Reviewer's report
Title:Blood ammonia levels in liver cirrhosis: a clue for the presence of
esophageal varices.
Version: 1Date:12 December 2008
Reviewer: Stephen Harrison
Reviewer's report:
Tarantino and colleagues present an interesting analysis of 201 cirrhotic patients
and correlate blood ammonia level with the presence of esophageal varices
(EV).. While expert statistical analysis may be beneficial, these results do confirm
a novel association between blood ammonia level & EV. While novel in their
findings, these likely will not change clinical practice as all patients with cirrhosis
undergo surveillence for EV, typically with an EGD. These authors propose
empiric treatment for EV with beta-blockers if blood ammonia levels are elevated
and that is certainly too much of a leap at this point. However, it would be
interesting to see if putting pt's on beta blockers or performing EVL on their
varices changed the ammonia level (an area of future study that might lead to
blood ammonia level's utility in clinical practice).
No major revisions required.
Minor essential: some minor wording issues throughout likely related to english
not being the primary language of the authors that could be easily corrected.
Overall, an interesting study that may lead to further study in the field relating
ammonia level to EV.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Blood ammonia levels in liver cirrhosis: a clue for the presence of
esophageal varices.
Version: 1Date:12 December 2008
Reviewer: Stephen Harrison
Reviewer's report:
Tarantino and colleagues present an interesting analysis of 201 cirrhotic patients
and correlate blood ammonia level with the presence of esophageal varices
(EV).. While expert statistical analysis may be beneficial, these results do confirm
a novel association between blood ammonia level & EV. While novel in their
findings, these likely will not change clinical practice as all patients with cirrhosis
undergo surveillence for EV, typically with an EGD. These authors propose
empiric treatment for EV with beta-blockers if blood ammonia levels are elevated
and that is certainly too much of a leap at this point. However, it would be
interesting to see if putting pt's on beta blockers or performing EVL on their
varices changed the ammonia level (an area of future study that might lead to
blood ammonia level's utility in clinical practice).
No major revisions required.
Minor essential: some minor wording issues throughout likely related to english
not being the primary language of the authors that could be easily corrected.
Overall, an interesting study that may lead to further study in the field relating
ammonia level to EV.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Blood ammonia levels in liver cirrhosis: a clue for the presence of
esophageal varices.
Version: 1Date:12 December 2008
Reviewer: Stephen Harrison
Reviewer's report:
Tarantino and colleagues present an interesting analysis of 201 cirrhotic patients
and correlate blood ammonia level with the presence of esophageal varices
(EV).. While expert statistical analysis may be beneficial, these results do confirm
a novel association between blood ammonia level & EV. While novel in their
findings, these likely will not change clinical practice as all patients with cirrhosis
undergo surveillence for EV, typically with an EGD. These authors propose
empiric treatment for EV with beta-blockers if blood ammonia levels are elevated
and that is certainly too much of a leap at this point. However, it would be
interesting to see if putting pt's on beta blockers or performing EVL on their
varices changed the ammonia level (an area of future study that might lead to
blood ammonia level's utility in clinical practice).
No major revisions required.
Minor essential: some minor wording issues throughout likely related to english
not being the primary language of the authors that could be easily corrected.
Overall, an interesting study that may lead to further study in the field relating
ammonia level to EV.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
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