Reviewer ’s report  
 
Title:  FREQUENCY PATTERNS OF CORE CONS TIPATION SYMPTOMS AMONG THE 
ASIAN ADULTS: A SYSTEMATIC REVIEW  
 
Version: 0 Date: 30 Apr 2017 
 
Reviewer:  Massimo  Bellini  
 
Reviewer’s report:  
 
It is a potentially interesting paper dealing with an intriguing matter : if frequency patterns of 
constipation symptoms in adults are different between the West and the East  
 
Constipation represents a very important and worldwide problem afflic ting, often in a silent way, 
many people, especially females.  
 
It is highly appreciable that the authors underline the need to increase the diagnostic  confidence 
of constipation and its subtypes  
 
 
The aim of the study is clearly defined and the methods are s ufficiently described  
 
1) Unfortunately I think that the authors should also describe not only core constipation 
symptoms and their frequency patterns among the Asian adults, but also the same issues in 
Western  population (producing tables comparing the po ssible geographical differences, if any), 
and discussing them more in depth. They use  only few lines of their  paper to describe the "core 
" sympotoms in Western countries.  
 
Inded, in my opinion, this in depth comparison could be the real "news" !  
 
 
They co uld use some papers dealing with this matter in Western countries such as:  
 
-Bellini M Chronic constipation diagnosis and treatment ev aluation: the "CHRO.CO.DI.T.E." 
study BMC, 2017  
 
 Wald A, A multinational survey of prevalence and patterns of laxative u se among adults with 
self-defined constipation. APT 2008;28:917 -30.  
 
Gambaccini D, Sa2033 Chronic Constipation: ROME III Criteria and What Patients Think. Are 
We Talking the Same Language? Gastroenterology. 2014;146:S -360. 
 
 Tack J, Muller -Lissner S, Stanghellini V, Boeckxstaens G, Kamm MA, Simren M, Galmiche JP, 
Fried M. Diagnosis and trea tment of chronic constipation -a European perspective. 
Neurogastroenterology Motil. 2011;23:697 -710. doi:10.1111/j.1365 -2982.2011.01709.x. PMID: 
21605282.  
 
Bellini M, Management of chronic constipation in general practice. Tech Coloproctol. 
2014;18:543 -9.doi:10.1007/s10151 -013-1093 -9. PMID: 24272606.  
 
Suares NC,. Prevalence of, and risk factors for, chronic idiopathic constipation in the 
comm unity: syste matic review and meta -analysis. Am J Gastroenterol. 2011;106:1582 -91. 
doi:10 .1038/ajg.2011.164. quiz 1, 92. PMID: 2160697  
 
Johanson JF, Kralstein J (2007) Chronic constipation: a survey of  the patient perspective. 
Aliment Pharmacol Ther 25:599 -608 
 
The discussion and conclusions will provide clear benefits because the data shown in these 
papers, and in many other ones, surely will improve the quality of the paper adequately 
supporting the authors' opinions   
 
2) In the discussion the authors shou ld report more in depth  
 
-how lifestyle and cultural and dietary behaviours are able to affect the perception of symptoms  
 
-is there a different symptom perception between male and females  
 
3) Here enclosed you'll find also the text with some note added wh ich the authors should reply  
 
4) English could be improved.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the au thors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
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 statistical 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 in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consid ering 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 publication of this 
manuscript, either now or in the future?  
 
2. Do yo u 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 currently applying for any patents relating to the content of the 
manu script?  
 
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 no competing interests' 
below. If your reply is yes to any, please give details below.  
 
No 
 
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 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:  FREQUENCY PATTERNS OF CORE CONS TIPATION SYMPTOMS AMONG THE 
ASIAN ADULTS: A SYSTEMATIC REVIEW  
 
Version: 0 Date: 30 Apr 2017 
 
Reviewer:  Massimo  Bellini  
 
Reviewer’s report:  
 
It is a potentially interesting paper dealing with an intriguing matter : if frequency patterns of 
constipation symptoms in adults are different between the West and the East  
 
Constipation represents a very important and worldwide problem afflic ting, often in a silent way, 
many people, especially females.  
 
It is highly appreciable that the authors underline the need to increase the diagnostic  confidence 
of constipation and its subtypes  
 
 
The aim of the study is clearly defined and the methods are s ufficiently described  
 
1) Unfortunately I think that the authors should also describe not only core constipation 
symptoms and their frequency patterns among the Asian adults, but also the same issues in 
Western  population (producing tables comparing the po ssible geographical differences, if any), 
and discussing them more in depth. They use  only few lines of their  paper to describe the "core 
" sympotoms in Western countries.  
 
Inded, in my opinion, this in depth comparison could be the real "news" !  
 
 
They co uld use some papers dealing with this matter in Western countries such as:  
 
-Bellini M Chronic constipation diagnosis and treatment ev aluation: the "CHRO.CO.DI.T.E." 
study BMC, 2017  
 
 Wald A, A multinational survey of prevalence and patterns of laxative u se among adults with 
self-defined constipation. APT 2008;28:917 -30.  
 
Gambaccini D, Sa2033 Chronic Constipation: ROME III Criteria and What Patients Think. Are 
We Talking the Same Language? Gastroenterology. 2014;146:S -360. 
 
