Reviewer's report 
 Gastroparesis secondary to a demyelinating disease: A Case Series Title: 
 1  23 November 2006 Version: Date: 
 Oliver Goetze Reviewer: 
Reviewer's report: 
Reddymasu et al. report in a case series of two patients an association of early brain demyelinations in the 
medullary region with delayed gastric emptying (GE) and show an improvement of gastric emptying as well 
as of gastrointestinal and neurological symptoms after treatment with glucocorticoids. The topic is of clinical, pathophysiological and therapeutical interest. To my knowledge only five cases have been published up to now. 
However, the authors should include more clinical data and differential pathophysiological and therapeutical
considerations and highlight how their findings relate to the published case reports and literature. 
Major comments: 
Abstract 
1.The authors should conclude that the improvement of gastrointestinal and neurological symptoms and 
gastroparesis by corticosteroids might only be achieved in early stages of the disease. Discussion: 
2.The authors should highlight how their case series relate to the published literature (Rhagav et al., multiple 
sclerosis 2006; Read et al., Lancet 1995; Atkinson et al., Digestive Diseases and Sciences 1998). 
3.Possible differential pathophysiological mechanisms should be provided e.g. lesions in the vestibular system could also be an explanation for generation of nausea and delayed GE. (Faas et al., Am J Phsiol 
Gastrointest Liver Physiol, 2001) 
4. The effect of other published therapeutical approaches (cisapride) and the effects of glucocorticoids in established multiple sclerosis should be discussed. 
Minor comments: 
Case presentation: 5.The neurological physical exam should be presented more precisely (e.g. cranial nerve function, kind of nystagmus, nystagmus on gaze, reflexes, Babinski signs etc.) 
6.Which technique for measurement of gastric emptying test was used (scintigraphy, MRI etc.) ? What was 
the caloric content of the test-meal ? Was gastric emptying measured until complete stomach emptying ? Was gastric half emptying time determined ? Normal values for GE should be provided in this section. 7.Were also autonomic (abdomino-vagal) function tests performed ? 
8.Which dose of methylprednisolone was administered ? 
Discussion: 9.The statement that corticosteroids can be used for treatment of nausea and vomiting, but not for treatment of gastroparesis should better be referenced. 
10. Table 1 should be deleted, since it repeats information already given in the text. 
11. More informative than the table could be an MRI image slice indicating the lesions in the medulla. 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests. 
Reviewer's report 
 Gastroparesis secondary to a demyelinating disease: A Case Series Title: 
 1  23 November 2006 Version: Date: 
 Oliver Goetze Reviewer: 
Reviewer's report: 
Reddymasu et al. report in a case series of two patients an association of early brain demyelinations in the 
medullary region with delayed gastric emptying (GE) and show an improvement of gastric emptying as well 
as of gastrointestinal and neurological symptoms after treatment with glucocorticoids. The topic is of clinical, pathophysiological and therapeutical interest. To my knowledge only five cases have been published up to now. 
However, the authors should include more clinical data and differential pathophysiological and therapeutical
considerations and highlight how their findings relate to the published case reports and literature. 
Major comments: 
Abstract 
1.The authors should conclude that the improvement of gastrointestinal and neurological symptoms and 
gastroparesis by corticosteroids might only be achieved in early stages of the disease. Discussion: 
2.The authors should highlight how their case series relate to the published literature (Rhagav et al., multiple 
sclerosis 2006; Read et al., Lancet 1995; Atkinson et al., Digestive Diseases and Sciences 1998). 
3.Possible differential pathophysiological mechanisms should be provided e.g. lesions in the vestibular system could also be an explanation for generation of nausea and delayed GE. (Faas et al., Am J Phsiol 
Gastrointest Liver Physiol, 2001) 
4. The effect of other published therapeutical approaches (cisapride) and the effects of glucocorticoids in established multiple sclerosis should be discussed. 
Minor comments: 
Case presentation: 5.The neurological physical exam should be presented more precisely (e.g. cranial nerve function, kind of nystagmus, nystagmus on gaze, reflexes, Babinski signs etc.) 
6.Which technique for measurement of gastric emptying test was used (scintigraphy, MRI etc.) ? What was 
the caloric content of the test-meal ? Was gastric emptying measured until complete stomach emptying ? Was gastric half emptying time determined ? Normal values for GE should be provided in this section. 7.Were also autonomic (abdomino-vagal) function tests performed ? 
8.Which dose of methylprednisolone was administered ? 
Discussion: 9.The statement that corticosteroids can be used for treatment of nausea and vomiting, but not for treatment of gastroparesis should better be referenced. 
10. Table 1 should be deleted, since it repeats information already given in the text. 
11. More informative than the table could be an MRI image slice indicating the lesions in the medulla. 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests. 
Please review this paper.
user
Reviewer's report 
 Gastroparesis secondary to a demyelinating disease: A Case Series Title: 
 1  23 November 2006 Version: Date: 
 Oliver Goetze Reviewer: 
Reviewer's report: 
Reddymasu et al. report in a case series of two patients an association of early brain demyelinations in the 
medullary region with delayed gastric emptying (GE) and show an improvement of gastric emptying as well 
as of gastrointestinal and neurological symptoms after treatment with glucocorticoids. The topic is of clinical, pathophysiological and therapeutical interest. To my knowledge only five cases have been published up to now. 
However, the authors should include more clinical data and differential pathophysiological and therapeutical
considerations and highlight how their findings relate to the published case reports and literature. 
Major comments: 
Abstract 
1.The authors should conclude that the improvement of gastrointestinal and neurological symptoms and 
gastroparesis by corticosteroids might only be achieved in early stages of the disease. Discussion: 
2.The authors should highlight how their case series relate to the published literature (Rhagav et al., multiple 
sclerosis 2006; Read et al., Lancet 1995; Atkinson et al., Digestive Diseases and Sciences 1998). 
3.Possible differential pathophysiological mechanisms should be provided e.g. lesions in the vestibular system could also be an explanation for generation of nausea and delayed GE. (Faas et al., Am J Phsiol 
Gastrointest Liver Physiol, 2001) 
4. The effect of other published therapeutical approaches (cisapride) and the effects of glucocorticoids in established multiple sclerosis should be discussed. 
Minor comments: 
Case presentation: 5.The neurological physical exam should be presented more precisely (e.g. cranial nerve function, kind of nystagmus, nystagmus on gaze, reflexes, Babinski signs etc.) 
6.Which technique for measurement of gastric emptying test was used (scintigraphy, MRI etc.) ? What was 
the caloric content of the test-meal ? Was gastric emptying measured until complete stomach emptying ? Was gastric half emptying time determined ? Normal values for GE should be provided in this section. 7.Were also autonomic (abdomino-vagal) function tests performed ? 
8.Which dose of methylprednisolone was administered ? 
Discussion: 9.The statement that corticosteroids can be used for treatment of nausea and vomiting, but not for treatment of gastroparesis should better be referenced. 
10. Table 1 should be deleted, since it repeats information already given in the text. 
11. More informative than the table could be an MRI image slice indicating the lesions in the medulla. 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests. 
assistant