Reviewer's report
Title:Hormone Replacement Therapy is associated with Gastro-Oesophageal
Reflux Disease: a retrospective cohort study
Version: 1Date:25 October 2011
Reviewer: Sachin Wani
Reviewer's report:
The authors Close et al have explored the association of HRT and GORD in
menopausal women using validated general practice records from the UK. The
authors report that oestrogen only use was associated with GORD and PPI
usage.
Strengths:
- Well written manuscript
- Use of large well defined and validated database
- Large number of patients
Comments:
Major:
1. The proportion of missing data for important variables associated with GORD
(as the authors note in the introduction) is unacceptably high (41% for smoking
and 43% for BMI). This prevented the final model to account for these factors.
This should be discussed further.
2. The definition of GORD is suspect. Was this based only on the diagnostic
code - gastro-oesophageal reflux? Please clarify. It should be acknowledged that
this is an inadequate method to capture patients with gastro-oesophageal reflux.
Lack fo standardization of GORD recording as acknowledged by the authors is a
major limitation.
3. Also it is unclear what classifies as GORD vs. gastro-oesophageal reflux
symptoms? How did the authors account for this? This should be discussed
further.
4. Limitations section should be included in the manuscript.
5. How many patients underwent endoscopy in this cohort? How many had
erosive esophagitis or other complications of GORD? Were those codes
included?
6. Basic limitations of any retrospective cohort study such as selection bias and
inability to explore temporal associations should be provided. This is especially
true due to large proportion of missing data on important confounding variables.
7. It is also unclear if PPI usage was factored into the adjusted analysis for
GORD outcomes between HRT users and non users.
Minor:
Figure 1 not available for review
Level of interest: An article whose findings are important to those with closely
related research interests
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:Hormone Replacement Therapy is associated with Gastro-Oesophageal
Reflux Disease: a retrospective cohort study
Version: 1Date:25 October 2011
Reviewer: Sachin Wani
Reviewer's report:
The authors Close et al have explored the association of HRT and GORD in
menopausal women using validated general practice records from the UK. The
authors report that oestrogen only use was associated with GORD and PPI
usage.
Strengths:
- Well written manuscript
- Use of large well defined and validated database
- Large number of patients
Comments:
Major:
1. The proportion of missing data for important variables associated with GORD
(as the authors note in the introduction) is unacceptably high (41% for smoking
and 43% for BMI). This prevented the final model to account for these factors.
This should be discussed further.
2. The definition of GORD is suspect. Was this based only on the diagnostic
code - gastro-oesophageal reflux? Please clarify. It should be acknowledged that
this is an inadequate method to capture patients with gastro-oesophageal reflux.
Lack fo standardization of GORD recording as acknowledged by the authors is a
major limitation.
3. Also it is unclear what classifies as GORD vs. gastro-oesophageal reflux
symptoms? How did the authors account for this? This should be discussed
further.
4. Limitations section should be included in the manuscript.
5. How many patients underwent endoscopy in this cohort? How many had
erosive esophagitis or other complications of GORD? Were those codes
included?
6. Basic limitations of any retrospective cohort study such as selection bias and
inability to explore temporal associations should be provided. This is especially
true due to large proportion of missing data on important confounding variables.
7. It is also unclear if PPI usage was factored into the adjusted analysis for
GORD outcomes between HRT users and non users.
Minor:
Figure 1 not available for review
Level of interest: An article whose findings are important to those with closely
related research interests
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:Hormone Replacement Therapy is associated with Gastro-Oesophageal
Reflux Disease: a retrospective cohort study
Version: 1Date:25 October 2011
Reviewer: Sachin Wani
Reviewer's report:
The authors Close et al have explored the association of HRT and GORD in
menopausal women using validated general practice records from the UK. The
authors report that oestrogen only use was associated with GORD and PPI
usage.
Strengths:
- Well written manuscript
- Use of large well defined and validated database
- Large number of patients
Comments:
Major:
1. The proportion of missing data for important variables associated with GORD
(as the authors note in the introduction) is unacceptably high (41% for smoking
and 43% for BMI). This prevented the final model to account for these factors.
This should be discussed further.
2. The definition of GORD is suspect. Was this based only on the diagnostic
code - gastro-oesophageal reflux? Please clarify. It should be acknowledged that
this is an inadequate method to capture patients with gastro-oesophageal reflux.
Lack fo standardization of GORD recording as acknowledged by the authors is a
major limitation.
3. Also it is unclear what classifies as GORD vs. gastro-oesophageal reflux
symptoms? How did the authors account for this? This should be discussed
further.
4. Limitations section should be included in the manuscript.
5. How many patients underwent endoscopy in this cohort? How many had
erosive esophagitis or other complications of GORD? Were those codes
included?
6. Basic limitations of any retrospective cohort study such as selection bias and
inability to explore temporal associations should be provided. This is especially
true due to large proportion of missing data on important confounding variables.
7. It is also unclear if PPI usage was factored into the adjusted analysis for
GORD outcomes between HRT users and non users.
Minor:
Figure 1 not available for review
Level of interest: An article whose findings are important to those with closely
related research interests
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