Reviewer ’s report  
 
Title: Healthcare use by 30,000 patients with Irritable bowel syndrome (IBS) in France: a 5 -year 
retrospective and one -year prospective national observational study  
 
Version: 0 Date: 29 Nov 2018  
 
Reviewer: Cesare Cremon  
 
Reviewer's report:  
 
Please include all comments for the authors in th is box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this te xt when adding your comments to the authors.  
This is a nationwide observational population -based study using the French National Health data 
System to estimate the utilization of healthcare resources 5 years before and one year after 
hospitalization of su bjects with  a diagnosis of IBS in 2015. This study revealed a large number 
of repeated outpatient visits, examinations and particularly radiological examinations, and 
numerous and urgent hospitalizations for patients with IBS, providing an overview of hea lthcare 
consumption for IBS in France.  
 
The study appears to be well designed and conducted, and the results are clearly reported. The 
discussion is consistent with the results. The limitations of the study are related to the nature of 
the study that was b ased on an administrative database used for reimbursement. In my opinion 
the Authors should be commended for this study that underlines the need of publication of 
physician guidelines by national learned societies for the management of patients with IBS.  
This reviewer has only the following remarks:  
 
Although the presence of the intestinal and extra -intestinal comorbidities commonly associated 
with IBS were investigated, data on anxiety and depression are not clearly reported. I think that 
this may be an i nteresting aspect in patients hospitalized for IBS, and should be more widely 
discussed.  
The use of laxatives (based on a least one reimbursement) was identified for more than 95% of 
all IBS patients. This is surprising taking into account that about 1/3  of patients should have IBS 
with diarrhea. I think that this aspect should be better interpreted and commented in the 
discussion, because this data clearly reduces the quality and the reliability of the study.  
Are the me thods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the futu re? 
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Acc ess Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Healthcare use by 30,000 patients with Irritable bowel syndrome (IBS) in France: a 5 -year 
retrospective and one -year prospective national observational study  
 
Version: 0 Date: 29 Nov 2018  
 
Reviewer: Cesare Cremon  
 
Reviewer's report:  
 
Please include all comments for the authors in th is box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this te xt when adding your comments to the authors.  
This is a nationwide observational population -based study using the French National Health data 
System to estimate the utilization of healthcare resources 5 years before and one year after 
hospitalization of su bjects with  a diagnosis of IBS in 2015. This study revealed a large number 
of repeated outpatient visits, examinations and particularly radiological examinations, and 
numerous and urgent hospitalizations for patients with IBS, providing an overview of hea lthcare 
consumption for IBS in France.  
 
The study appears to be well designed and conducted, and the results are clearly reported. The 
discussion is consistent with the results. The limitations of the study are related to the nature of 
the study that was b ased on an administrative database used for reimbursement. In my opinion 
the Authors should be commended for this study that underlines the need of publication of 
physician guidelines by national learned societies for the management of patients with IBS.  
This reviewer has only the following remarks:  
 
Although the presence of the intestinal and extra -intestinal comorbidities commonly associated 
with IBS were investigated, data on anxiety and depression are not clearly reported. I think that 
this may be an i nteresting aspect in patients hospitalized for IBS, and should be more widely 
discussed.  
The use of laxatives (based on a least one reimbursement) was identified for more than 95% of 
all IBS patients. This is surprising taking into account that about 1/3  of patients should have IBS 
with diarrhea. I think that this aspect should be better interpreted and commented in the 
discussion, because this data clearly reduces the quality and the reliability of the study.  
Are the me thods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the futu re? 
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Acc ess Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Healthcare use by 30,000 patients with Irritable bowel syndrome (IBS) in France: a 5 -year 
retrospective and one -year prospective national observational study  
 
Version: 0 Date: 29 Nov 2018  
 
Reviewer: Cesare Cremon  
 
Reviewer's report:  
 
Please include all comments for the authors in th is box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this te xt when adding your comments to the authors.  
This is a nationwide observational population -based study using the French National Health data 
System to estimate the utilization of healthcare resources 5 years before and one year after 
hospitalization of su bjects with  a diagnosis of IBS in 2015. This study revealed a large number 
of repeated outpatient visits, examinations and particularly radiological examinations, and 
numerous and urgent hospitalizations for patients with IBS, providing an overview of hea lthcare 
consumption for IBS in France.  
 
The study appears to be well designed and conducted, and the results are clearly reported. The 
discussion is consistent with the results. The limitations of the study are related to the nature of 
the study that was b ased on an administrative database used for reimbursement. In my opinion 
the Authors should be commended for this study that underlines the need of publication of 
physician guidelines by national learned societies for the management of patients with IBS.  
This reviewer has only the following remarks:  
 
Although the presence of the intestinal and extra -intestinal comorbidities commonly associated 
with IBS were investigated, data on anxiety and depression are not clearly reported. I think that 
this may be an i nteresting aspect in patients hospitalized for IBS, and should be more widely 
discussed.  
The use of laxatives (based on a least one reimbursement) was identified for more than 95% of 
all IBS patients. This is surprising taking into account that about 1/3  of patients should have IBS 
with diarrhea. I think that this aspect should be better interpreted and commented in the 
discussion, because this data clearly reduces the quality and the reliability of the study.  
Are the me thods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the futu re? 
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Acc ess Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant