte-colony stimulating factor (G-CSF) treatment and reduced
mortality is mentioned, but the explanation of how G-CSF impacts NE specifically is somewhat
brief. A more detailed discussion of the mechanism of action of G-CSF and its potential role in
improving immune function in neutropenic patients could provide additional context. Moreover,
it would be helpful to discuss the uncertainty surrounding its role in managing NE, as its efficacy
is not universally agreed upon.
-The chemotherapeutic agents most commonly associated with NE (e.g., cytarabine, vincristine,
and doxorubicin) are mentioned in the context of pathophysiology, but a more detailed analysis
of which agents are particularly high-risk for NE development and how they contribute to
mucosal injury would be beneficial. More data on specific chemotherapeutic regimens and their
relationship with NE could help clinicians make more informed decisions when considering the
risk of NE in chemotherapy planning.
Title: Investigating Neutropenic Enterocolitis: A Systematic Review of Case Reports and
Clinical Insights
Version: 4 Date: 20 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the review mentions broad-spectrum antibiotics and bowel rest as the mainstay of
treatment, a deeper exploration of more recent or advanced management strategies could
strengthen the manuscript. For example, new therapies, such as the use of antifungal agents,
biologics, or surgical interventions in severe cases, could be discussed if these were noted in
the included case reports.
-The manuscript mentions that some cases underwent surgical treatments, but these are not
discussed in depth. Given the serious nature of NE, it would be beneficial to provide more detail
on the role of surgery in the management of NE, such as indications for surgery (e.g., perforation,
bowel necrosis) and outcomes related to surgical interventions.
-While the statistical findings are mentioned (e.g., odds ratios for risk factors), the discussion
could benefit from a more detailed interpretation of these results. For example, while
antibacterial prophylaxis and broad-spectrum antibiotics were associated with a reduced risk
of death, it would be helpful to explain the clinical significance of the adjusted odds ratios
(aOR) and discuss any potential confounders that might explain these associations. A deeper
exploration of non-significant findings, such as the relationship between bowel wall thickening
and mortality, could also add more nuance to the interpretation.
-The association between granulocyte-colony stimulating factor (G-CSF) treatment and reduced
mortality is mentioned, but the explanation of how G-CSF impacts NE specifically is somewhat
brief. A more detailed discussion of the mechanism of action of G-CSF and its potential role in
improving immune function in neutropenic patients could provide additional context. Moreover,
it would be helpful to discuss the uncertainty surrounding its role in managing NE, as its efficacy
is not universally agreed upon.
-The chemotherapeutic agents most commonly associated with NE (e.g., cytarabine, vincristine,
and doxorubicin) are mentioned in the context of pathophysiology, but a more detailed analysis
of which agents are particularly high-risk for NE development and how they contribute to
mucosal injury would be beneficial. More data on specific chemotherapeutic regimens and their
relationship with NE could help clinicians make more informed decisions when considering the
risk of NE in chemotherapy planning.
Please review this paper.
user
Title: Investigating Neutropenic Enterocolitis: A Systematic Review of Case Reports and
Clinical Insights
Version: 4 Date: 20 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the review mentions broad-spectrum antibiotics and bowel rest as the mainstay of
treatment, a deeper exploration of more recent or advanced management strategies could
strengthen the manuscript. For example, new therapies, such as the use of antifungal agents,
biologics, or surgical interventions in severe cases, could be discussed if these were noted in
the included case reports.
-The manuscript mentions that some cases underwent surgical treatments, but these are not
discussed in depth. Given the serious nature of NE, it would be beneficial to provide more detail
on the role of surgery in the management of NE, such as indications for surgery (e.g., perforation,
bowel necrosis) and outcomes related to surgical interventions.
-While the statistical findings are mentioned (e.g., odds ratios for risk factors), the discussion
could benefit from a more detailed interpretation of these results. For example, while
antibacterial prophylaxis and broad-spectrum antibiotics were associated with a reduced risk
of death, it would be helpful to explain the clinical significance of the adjusted odds ratios
(aOR) and discuss any potential confounders that might explain these associations. A deeper
exploration of non-significant findings, such as the relationship between bowel wall thickening
and mortality, could also add more nuance to the interpretation.
-The association between granulocyte-colony stimulating factor (G-CSF) treatment and reduced
mortality is mentioned, but the explanation of how G-CSF impacts NE specifically is somewhat
brief. A more detailed discussion of the mechanism of action of G-CSF and its potential role in
improving immune function in neutropenic patients could provide additional context. Moreover,
it would be helpful to discuss the uncertainty surrounding its role in managing NE, as its efficacy
is not universally agreed upon.
-The chemotherapeutic agents most commonly associated with NE (e.g., cytarabine, vincristine,
and doxorubicin) are mentioned in the context of pathophysiology, but a more detailed analysis
of which agents are particularly high-risk for NE development and how they contribute to
mucosal injury would be beneficial. More data on specific chemotherapeutic regimens and their
relationship with NE could help clinicians make more informed decisions when considering the
risk of NE in chemotherapy planning.
assistant