Reviewer ’s report  
Title : Motility Characteristics in The Transition Zone in Gastroesophageal Reflux Disease 
(GORD) patients  
 
Version:  0 Date : 08 May 2016  
 
Reviewer : Mentore Ribolsi  
 
Reviewer's report:  
This investigation is aimed to transition zone (TZ) defect in GERD patients as well as to explore 
the relationship between transition zone defect and bolus transit. The  Authors studied 101 
patients with reflux symptoms and 20 healthy controls with upper gastrointestinal endoscopy, 
HRM combined with esophageal impedance and 24 -h ambulatory multichannel impedance pH 
monitoring. Patients were, thereafter, divided into reflu x oesophagitis (RE), Non -erosive Reflux 
Disease (NERD), hypersensitive oesophagus and functional heartburn (FH) group. According to 
the results, in liquid swallows, TZ were similar for length and duration among the groups. 
However, individuals with TZ defe ct had lower complete BT rates compared with those without 
TZ defect. There were also significantly more incomplete BT in RE, hypersensitive oesophagus 
and FH than in healthy controls.  
 
The study is well explained, however, I have several concerns:  
 
- Wher e FH patients not responding to PPIs? Since the Authors referred to Rome III criteria, 
the PPI response should be mentioned.  
- According to the results, the majority of patients have reflux esophagitis (38 vs 15 NERD and 
9 hypersensitive esophagus). This p roportion seems to be higher than that usually observed in 
a consecutive series of GERD patients. Moreover, the grading of esophagitis is not 
mentioned. It is thought that severe esophagitis might cause, or be caused, by weak 
peristalsis. I wonder if Autho rs provide the results of TZ and BT in the RE patients according 
to their grade.  
- The Authors stated that BT was calculated according Simren et al.. In my opinion the Authors 
should have to consider the duration (seconds) of BT also and, possibly, correla te this 
parameter with the length of TZ. Maybe, even if complete, a prolonged BT time could be 
relevant.  
- Were the study groups different in terms of reflux clearing time? Did patients with a higher 
frequency of incomplete BT have prolonged reflux clearin g as well as acid exposure time? 
These data should be provided.  
- Did patients have dysphagia also?  If so, there was any correlation with TZ and BT?  
 
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.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
No 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistica l 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 i n 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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publi cation of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 curr ently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received 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 n o 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 website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY l icense ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named 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 : Motility Characteristics in The Transition Zone in Gastroesophageal Reflux Disease 
(GORD) patients  
 
Version:  0 Date : 08 May 2016  
 
Reviewer : Mentore Ribolsi  
 
Reviewer's report:  
This investigation is aimed to transition zone (TZ) defect in GERD patients as well as to explore 
the relationship between transition zone defect and bolus transit. The  Authors studied 101 
patients with reflux symptoms and 20 healthy controls with upper gastrointestinal endoscopy, 
HRM combined with esophageal impedance and 24 -h ambulatory multichannel impedance pH 
monitoring. Patients were, thereafter, divided into reflu x oesophagitis (RE), Non -erosive Reflux 
Disease (NERD), hypersensitive oesophagus and functional heartburn (FH) group. According to 
the results, in liquid swallows, TZ were similar for length and duration among the groups. 
However, individuals with TZ defe ct had lower complete BT rates compared with those without 
TZ defect. There were also significantly more incomplete BT in RE, hypersensitive oesophagus 
and FH than in healthy controls.  
 
The study is well explained, however, I have several concerns:  
 
- Wher e FH patients not responding to PPIs? Since the Authors referred to Rome III criteria, 
the PPI response should be mentioned.  
- According to the results, the majority of patients have reflux esophagitis (38 vs 15 NERD and 
9 hypersensitive esophagus). This p roportion seems to be higher than that usually observed in 
a consecutive series of GERD patients. Moreover, the grading of esophagitis is not 
mentioned. It is thought that severe esophagitis might cause, or be caused, by weak 
peristalsis. I wonder if Autho rs provide the results of TZ and BT in the RE patients according 
to their grade.  
- The Authors stated that BT was calculated according Simren et al.. In my opinion the Authors 
should have to consider the duration (seconds) of BT also and, possibly, correla te this 
parameter with the length of TZ. Maybe, even if complete, a prolonged BT time could be 
relevant.  
- Were the study groups different in terms of reflux clearing time? Did patients with a higher 
frequency of incomplete BT have prolonged reflux clearin g as well as acid exposure time? 
These data should be provided.  
- Did patients have dysphagia also?  If so, there was any correlation with TZ and BT?  
 
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.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
No 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistica l 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 i n 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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publi cation of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 curr ently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received 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 n o 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 website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY l icense ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named 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 : Motility Characteristics in The Transition Zone in Gastroesophageal Reflux Disease 
(GORD) patients  
 
Version:  0 Date : 08 May 2016  
 
Reviewer : Mentore Ribolsi  
 
Reviewer's report:  
This investigation is aimed to transition zone (TZ) defect in GERD patients as well as to explore 
the relationship between transition zone defect and bolus transit. The  Authors studied 101 
patients with reflux symptoms and 20 healthy controls with upper gastrointestinal endoscopy, 
HRM combined with esophageal impedance and 24 -h ambulatory multichannel impedance pH 
monitoring. Patients were, thereafter, divided into reflu x oesophagitis (RE), Non -erosive Reflux 
Disease (NERD), hypersensitive oesophagus and functional heartburn (FH) group. According to 
the results, in liquid swallows, TZ were similar for length and duration among the groups. 
However, individuals with TZ defe ct had lower complete BT rates compared with those without 
TZ defect. There were also significantly more incomplete BT in RE, hypersensitive oesophagus 
and FH than in healthy controls.  
 
The study is well explained, however, I have several concerns:  
 
- Wher e FH patients not responding to PPIs? Since the Authors referred to Rome III criteria, 
the PPI response should be mentioned.  
- According to the results, the majority of patients have reflux esophagitis (38 vs 15 NERD and 
9 hypersensitive esophagus). This p roportion seems to be higher than that usually observed in 
a consecutive series of GERD patients. Moreover, the grading of esophagitis is not 
mentioned. It is thought that severe esophagitis might cause, or be caused, by weak 
peristalsis. I wonder if Autho rs provide the results of TZ and BT in the RE patients according 
to their grade.  
- The Authors stated that BT was calculated according Simren et al.. In my opinion the Authors 
should have to consider the duration (seconds) of BT also and, possibly, correla te this 
parameter with the length of TZ. Maybe, even if complete, a prolonged BT time could be 
relevant.  
- Were the study groups different in terms of reflux clearing time? Did patients with a higher 
frequency of incomplete BT have prolonged reflux clearin g as well as acid exposure time? 
These data should be provided.  
- Did patients have dysphagia also?  If so, there was any correlation with TZ and BT?  
 
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.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
No 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistica l 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 i n 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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publi cation of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 curr ently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received 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 n o 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 website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY l icense ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named 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