Reviewer's report
Title:The Association Between Celiac Disease and Eosinophilic Esophagitis in
Children and Adults
Version: 1Date:24 February 2013
Reviewer: Carlo Catassi
Reviewer's report:
This is an epidemiological study investigating the association between
eosinophylic esophagitis (EoE) and celiac disease (CD) in a large Canadian
population sample. The incidence of EoE ranged from 2.1 to 10.7 cases per
100,000 population. The incidence of CD ranged from 10.4 to 15.7 cases per
100,000 population. The concomitant diagnosis of both EoE and CD was made
in three patients, all of whom were pediatric males. The SIR for EoE in the CD
cohort was 48.4 with a SIR for CD within the paediatric EoE cohort of 75.05.
This is a simple epidemiological work that is clearly presented. The sample size
is large, however the relevant disease association (EoE + CD) was present only
in three cases, a finding that weakens the conclusions. Furthermore I don’t think
this study really demonstrates that CD is significantly associated with EoE, since
the prevalence of CD in patients with EoE was 3/421, i.e. the same (around 1%)
expected in the general population. These contradictory findings are likely to be
explained by a possible detection bias, in that a patient undergoing EGDS
because of suspected EoE is more likely to end up with a diagnosis of CD than a
subject who is not performing the EGDS.
Minor comments:
Page 2 line 12: The SIR of EoE in the CD cohort…(“in the” is missing)
Pages 3-4: the introduction is too long, particularly concerning the description of
EoE. There is no need to describe clinical and pathophysiological details here,
since the study did not address these issues. Likewise the number of references
on EoE should be cutted accordingly;
Page 4 line 7: change “effect” with “affect”
Page 6 line 3: the diagnostic criteria for celiac disease (CD) should be stated
more clearly, e.g. patients with a Marsh 3a-c biopsy, Marsh 3a-c biopsy or Marsh
1 plus typical serological CD pattern (e.g. anti-tTG higher than 10x normal
values, etc)
Page 8 line 13: delete “in”
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:The Association Between Celiac Disease and Eosinophilic Esophagitis in
Children and Adults
Version: 1Date:24 February 2013
Reviewer: Carlo Catassi
Reviewer's report:
This is an epidemiological study investigating the association between
eosinophylic esophagitis (EoE) and celiac disease (CD) in a large Canadian
population sample. The incidence of EoE ranged from 2.1 to 10.7 cases per
100,000 population. The incidence of CD ranged from 10.4 to 15.7 cases per
100,000 population. The concomitant diagnosis of both EoE and CD was made
in three patients, all of whom were pediatric males. The SIR for EoE in the CD
cohort was 48.4 with a SIR for CD within the paediatric EoE cohort of 75.05.
This is a simple epidemiological work that is clearly presented. The sample size
is large, however the relevant disease association (EoE + CD) was present only
in three cases, a finding that weakens the conclusions. Furthermore I don’t think
this study really demonstrates that CD is significantly associated with EoE, since
the prevalence of CD in patients with EoE was 3/421, i.e. the same (around 1%)
expected in the general population. These contradictory findings are likely to be
explained by a possible detection bias, in that a patient undergoing EGDS
because of suspected EoE is more likely to end up with a diagnosis of CD than a
subject who is not performing the EGDS.
Minor comments:
Page 2 line 12: The SIR of EoE in the CD cohort…(“in the” is missing)
Pages 3-4: the introduction is too long, particularly concerning the description of
EoE. There is no need to describe clinical and pathophysiological details here,
since the study did not address these issues. Likewise the number of references
on EoE should be cutted accordingly;
Page 4 line 7: change “effect” with “affect”
Page 6 line 3: the diagnostic criteria for celiac disease (CD) should be stated
more clearly, e.g. patients with a Marsh 3a-c biopsy, Marsh 3a-c biopsy or Marsh
1 plus typical serological CD pattern (e.g. anti-tTG higher than 10x normal
values, etc)
Page 8 line 13: delete “in”
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:The Association Between Celiac Disease and Eosinophilic Esophagitis in
Children and Adults
Version: 1Date:24 February 2013
Reviewer: Carlo Catassi
Reviewer's report:
This is an epidemiological study investigating the association between
eosinophylic esophagitis (EoE) and celiac disease (CD) in a large Canadian
population sample. The incidence of EoE ranged from 2.1 to 10.7 cases per
100,000 population. The incidence of CD ranged from 10.4 to 15.7 cases per
100,000 population. The concomitant diagnosis of both EoE and CD was made
in three patients, all of whom were pediatric males. The SIR for EoE in the CD
cohort was 48.4 with a SIR for CD within the paediatric EoE cohort of 75.05.
This is a simple epidemiological work that is clearly presented. The sample size
is large, however the relevant disease association (EoE + CD) was present only
in three cases, a finding that weakens the conclusions. Furthermore I don’t think
this study really demonstrates that CD is significantly associated with EoE, since
the prevalence of CD in patients with EoE was 3/421, i.e. the same (around 1%)
expected in the general population. These contradictory findings are likely to be
explained by a possible detection bias, in that a patient undergoing EGDS
because of suspected EoE is more likely to end up with a diagnosis of CD than a
subject who is not performing the EGDS.
Minor comments:
Page 2 line 12: The SIR of EoE in the CD cohort…(“in the” is missing)
Pages 3-4: the introduction is too long, particularly concerning the description of
EoE. There is no need to describe clinical and pathophysiological details here,
since the study did not address these issues. Likewise the number of references
on EoE should be cutted accordingly;
Page 4 line 7: change “effect” with “affect”
Page 6 line 3: the diagnostic criteria for celiac disease (CD) should be stated
more clearly, e.g. patients with a Marsh 3a-c biopsy, Marsh 3a-c biopsy or Marsh
1 plus typical serological CD pattern (e.g. anti-tTG higher than 10x normal
values, etc)
Page 8 line 13: delete “in”
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
assistant