Reviewer's report 
 Therapeutic approach to downhill esophageal varices bleeding due to SVC syndrome in Behcets Title: 
disease: a case report. 
 1  15 November 2006 Version: Date: 
 Yih-Huei Uen Reviewer: 
Reviewer's report: 
General 
This is a rare case report presenting a case of Behcet’s disease suffered from superior vena cava (SVC) 
thrombosis/ syndrome which resulted in “downhill” esophageal varices (DEV) bleeding, and was 
successfully treated by medication (cyclophosphamide) and endoscopic band ligation. 
The reviewer highly suggests on this manuscript that some revisions are necessary before being accepted. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
1.The sentence“the safest method for controlling DEV bleeding”in the conclusions of abstract is not really 
supported by the unique case presented here. The following is suggested “a safe and effective method for 
controlling DEV bleeding”. 
2.Thorough literatures review of DEV bleeding, including the cases after Maton et al (1985), should be 
attempted to conclude the indications, results and the possible complications of different therapeutic 
methods, and to summary all the patients’ data into a table. 
3.For declaring the patency of SVC and indirectly reflect the possible role of medication in DEV bleeding, 
the sentence“the patient was discharged without any problem”(page 7, line 9?should be given more detail 
expression including or except the manifestation of the SVC syndrome. ------------------------------------------------------------------------------- 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.In order to describe the title more accurate, the word “bleeding” should be added following the term 
“downhill” esophageal varices. 
2.Through the whole manuscript,the word downhill should be given as?"downhill”. 
3.About the key words. Use“downhill”esophageal varices, endoscopic ligation and Behcet’s disease instead 
of the original ones in the manuscript. 
4.The patient’s age is not consistent with each other on page 2?39-year-old?and 5?42-year-old?. It should 
be numbered in consistency. 
5.On page 6, line 4, the word “elevated JVP” should be written as “engorgement of jugular vein”. 
6.On page 7, line 1, the etiology of “not able to perform MR angiography” should be given more description. 
7.The endoscopic findings on page 7, line 4 should mention about the presence of red color sign or stigma 
of recent bleeding in order to confirm DEV as the source of GI bleeding. 
8.For the further understand, suggests to put the words of “Endoscopic findings on”in front of“upper third of 
esophagus”on Figure 3. 
9.The reference on number 29 and 30 must be fully formatted as the instructions of reference. 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
N/A 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interest. 
Reviewer's report 
 Therapeutic approach to downhill esophageal varices bleeding due to SVC syndrome in Behcets Title: 
disease: a case report. 
 1  15 November 2006 Version: Date: 
 Yih-Huei Uen Reviewer: 
Reviewer's report: 
General 
This is a rare case report presenting a case of Behcet’s disease suffered from superior vena cava (SVC) 
thrombosis/ syndrome which resulted in “downhill” esophageal varices (DEV) bleeding, and was 
successfully treated by medication (cyclophosphamide) and endoscopic band ligation. 
The reviewer highly suggests on this manuscript that some revisions are necessary before being accepted. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
1.The sentence“the safest method for controlling DEV bleeding”in the conclusions of abstract is not really 
supported by the unique case presented here. The following is suggested “a safe and effective method for 
controlling DEV bleeding”. 
2.Thorough literatures review of DEV bleeding, including the cases after Maton et al (1985), should be 
attempted to conclude the indications, results and the possible complications of different therapeutic 
methods, and to summary all the patients’ data into a table. 
3.For declaring the patency of SVC and indirectly reflect the possible role of medication in DEV bleeding, 
the sentence“the patient was discharged without any problem”(page 7, line 9?should be given more detail 
expression including or except the manifestation of the SVC syndrome. ------------------------------------------------------------------------------- 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.In order to describe the title more accurate, the word “bleeding” should be added following the term 
“downhill” esophageal varices. 
2.Through the whole manuscript,the word downhill should be given as?"downhill”. 
3.About the key words. Use“downhill”esophageal varices, endoscopic ligation and Behcet’s disease instead 
of the original ones in the manuscript. 
4.The patient’s age is not consistent with each other on page 2?39-year-old?and 5?42-year-old?. It should 
be numbered in consistency. 
5.On page 6, line 4, the word “elevated JVP” should be written as “engorgement of jugular vein”. 
6.On page 7, line 1, the etiology of “not able to perform MR angiography” should be given more description. 
7.The endoscopic findings on page 7, line 4 should mention about the presence of red color sign or stigma 
of recent bleeding in order to confirm DEV as the source of GI bleeding. 
8.For the further understand, suggests to put the words of “Endoscopic findings on”in front of“upper third of 
esophagus”on Figure 3. 
9.The reference on number 29 and 30 must be fully formatted as the instructions of reference. 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
N/A 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interest. 
Please review this paper.
user
Reviewer's report 
 Therapeutic approach to downhill esophageal varices bleeding due to SVC syndrome in Behcets Title: 
disease: a case report. 
 1  15 November 2006 Version: Date: 
 Yih-Huei Uen Reviewer: 
Reviewer's report: 
General 
This is a rare case report presenting a case of Behcet’s disease suffered from superior vena cava (SVC) 
thrombosis/ syndrome which resulted in “downhill” esophageal varices (DEV) bleeding, and was 
successfully treated by medication (cyclophosphamide) and endoscopic band ligation. 
The reviewer highly suggests on this manuscript that some revisions are necessary before being accepted. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
1.The sentence“the safest method for controlling DEV bleeding”in the conclusions of abstract is not really 
supported by the unique case presented here. The following is suggested “a safe and effective method for 
controlling DEV bleeding”. 
2.Thorough literatures review of DEV bleeding, including the cases after Maton et al (1985), should be 
attempted to conclude the indications, results and the possible complications of different therapeutic 
methods, and to summary all the patients’ data into a table. 
3.For declaring the patency of SVC and indirectly reflect the possible role of medication in DEV bleeding, 
the sentence“the patient was discharged without any problem”(page 7, line 9?should be given more detail 
expression including or except the manifestation of the SVC syndrome. ------------------------------------------------------------------------------- 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.In order to describe the title more accurate, the word “bleeding” should be added following the term 
“downhill” esophageal varices. 
2.Through the whole manuscript,the word downhill should be given as?"downhill”. 
3.About the key words. Use“downhill”esophageal varices, endoscopic ligation and Behcet’s disease instead 
of the original ones in the manuscript. 
4.The patient’s age is not consistent with each other on page 2?39-year-old?and 5?42-year-old?. It should 
be numbered in consistency. 
5.On page 6, line 4, the word “elevated JVP” should be written as “engorgement of jugular vein”. 
6.On page 7, line 1, the etiology of “not able to perform MR angiography” should be given more description. 
7.The endoscopic findings on page 7, line 4 should mention about the presence of red color sign or stigma 
of recent bleeding in order to confirm DEV as the source of GI bleeding. 
8.For the further understand, suggests to put the words of “Endoscopic findings on”in front of“upper third of 
esophagus”on Figure 3. 
9.The reference on number 29 and 30 must be fully formatted as the instructions of reference. 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
N/A 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interest. 
assistant