Reviewer ’s report  
 
Title: Risk Factor for Steatorrhea in Pediatric Chronic Pancreatitis Patients  
 
Version: 1 Date: 17 Dec 2017  
 
Reviewer: Rupjyoti Talukdar  
 
Reviewer's report:  
 
In this manuscript, the authors have evaluated the prevalence and risk factors for steatorrhea in 
children w ith chronic pancreatitis. The authors have combined data of one retrospectively 
collected cohort of patients (2000 -2004) and another prospectively followed cohort from 2005 -
2013. This is a long period and several developments have occurred during this peri od. 
Therefore, if the authors present data from 2000 -2004 as a discovery data and 2005 to 2013 as 
validation data, the credibility of the paper will increase substantially.  
 
I have the following issues to be discussed:  
1. Diagnosis was done based on the pr esence of steatorrhea or fecal fat quantification. Which 
method was used? For how many patients was fecal fat excretion done?  
 
2. In such large cohort, there must have been a substantial number of patients who did not have 
steatorrhea and fecal fat estimat ion have also not been done. Yet many of them must have 
had pancreatic exocrine insufficiency. How were data from those patients handled? 
Steatorrhea is an extreme manifestation of CP. It would be more important to have 
predictors of early exocrine insuffi ciency.  
 
3. Since CP is a progressive disease, it is expected that development of steatorrhea will be 
there as a function of time. So a patient who developed the disease at an early age will have 
a longer time between disease onset and testing in this stud y compared to a patient who 
develops CP during adulthood. Therefore, it is not surprising to observe that adult patients 
with older age of CP diagnosis had a decreased risk of developing steatorrhea. How long 
were these adult patients followed?  
 
4. Diabetes  has been proven to be a risk factor of steatorrhea and now the mechanisms have 
also been somewhat described in different studies. Therefore, this information is also 
nothing new in this study.  
 
5. Male gender had a higher risk of developing steatorrhea. Wh at explanation do the authors 
offer for this observation?  
 
6. How was severe acute pancreatitis (SAP) defined? Definitions of SAP have changed from 
2000 to 2013.  
 
7. In Tables 2 and 3, what does Control indicate?  
Are the methods 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.  
 
No 
 
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 th e 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:  
 
Needs some language corrections before being published  
 
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 recei ved 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 websi te along with the authors'  
responses. 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/ ). I understand that any comments  
which I do not wish to be included in my name d 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: Risk Factor for Steatorrhea in Pediatric Chronic Pancreatitis Patients  
 
Version: 1 Date: 17 Dec 2017  
 
Reviewer: Rupjyoti Talukdar  
 
Reviewer's report:  
 
In this manuscript, the authors have evaluated the prevalence and risk factors for steatorrhea in 
children w ith chronic pancreatitis. The authors have combined data of one retrospectively 
collected cohort of patients (2000 -2004) and another prospectively followed cohort from 2005 -
2013. This is a long period and several developments have occurred during this peri od. 
Therefore, if the authors present data from 2000 -2004 as a discovery data and 2005 to 2013 as 
validation data, the credibility of the paper will increase substantially.  
 
I have the following issues to be discussed:  
1. Diagnosis was done based on the pr esence of steatorrhea or fecal fat quantification. Which 
method was used? For how many patients was fecal fat excretion done?  
 
2. In such large cohort, there must have been a substantial number of patients who did not have 
steatorrhea and fecal fat estimat ion have also not been done. Yet many of them must have 
had pancreatic exocrine insufficiency. How were data from those patients handled? 
Steatorrhea is an extreme manifestation of CP. It would be more important to have 
predictors of early exocrine insuffi ciency.  
 
3. Since CP is a progressive disease, it is expected that development of steatorrhea will be 
there as a function of time. So a patient who developed the disease at an early age will have 
a longer time between disease onset and testing in this stud y compared to a patient who 
develops CP during adulthood. Therefore, it is not surprising to observe that adult patients 
with older age of CP diagnosis had a decreased risk of developing steatorrhea. How long 
were these adult patients followed?  
 
4. Diabetes  has been proven to be a risk factor of steatorrhea and now the mechanisms have 
also been somewhat described in different studies. Therefore, this information is also 
nothing new in this study.  
 
5. Male gender had a higher risk of developing steatorrhea. Wh at explanation do the authors 
offer for this observation?  
 
6. How was severe acute pancreatitis (SAP) defined? Definitions of SAP have changed from 
2000 to 2013.  
 
7. In Tables 2 and 3, what does Control indicate?  
Are the methods 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.  
 
No 
 
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 th e 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:  
 
Needs some language corrections before being published  
 
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 recei ved 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 websi te along with the authors'  
responses. 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/ ). I understand that any comments  
which I do not wish to be included in my name d 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: Risk Factor for Steatorrhea in Pediatric Chronic Pancreatitis Patients  
 
Version: 1 Date: 17 Dec 2017  
 
Reviewer: Rupjyoti Talukdar  
 
Reviewer's report:  
 
In this manuscript, the authors have evaluated the prevalence and risk factors for steatorrhea in 
children w ith chronic pancreatitis. The authors have combined data of one retrospectively 
collected cohort of patients (2000 -2004) and another prospectively followed cohort from 2005 -
2013. This is a long period and several developments have occurred during this peri od. 
Therefore, if the authors present data from 2000 -2004 as a discovery data and 2005 to 2013 as 
validation data, the credibility of the paper will increase substantially.  
 
I have the following issues to be discussed:  
1. Diagnosis was done based on the pr esence of steatorrhea or fecal fat quantification. Which 
method was used? For how many patients was fecal fat excretion done?  
 
2. In such large cohort, there must have been a substantial number of patients who did not have 
steatorrhea and fecal fat estimat ion have also not been done. Yet many of them must have 
had pancreatic exocrine insufficiency. How were data from those patients handled? 
Steatorrhea is an extreme manifestation of CP. It would be more important to have 
predictors of early exocrine insuffi ciency.  
 
3. Since CP is a progressive disease, it is expected that development of steatorrhea will be 
there as a function of time. So a patient who developed the disease at an early age will have 
a longer time between disease onset and testing in this stud y compared to a patient who 
develops CP during adulthood. Therefore, it is not surprising to observe that adult patients 
with older age of CP diagnosis had a decreased risk of developing steatorrhea. How long 
were these adult patients followed?  
 
4. Diabetes  has been proven to be a risk factor of steatorrhea and now the mechanisms have 
also been somewhat described in different studies. Therefore, this information is also 
nothing new in this study.  
 
5. Male gender had a higher risk of developing steatorrhea. Wh at explanation do the authors 
offer for this observation?  
 
6. How was severe acute pancreatitis (SAP) defined? Definitions of SAP have changed from 
2000 to 2013.  
 
7. In Tables 2 and 3, what does Control indicate?  
Are the methods 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.  
 
No 
 
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 th e 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:  
 
Needs some language corrections before being published  
 
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 recei ved 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 websi te along with the authors'  
responses. 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/ ). I understand that any comments  
which I do not wish to be included in my name d 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