Reviewer's report
Title:Cost and burden of gastroesophageal reflux disease among patients with
persistent symptoms despite proton pump inhibitor therapy: an observational
study in France
Version: 1Date:7 October 2012
Reviewer: Fermin Mearin
Reviewer's report:
This study was aimed to provide information on the treatment pathways,
resource utilization, costs, symptoms and HRQL in European patients (France)
with GERD who were newly identified as partial responders to optimized PPI
therapy.
He paper is interesting and is well written. I just have some concerns about some
of the definitions, but this does not hamper the value of the study. I do
understand that this is an observational study and some variables are difficult to
control but, then, the conclusions (and methods related to these conclusions)
should be putted in a more clinical practice context.
Specifically I have some concerns about how GERD diagnosis was made, and
how “optimized PPI therapy” and “partial response to PPI therapy” were defined.
GERD was diagnosed when “#6 month history of GERD symptoms” but this is
not much to say. This is important because, as cited by the authors in the
Discussion section, possibility of incorrect diagnosis is one of the main reasons
of therapeutic failure.
There is neither clear definition of “partial response”, when several guidelines
have defined it (8 weeks double doses? Need of pHmetric response?)
The same for “optimized treatment with a PPI”: double doses? Triple doses?
Under pHmetric control?
I do not mind that pHmetry had to be done in this study, just that this
observational study (and its conclusions) should be putted in a more
clinical/practical context.
Other comments
Results. “the maximum dose had been reached in 86% of patients”. Please
explain what the authors mind by maximum dose.
Results. “A total of 6 patients (2%) were reported as being hospitalized during the
study”. Related to GERD? Please specify causes of admission.
I miss a practical conclusion. It is clear that partial response to PPI therapy for
GERD is associated with a high costs and burden. I suggest including, not in the
abstract but at the end of the Discussion section, the need of better diagnosis
and new therapies.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests
Reviewer's report
Title:Cost and burden of gastroesophageal reflux disease among patients with
persistent symptoms despite proton pump inhibitor therapy: an observational
study in France
Version: 1Date:7 October 2012
Reviewer: Fermin Mearin
Reviewer's report:
This study was aimed to provide information on the treatment pathways,
resource utilization, costs, symptoms and HRQL in European patients (France)
with GERD who were newly identified as partial responders to optimized PPI
therapy.
He paper is interesting and is well written. I just have some concerns about some
of the definitions, but this does not hamper the value of the study. I do
understand that this is an observational study and some variables are difficult to
control but, then, the conclusions (and methods related to these conclusions)
should be putted in a more clinical practice context.
Specifically I have some concerns about how GERD diagnosis was made, and
how “optimized PPI therapy” and “partial response to PPI therapy” were defined.
GERD was diagnosed when “#6 month history of GERD symptoms” but this is
not much to say. This is important because, as cited by the authors in the
Discussion section, possibility of incorrect diagnosis is one of the main reasons
of therapeutic failure.
There is neither clear definition of “partial response”, when several guidelines
have defined it (8 weeks double doses? Need of pHmetric response?)
The same for “optimized treatment with a PPI”: double doses? Triple doses?
Under pHmetric control?
I do not mind that pHmetry had to be done in this study, just that this
observational study (and its conclusions) should be putted in a more
clinical/practical context.
Other comments
Results. “the maximum dose had been reached in 86% of patients”. Please
explain what the authors mind by maximum dose.
Results. “A total of 6 patients (2%) were reported as being hospitalized during the
study”. Related to GERD? Please specify causes of admission.
I miss a practical conclusion. It is clear that partial response to PPI therapy for
GERD is associated with a high costs and burden. I suggest including, not in the
abstract but at the end of the Discussion section, the need of better diagnosis
and new therapies.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Cost and burden of gastroesophageal reflux disease among patients with
persistent symptoms despite proton pump inhibitor therapy: an observational
study in France
Version: 1Date:7 October 2012
Reviewer: Fermin Mearin
Reviewer's report:
This study was aimed to provide information on the treatment pathways,
resource utilization, costs, symptoms and HRQL in European patients (France)
with GERD who were newly identified as partial responders to optimized PPI
therapy.
He paper is interesting and is well written. I just have some concerns about some
of the definitions, but this does not hamper the value of the study. I do
understand that this is an observational study and some variables are difficult to
control but, then, the conclusions (and methods related to these conclusions)
should be putted in a more clinical practice context.
Specifically I have some concerns about how GERD diagnosis was made, and
how “optimized PPI therapy” and “partial response to PPI therapy” were defined.
GERD was diagnosed when “#6 month history of GERD symptoms” but this is
not much to say. This is important because, as cited by the authors in the
Discussion section, possibility of incorrect diagnosis is one of the main reasons
of therapeutic failure.
There is neither clear definition of “partial response”, when several guidelines
have defined it (8 weeks double doses? Need of pHmetric response?)
The same for “optimized treatment with a PPI”: double doses? Triple doses?
Under pHmetric control?
I do not mind that pHmetry had to be done in this study, just that this
observational study (and its conclusions) should be putted in a more
clinical/practical context.
Other comments
Results. “the maximum dose had been reached in 86% of patients”. Please
explain what the authors mind by maximum dose.
Results. “A total of 6 patients (2%) were reported as being hospitalized during the
study”. Related to GERD? Please specify causes of admission.
I miss a practical conclusion. It is clear that partial response to PPI therapy for
GERD is associated with a high costs and burden. I suggest including, not in the
abstract but at the end of the Discussion section, the need of better diagnosis
and new therapies.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests
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