Reviewer's report
Title:Antibodies against gonadotropin-releasing hormone (GnRH) and
destruction of enteric neurons in 3 patients suffering from gastrointestinal
dysfunction
Version: 2Date:11 December 2009
Reviewer: Jackie Wood
Reviewer's report:
The authors in my view have replied adequately to the concerns of Reviewers
2&3. Although, the work raises many specific and unanswered questions, I
refrained from nit-picking criticisms in my earlier review because the paper has
significant clinical relevance of broader scope for understanding functional GI
disorders. The importance of the paper is that it represents another step in
stimulation of interest in the concept that multiple gastrointestinal disorders
hitherto having a symptom-based classification of functional in fact reflect an
autoimmune degenerative enteric neuropathy. The concept started with the
discovery by Verne et. al. (Dig Dis Sci 1997; 42:307) that lower esophageal
sphincter achalasia in a majority of patients was explained by the presence of
circulating anti-enteric antibodies and immune-related degeneration of the enteric
inhibitory motor neurons, which innervate and open the sphincter. This
manuscript should add to impetus in stimulating interest in research on
autoimmune degenerative enteric neuropathy as the common factor underlying
multiple FGIDs (e.g., functional dyspepsia, IBS, idiopathic pseudoobstruction and
achalasia in various sphincters. After all, the gut does not work well when the
enteric nervous system (ENS) is not working well. The gut does not work at all
without the ENS minibrain.
Level of interest: An article of outstanding merit and interest in its field
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:Antibodies against gonadotropin-releasing hormone (GnRH) and
destruction of enteric neurons in 3 patients suffering from gastrointestinal
dysfunction
Version: 2Date:11 December 2009
Reviewer: Jackie Wood
Reviewer's report:
The authors in my view have replied adequately to the concerns of Reviewers
2&3. Although, the work raises many specific and unanswered questions, I
refrained from nit-picking criticisms in my earlier review because the paper has
significant clinical relevance of broader scope for understanding functional GI
disorders. The importance of the paper is that it represents another step in
stimulation of interest in the concept that multiple gastrointestinal disorders
hitherto having a symptom-based classification of functional in fact reflect an
autoimmune degenerative enteric neuropathy. The concept started with the
discovery by Verne et. al. (Dig Dis Sci 1997; 42:307) that lower esophageal
sphincter achalasia in a majority of patients was explained by the presence of
circulating anti-enteric antibodies and immune-related degeneration of the enteric
inhibitory motor neurons, which innervate and open the sphincter. This
manuscript should add to impetus in stimulating interest in research on
autoimmune degenerative enteric neuropathy as the common factor underlying
multiple FGIDs (e.g., functional dyspepsia, IBS, idiopathic pseudoobstruction and
achalasia in various sphincters. After all, the gut does not work well when the
enteric nervous system (ENS) is not working well. The gut does not work at all
without the ENS minibrain.
Level of interest: An article of outstanding merit and interest in its field
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:Antibodies against gonadotropin-releasing hormone (GnRH) and
destruction of enteric neurons in 3 patients suffering from gastrointestinal
dysfunction
Version: 2Date:11 December 2009
Reviewer: Jackie Wood
Reviewer's report:
The authors in my view have replied adequately to the concerns of Reviewers
2&3. Although, the work raises many specific and unanswered questions, I
refrained from nit-picking criticisms in my earlier review because the paper has
significant clinical relevance of broader scope for understanding functional GI
disorders. The importance of the paper is that it represents another step in
stimulation of interest in the concept that multiple gastrointestinal disorders
hitherto having a symptom-based classification of functional in fact reflect an
autoimmune degenerative enteric neuropathy. The concept started with the
discovery by Verne et. al. (Dig Dis Sci 1997; 42:307) that lower esophageal
sphincter achalasia in a majority of patients was explained by the presence of
circulating anti-enteric antibodies and immune-related degeneration of the enteric
inhibitory motor neurons, which innervate and open the sphincter. This
manuscript should add to impetus in stimulating interest in research on
autoimmune degenerative enteric neuropathy as the common factor underlying
multiple FGIDs (e.g., functional dyspepsia, IBS, idiopathic pseudoobstruction and
achalasia in various sphincters. After all, the gut does not work well when the
enteric nervous system (ENS) is not working well. The gut does not work at all
without the ENS minibrain.
Level of interest: An article of outstanding merit and interest in its field
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'
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