Reviewer's report 
 Findings in patients with chronic intestinal dysmotility investigated by capsule endoscopy Title: 
 1  3 March 2007 Version: Date: 
 Ervin Toth Reviewer: 
Reviewer's report: 
General 
Despite that capsule endoscopy is a relatively new method there are several hundred published paper on 
this topic. However,there is only one study in the literature reporting mucosal lesions detected by capsule endoscopy in patients with chronic intestinal dysmotility. The present paper has examined the feasibility of using capsule endoscopy in patients with chronic 
intestinal dysmotility. Therefore, the object of this paper is interesting. The authors find a high level of 
mucosal breaks in this patient group and provide convincing data that chronic intestinal dysmotility should not be considered to be a contraindication for capsule endoscopy. The results of this prospective, controlled, well-designed and well-written study constitute an important contribution and expand the clinical 
use of capsule endoscopy. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
1. There was almost a significant difference in the transit times between patients with chronic intestinal 
dysmotility and controls and one wonders whether the study may have been under-powered to actually detect a difference. Was a power calculation performed? Otherwise the data should perhaps be interpreted a little bit more carefully. 
2. Some concern relates to the summary of the previous literature on this topic. In the “Discussion” on page 
9, authors states that “it is the first systematic study using capsule endoscopy in patients with chronic 
intestinal dysmotility”, however, this not correct considering that the actual first study was published in Gut 
already in 2005 (Reference 11 in the present paper). Along these lines, the statement in the Background on 
page 3 “In the literature there are only sporadic case reports where capsule endoscopy have been performed in chronic intestinal dysmotility” is also not correct, considering that the original study published 
in Gut 2005 on this topic showed that patients with chronic intestinal dysmotility have high levels of mucosal 
breaks revealed by use of capsule endoscopy. That study in Gut 2005 examined 6 patients and should not 
be classified as a case report. Nonetheless, the present paper by Hoog et al. is unique and significantly expands our knowledge in this field but a more appropriate description of the previous literature is indeed 
warranted. 
3. The section on “luminal distension” is speculative without validation. I strongly suggest that this part on 
”luminal distension” should be deleted throughout the paper (results, discussion and table). 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after minor essential revisions What next?: 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No, the manuscript does not need to be seen by a statistician. Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests. 
Reviewer's report 
 Findings in patients with chronic intestinal dysmotility investigated by capsule endoscopy Title: 
 1  3 March 2007 Version: Date: 
 Ervin Toth Reviewer: 
Reviewer's report: 
General 
Despite that capsule endoscopy is a relatively new method there are several hundred published paper on 
this topic. However,there is only one study in the literature reporting mucosal lesions detected by capsule endoscopy in patients with chronic intestinal dysmotility. The present paper has examined the feasibility of using capsule endoscopy in patients with chronic 
intestinal dysmotility. Therefore, the object of this paper is interesting. The authors find a high level of 
mucosal breaks in this patient group and provide convincing data that chronic intestinal dysmotility should not be considered to be a contraindication for capsule endoscopy. The results of this prospective, controlled, well-designed and well-written study constitute an important contribution and expand the clinical 
use of capsule endoscopy. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
1. There was almost a significant difference in the transit times between patients with chronic intestinal 
dysmotility and controls and one wonders whether the study may have been under-powered to actually detect a difference. Was a power calculation performed? Otherwise the data should perhaps be interpreted a little bit more carefully. 
2. Some concern relates to the summary of the previous literature on this topic. In the “Discussion” on page 
9, authors states that “it is the first systematic study using capsule endoscopy in patients with chronic 
intestinal dysmotility”, however, this not correct considering that the actual first study was published in Gut 
already in 2005 (Reference 11 in the present paper). Along these lines, the statement in the Background on 
page 3 “In the literature there are only sporadic case reports where capsule endoscopy have been performed in chronic intestinal dysmotility” is also not correct, considering that the original study published 
in Gut 2005 on this topic showed that patients with chronic intestinal dysmotility have high levels of mucosal 
breaks revealed by use of capsule endoscopy. That study in Gut 2005 examined 6 patients and should not 
be classified as a case report. Nonetheless, the present paper by Hoog et al. is unique and significantly expands our knowledge in this field but a more appropriate description of the previous literature is indeed 
warranted. 
3. The section on “luminal distension” is speculative without validation. I strongly suggest that this part on 
”luminal distension” should be deleted throughout the paper (results, discussion and table). 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after minor essential revisions What next?: 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No, the manuscript does not need to be seen by a statistician. Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests. 
Please review this paper.
user
Reviewer's report 
 Findings in patients with chronic intestinal dysmotility investigated by capsule endoscopy Title: 
 1  3 March 2007 Version: Date: 
 Ervin Toth Reviewer: 
Reviewer's report: 
General 
Despite that capsule endoscopy is a relatively new method there are several hundred published paper on 
this topic. However,there is only one study in the literature reporting mucosal lesions detected by capsule endoscopy in patients with chronic intestinal dysmotility. The present paper has examined the feasibility of using capsule endoscopy in patients with chronic 
intestinal dysmotility. Therefore, the object of this paper is interesting. The authors find a high level of 
mucosal breaks in this patient group and provide convincing data that chronic intestinal dysmotility should not be considered to be a contraindication for capsule endoscopy. The results of this prospective, controlled, well-designed and well-written study constitute an important contribution and expand the clinical 
use of capsule endoscopy. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
1. There was almost a significant difference in the transit times between patients with chronic intestinal 
dysmotility and controls and one wonders whether the study may have been under-powered to actually detect a difference. Was a power calculation performed? Otherwise the data should perhaps be interpreted a little bit more carefully. 
2. Some concern relates to the summary of the previous literature on this topic. In the “Discussion” on page 
9, authors states that “it is the first systematic study using capsule endoscopy in patients with chronic 
intestinal dysmotility”, however, this not correct considering that the actual first study was published in Gut 
already in 2005 (Reference 11 in the present paper). Along these lines, the statement in the Background on 
page 3 “In the literature there are only sporadic case reports where capsule endoscopy have been performed in chronic intestinal dysmotility” is also not correct, considering that the original study published 
in Gut 2005 on this topic showed that patients with chronic intestinal dysmotility have high levels of mucosal 
breaks revealed by use of capsule endoscopy. That study in Gut 2005 examined 6 patients and should not 
be classified as a case report. Nonetheless, the present paper by Hoog et al. is unique and significantly expands our knowledge in this field but a more appropriate description of the previous literature is indeed 
warranted. 
3. The section on “luminal distension” is speculative without validation. I strongly suggest that this part on 
”luminal distension” should be deleted throughout the paper (results, discussion and table). 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after minor essential revisions What next?: 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No, the manuscript does not need to be seen by a statistician. Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests. 
assistant