Reviewer’s report
Title: 
Recurrence of moderate to severe ulcerative colitis after fecal microbiota
transplantation treatment and the efficacy of re-FMT a case series
Version: 
1 
Date: 
26 May 2020
Reviewer's report:
This paper outlines a case series of 12 UC patients who underwent FMT. FMT is
an emerging valuable treatment for UC and I strongly support research in this
area. However, unfortunately this manuscript in its current form is unsuitable for
publication due to the unclear aims, methods and results and the lack of clear
novelty. Please see my specific comments below:
- The abstract is poorly structured and has an unclear flow. Methods and results
are presented in the conclusion. The poor structure and unclear flow extends
throughout the manuscript.
- There is inconsistent use of abbreviations throughout. Define an abbreviation
on the first use and use the abbreviation consistently throughout. 
- There are spelling, grammatical and general errors throughout e.g. in the first
line "disease" not "symptoms" begin in the bowel, line 17, pg 1 "theraping" is
not a word, line 42, pg 9 "reveal" is missing an r
- The aim is unclear
- Was this a retrospective or prospective study? The text indicates it was
retrospective but the methods describe prospective collection of data.
- How were patients identified? Why were these 12 cases included? Where these
all the UC cases treated with FMT? Did you have any other cases treated with
FMT? Did you have any other UC patients? What time frame did you select the
patients from? The lack of clear description of how these patients were identified
promotes bias.
- Page 4, line 9: heading says history of past illness and then line 10 says present
illness. Which is it?
- The use of "most" throughout is uninformative. Please change to the number
and percentage of patients. 
- The layout of table 1 and 2 are reversed. Make both the same for ease of
reading and comparison. 
- The processing of FMT can be included in the appendices
- Page 7, line 1- what colonoscopy record did patients maintain?
- Why were 4 cases chosen to be reported on in further detail? 
- Where there differences in responses to different donors?
- How many FMT did each patient receive? How frequently? Did all patients
receive the same number of FMT?
- Table 2: inconsistent use of capitalisation 
- There are no methods defined for the literature review. The review reads more
as a historical overview. Does it add value to this case series? There has been a
systematic review and meta-analysis completed on this topic and an updated one
is due to be published this year.
- Page 11, line 12: it cannot be concluded that outcomes observed in this report
are from differences in gut microbiota as this was NOT measured in this study
- the manuscripts states that you performed analysis on the donor stools but the
outcomes of this are not reported 
- How does this case series add new or additional value to the current published
literature on UC and FMT? 
Figure 1: Why are these 4 patients presented? Consider adding a line to indicate
a score for clinical remission. 
Figures 2-4: Indicate location of photos
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
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.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Not suitable for publication unless extensively edited
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 future?
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 receive a salary from an organisation that holds patents relating to the contents
of the manuscript
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Reviewer’s report
Title: 
Recurrence of moderate to severe ulcerative colitis after fecal microbiota
transplantation treatment and the efficacy of re-FMT a case series
Version: 
1 
Date: 
26 May 2020
Reviewer's report:
This paper outlines a case series of 12 UC patients who underwent FMT. FMT is
an emerging valuable treatment for UC and I strongly support research in this
area. However, unfortunately this manuscript in its current form is unsuitable for
publication due to the unclear aims, methods and results and the lack of clear
novelty. Please see my specific comments below:
- The abstract is poorly structured and has an unclear flow. Methods and results
are presented in the conclusion. The poor structure and unclear flow extends
throughout the manuscript.
- There is inconsistent use of abbreviations throughout. Define an abbreviation
on the first use and use the abbreviation consistently throughout. 
- There are spelling, grammatical and general errors throughout e.g. in the first
line "disease" not "symptoms" begin in the bowel, line 17, pg 1 "theraping" is
not a word, line 42, pg 9 "reveal" is missing an r
- The aim is unclear
- Was this a retrospective or prospective study? The text indicates it was
retrospective but the methods describe prospective collection of data.
- How were patients identified? Why were these 12 cases included? Where these
all the UC cases treated with FMT? Did you have any other cases treated with
FMT? Did you have any other UC patients? What time frame did you select the
patients from? The lack of clear description of how these patients were identified
promotes bias.