 Tack J, Muller -Lissner S, Stanghellini V, Boeckxstaens G, Kamm MA, Simren M, Galmiche JP, 
Fried M. Diagnosis and trea tment of chronic constipation -a European perspective. 
Neurogastroenterology Motil. 2011;23:697 -710. doi:10.1111/j.1365 -2982.2011.01709.x. PMID: 
21605282.  
 
Bellini M, Management of chronic constipation in general practice. Tech Coloproctol. 
2014;18:543 -9.doi:10.1007/s10151 -013-1093 -9. PMID: 24272606.  
 
Suares NC,. Prevalence of, and risk factors for, chronic idiopathic constipation in the 
comm unity: syste matic review and meta -analysis. Am J Gastroenterol. 2011;106:1582 -91. 
doi:10 .1038/ajg.2011.164. quiz 1, 92. PMID: 2160697  
 
Johanson JF, Kralstein J (2007) Chronic constipation: a survey of  the patient perspective. 
Aliment Pharmacol Ther 25:599 -608 
 
The discussion and conclusions will provide clear benefits because the data shown in these 
papers, and in many other ones, surely will improve the quality of the paper adequately 
supporting the authors' opinions   
 
2) In the discussion the authors shou ld report more in depth  
 
-how lifestyle and cultural and dietary behaviours are able to affect the perception of symptoms  
 
-is there a different symptom perception between male and females  
 
3) Here enclosed you'll find also the text with some note added wh ich the authors should reply  
 
4) English could be improved.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the au thors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
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 statistical 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 in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consid ering 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 publication of this 
manuscript, either now or in the future?  
 
2. Do yo u 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 currently applying for any patents relating to the content of the 
manu script?  
 
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 no competing interests' 
below. If your reply is yes to any, please give details below.  
 
No 
 
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 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:  FREQUENCY PATTERNS OF CORE CONS TIPATION SYMPTOMS AMONG THE 
ASIAN ADULTS: A SYSTEMATIC REVIEW  
 
Version: 0 Date: 30 Apr 2017 
 
Reviewer:  Massimo  Bellini  
 
Reviewer’s report:  
 
It is a potentially interesting paper dealing with an intriguing matter : if frequency patterns of 
constipation symptoms in adults are different between the West and the East  
 
Constipation represents a very important and worldwide problem afflic ting, often in a silent way, 
many people, especially females.  
 
It is highly appreciable that the authors underline the need to increase the diagnostic  confidence 
of constipation and its subtypes  
 
 
The aim of the study is clearly defined and the methods are s ufficiently described  
 
1) Unfortunately I think that the authors should also describe not only core constipation 
symptoms and their frequency patterns among the Asian adults, but also the same issues in 
Western  population (producing tables comparing the po ssible geographical differences, if any), 
and discussing them more in depth. They use  only few lines of their  paper to describe the "core 
" sympotoms in Western countries.  
 
Inded, in my opinion, this in depth comparison could be the real "news" !  
 
 
They co uld use some papers dealing with this matter in Western countries such as:  
 
-Bellini M Chronic constipation diagnosis and treatment ev aluation: the "CHRO.CO.DI.T.E." 
study BMC, 2017  
 
 Wald A, A multinational survey of prevalence and patterns of laxative u se among adults with 
self-defined constipation. APT 2008;28:917 -30.  
 
Gambaccini D, Sa2033 Chronic Constipation: ROME III Criteria and What Patients Think. Are 
We Talking the Same Language? Gastroenterology. 2014;146:S -360. 
 
 Tack J, Muller -Lissner S, Stanghellini V, Boeckxstaens G, Kamm MA, Simren M, Galmiche JP, 
Fried M. Diagnosis and trea tment of chronic constipation -a European perspective. 
Neurogastroenterology Motil. 2011;23:697 -710. doi:10.1111/j.1365 -2982.2011.01709.x. PMID: 
21605282.  
 
Bellini M, Management of chronic constipation in general practice. Tech Coloproctol. 
2014;18:543 -9.doi:10.1007/s10151 -013-1093 -9. PMID: 24272606.  
 
Suares NC,. Prevalence of, and risk factors for, chronic idiopathic constipation in the 
comm unity: syste matic review and meta -analysis. Am J Gastroenterol. 2011;106:1582 -91. 
doi:10 .1038/ajg.2011.164. quiz 1, 92. PMID: 2160697  
 
Johanson JF, Kralstein J (2007) Chronic constipation: a survey of  the patient perspective. 
Aliment Pharmacol Ther 25:599 -608 
 
The discussion and conclusions will provide clear benefits because the data shown in these 
papers, and in many other ones, surely will improve the quality of the paper adequately 
supporting the authors' opinions   
 
2) In the discussion the authors shou ld report more in depth  
 
-how lifestyle and cultural and dietary behaviours are able to affect the perception of symptoms  
 
-is there a different symptom perception between male and females  
 
3) Here enclosed you'll find also the text with some note added wh ich the authors should reply  
 
4) English could be improved.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the au thors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
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 statistical 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 in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consid ering 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 publication of this 
manuscript, either now or in the future?  
 
2. Do yo u 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 currently applying for any patents relating to the content of the 
manu script?  
 
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 no competing interests' 
below. If your reply is yes to any, please give details below.  
 
No 
 
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 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