Reviewer's report
Title:Importance of Duodenal Bulb Biopsies in the Diagnosis of Celiac Disease
in Clinical Practice
Version: 1Date:6 July 2009
Reviewer: Peter Green
Reviewer's report:
major revisions
The aim of this paper is to document that biopsy of the duodenal bulb increases
the yield of celiac disease diagnosis in patients in whom the diagnosis is
considered.
1. The study is a retrospective review of biopsy reports, performed without the
aid of a pathologist. This must be stated.
2. Discussion
The authors accept that there may be differences in villous height in the
duodenal bulb. Why is that? This must be referenced.
3. Page 6, second paragraph. Were the patients with Marsh I and II lesions
diagnosed as celiac disease and commenced on a GF diet. This is somewhat
controversial as villous atrophy is usually required for a dx of celiac disease Why
were these patients diagnosed with celiac disease.
Discretionary revisions
There are many issues raised by gastroenterologists when one talks about
biopsy of the duodenal bulb because we are taught NOT to biopsy the bulb.
European studies have shown what the authors have shown. There is no new
data presented in this paper.
Specific points
Results
There is insufficient pathological data presented
How many biopsy pieces were sufficiently oriented for assessment of villous
atrophy?
There is no data as to the presence or absence of Brunner’s glands, and whether
they were in the mucosa or submucosa and if they interfered with the villous
architecture interpretation.
Was gastric metaplasia present? Did that interfere with the interpretation of
villous atrophy.
These are all factors that are used to argue against taking duodenal bulbar
biopsies.
A pathologist should review the slides to record this data
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Reviewer's report
Title:Importance of Duodenal Bulb Biopsies in the Diagnosis of Celiac Disease
in Clinical Practice
Version: 1Date:6 July 2009
Reviewer: Peter Green
Reviewer's report:
major revisions
The aim of this paper is to document that biopsy of the duodenal bulb increases
the yield of celiac disease diagnosis in patients in whom the diagnosis is
considered.
1. The study is a retrospective review of biopsy reports, performed without the
aid of a pathologist. This must be stated.
2. Discussion
The authors accept that there may be differences in villous height in the
duodenal bulb. Why is that? This must be referenced.
3. Page 6, second paragraph. Were the patients with Marsh I and II lesions
diagnosed as celiac disease and commenced on a GF diet. This is somewhat
controversial as villous atrophy is usually required for a dx of celiac disease Why
were these patients diagnosed with celiac disease.
Discretionary revisions
There are many issues raised by gastroenterologists when one talks about
biopsy of the duodenal bulb because we are taught NOT to biopsy the bulb.
European studies have shown what the authors have shown. There is no new
data presented in this paper.
Specific points
Results
There is insufficient pathological data presented
How many biopsy pieces were sufficiently oriented for assessment of villous
atrophy?
There is no data as to the presence or absence of Brunner’s glands, and whether
they were in the mucosa or submucosa and if they interfered with the villous
architecture interpretation.
Was gastric metaplasia present? Did that interfere with the interpretation of
villous atrophy.
These are all factors that are used to argue against taking duodenal bulbar
biopsies.
A pathologist should review the slides to record this data
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:Importance of Duodenal Bulb Biopsies in the Diagnosis of Celiac Disease
in Clinical Practice
Version: 1Date:6 July 2009
Reviewer: Peter Green
Reviewer's report:
major revisions
The aim of this paper is to document that biopsy of the duodenal bulb increases
the yield of celiac disease diagnosis in patients in whom the diagnosis is
considered.
1. The study is a retrospective review of biopsy reports, performed without the
aid of a pathologist. This must be stated.
2. Discussion
The authors accept that there may be differences in villous height in the
duodenal bulb. Why is that? This must be referenced.
3. Page 6, second paragraph. Were the patients with Marsh I and II lesions
diagnosed as celiac disease and commenced on a GF diet. This is somewhat
controversial as villous atrophy is usually required for a dx of celiac disease Why
were these patients diagnosed with celiac disease.
Discretionary revisions
There are many issues raised by gastroenterologists when one talks about
biopsy of the duodenal bulb because we are taught NOT to biopsy the bulb.
European studies have shown what the authors have shown. There is no new
data presented in this paper.
Specific points
Results
There is insufficient pathological data presented
How many biopsy pieces were sufficiently oriented for assessment of villous
atrophy?
There is no data as to the presence or absence of Brunner’s glands, and whether
they were in the mucosa or submucosa and if they interfered with the villous
architecture interpretation.
Was gastric metaplasia present? Did that interfere with the interpretation of
villous atrophy.
These are all factors that are used to argue against taking duodenal bulbar
biopsies.
A pathologist should review the slides to record this data
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
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