- Page 4, line 9: heading says history of past illness and then line 10 says present
illness. Which is it?
- The use of "most" throughout is uninformative. Please change to the number
and percentage of patients. 
- The layout of table 1 and 2 are reversed. Make both the same for ease of
reading and comparison. 
- The processing of FMT can be included in the appendices
- Page 7, line 1- what colonoscopy record did patients maintain?
- Why were 4 cases chosen to be reported on in further detail? 
- Where there differences in responses to different donors?
- How many FMT did each patient receive? How frequently? Did all patients
receive the same number of FMT?
- Table 2: inconsistent use of capitalisation 
- There are no methods defined for the literature review. The review reads more
as a historical overview. Does it add value to this case series? There has been a
systematic review and meta-analysis completed on this topic and an updated one
is due to be published this year.
- Page 11, line 12: it cannot be concluded that outcomes observed in this report
are from differences in gut microbiota as this was NOT measured in this study
- the manuscripts states that you performed analysis on the donor stools but the
outcomes of this are not reported 
- How does this case series add new or additional value to the current published
literature on UC and FMT? 
Figure 1: Why are these 4 patients presented? Consider adding a line to indicate
a score for clinical remission. 
Figures 2-4: Indicate location of photos
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
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.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Not suitable for publication unless extensively edited
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 future?
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 receive a salary from an organisation that holds patents relating to the contents
of the manuscript
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Please review this paper.
user
Reviewer’s report
Title: 
Recurrence of moderate to severe ulcerative colitis after fecal microbiota
transplantation treatment and the efficacy of re-FMT a case series
Version: 
1 
Date: 
26 May 2020
Reviewer's report:
This paper outlines a case series of 12 UC patients who underwent FMT. FMT is
an emerging valuable treatment for UC and I strongly support research in this
area. However, unfortunately this manuscript in its current form is unsuitable for
publication due to the unclear aims, methods and results and the lack of clear
novelty. Please see my specific comments below:
- The abstract is poorly structured and has an unclear flow. Methods and results
are presented in the conclusion. The poor structure and unclear flow extends
throughout the manuscript.
- There is inconsistent use of abbreviations throughout. Define an abbreviation
on the first use and use the abbreviation consistently throughout. 
- There are spelling, grammatical and general errors throughout e.g. in the first
line "disease" not "symptoms" begin in the bowel, line 17, pg 1 "theraping" is
not a word, line 42, pg 9 "reveal" is missing an r
- The aim is unclear
- Was this a retrospective or prospective study? The text indicates it was
retrospective but the methods describe prospective collection of data.
- How were patients identified? Why were these 12 cases included? Where these
all the UC cases treated with FMT? Did you have any other cases treated with
FMT? Did you have any other UC patients? What time frame did you select the
patients from? The lack of clear description of how these patients were identified
promotes bias.
- Page 4, line 9: heading says history of past illness and then line 10 says present
illness. Which is it?
- The use of "most" throughout is uninformative. Please change to the number
and percentage of patients. 
- The layout of table 1 and 2 are reversed. Make both the same for ease of
reading and comparison. 
- The processing of FMT can be included in the appendices
- Page 7, line 1- what colonoscopy record did patients maintain?
- Why were 4 cases chosen to be reported on in further detail? 
- Where there differences in responses to different donors?
- How many FMT did each patient receive? How frequently? Did all patients
receive the same number of FMT?
- Table 2: inconsistent use of capitalisation 
- There are no methods defined for the literature review. The review reads more
as a historical overview. Does it add value to this case series? There has been a
systematic review and meta-analysis completed on this topic and an updated one
is due to be published this year.
- Page 11, line 12: it cannot be concluded that outcomes observed in this report
are from differences in gut microbiota as this was NOT measured in this study
- the manuscripts states that you performed analysis on the donor stools but the
outcomes of this are not reported 
- How does this case series add new or additional value to the current published
literature on UC and FMT? 
Figure 1: Why are these 4 patients presented? Consider adding a line to indicate
a score for clinical remission. 
Figures 2-4: Indicate location of photos
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
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.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Not suitable for publication unless extensively edited
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 future?
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 receive a salary from an organisation that holds patents relating to the contents
of the manuscript
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
assistant