Reviewer ’s report  
 
Title: Trans -anal irrigation therapy to treat adult chronic functional constipation: A systematic  
review and meta -analysis  
 
Version: 0 Date: 20 Aug 2015  
 
Reviewer: Guillaume Bouguen  
 
Reviewer's report:  
 
In this manuscript, the authors reviewed current evidences on efficacy of transanal irrigation for  
functional constipation. I have no major concern for this study regarding the methodology and 
the main manuscript. Finally the main criticism remains on the value of such meta -analyse based 
on not well defined studies. The authors largely discuss this point and the conclusion sounds  
reasonable for this reason. That said, few data are available on the topic and usually 
assess/include  neurologic constipation (on e randomized trial on this population). Minor concern:  
Introduction  states outcomes of transanal irrigation "on the long term". Please add in the text the 
range of  follow -up period/treatment as well as in the table and states not available in the Table in 
the absence of such important date in the original paper. PLease a point on long term outcomes 
in the  discussion.  Table 5, please remove (0%).  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the aut hors.  
 
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.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to th e editors.  
 
I am able to assess the statistics  
 
 
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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, fees, 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 that 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 s alary 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 no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
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 attac hments 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 license ( 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: Trans -anal irrigation therapy to treat adult chronic functional constipation: A systematic  
review and meta -analysis  
 
Version: 0 Date: 20 Aug 2015  
 
Reviewer: Guillaume Bouguen  
 
Reviewer's report:  
 
In this manuscript, the authors reviewed current evidences on efficacy of transanal irrigation for  
functional constipation. I have no major concern for this study regarding the methodology and 
the main manuscript. Finally the main criticism remains on the value of such meta -analyse based 
on not well defined studies. The authors largely discuss this point and the conclusion sounds  
reasonable for this reason. That said, few data are available on the topic and usually 
assess/include  neurologic constipation (on e randomized trial on this population). Minor concern:  
Introduction  states outcomes of transanal irrigation "on the long term". Please add in the text the 
range of  follow -up period/treatment as well as in the table and states not available in the Table in 
the absence of such important date in the original paper. PLease a point on long term outcomes 
in the  discussion.  Table 5, please remove (0%).  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the aut hors.  
 
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.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to th e editors.  
 
I am able to assess the statistics  
 
 
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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, fees, 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 that 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 s alary 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 no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
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 attac hments 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 license ( 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: Trans -anal irrigation therapy to treat adult chronic functional constipation: A systematic  
review and meta -analysis  
 
Version: 0 Date: 20 Aug 2015  
 
Reviewer: Guillaume Bouguen  
 
Reviewer's report:  
 
In this manuscript, the authors reviewed current evidences on efficacy of transanal irrigation for  
functional constipation. I have no major concern for this study regarding the methodology and 
the main manuscript. Finally the main criticism remains on the value of such meta -analyse based 
on not well defined studies. The authors largely discuss this point and the conclusion sounds  
reasonable for this reason. That said, few data are available on the topic and usually 
assess/include  neurologic constipation (on e randomized trial on this population). Minor concern:  
Introduction  states outcomes of transanal irrigation "on the long term". Please add in the text the 
range of  follow -up period/treatment as well as in the table and states not available in the Table in 
the absence of such important date in the original paper. PLease a point on long term outcomes 
in the  discussion.  Table 5, please remove (0%).  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the aut hors.  
 
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.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to th e editors.  
 
I am able to assess the statistics  
 
 
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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, fees, 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 that 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 s alary 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 no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
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 attac hments 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 license ( 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