Reviewer ’s report  
Title:  An Appraisal of Clinical Practice Guidelines for Constipat ion:a Right Attitude Towards to 
Guidelines  
 
Version:  0 Date:  31 Aug 2015  
 
Reviewer:  Uday Ghoshal  
 
Reviewer's report:  
In this review, the authors evaluated the quality of the guidelines on constipation using Appraisal 
of Guidelines and Res earch and Evaluation (AGREEII) instrument. Though this is an important 
paper, there are several issues that require attention.  
1. Authors mentioned that the population prevalence of constipation is 16%. This may not be 
entirely correct as the prevalence w ould be variable in different population. Hence, it is 
important to review the prevalence in different population and give range rather than a 
single value.  
2. "Constipation is often associated with infrequent and/or painful defecation, fecal  
incontinence,  and abdominal pain; causes significant distress to the child and family" - 
authors should rather define constipation here remembering that frequency is less 
important in defining constipation currently; difficulty in passing stool and stool forms are 
more  important.  
3. Authors should more clearly present AGREII briefly so that reader can follow the article 
more clearly. Currently, it is difficult to follow the article without independently reading 
about AGREII.  
4. Authors mentioned in one place that there was no restriction as per language though in the 
other place they mentioned that only English and Chinese literature were reviewed.  
5. For some abbreviations, full forms are missing  
6. English needs substantial editing  
7. When was AGREII developed? Authors  evaluated the guidelines published from 2000 and 
onwards. Was AGREII available before that?  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
No 
Does the work include the necessary contro ls? 
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.  
Yes 
Are you able to assess any s tatistics 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 recommend additional statistica l review  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Not suitable for publication unless extensively edited  
Declaration of competing interests  
Please c omplete 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 publication o f 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 currently ap plying 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 no competing interests' 
below. If your reply is yes to any, please give details below.  
None  
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 co mments 
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:  An Appraisal of Clinical Practice Guidelines for Constipat ion:a Right Attitude Towards to 
Guidelines  
 
Version:  0 Date:  31 Aug 2015  
 
Reviewer:  Uday Ghoshal  
 
Reviewer's report:  
In this review, the authors evaluated the quality of the guidelines on constipation using Appraisal 
of Guidelines and Res earch and Evaluation (AGREEII) instrument. Though this is an important 
paper, there are several issues that require attention.  
1. Authors mentioned that the population prevalence of constipation is 16%. This may not be 
entirely correct as the prevalence w ould be variable in different population. Hence, it is 
important to review the prevalence in different population and give range rather than a 
single value.  
2. "Constipation is often associated with infrequent and/or painful defecation, fecal  
incontinence,  and abdominal pain; causes significant distress to the child and family" - 
authors should rather define constipation here remembering that frequency is less 
important in defining constipation currently; difficulty in passing stool and stool forms are 
more  important.  
3. Authors should more clearly present AGREII briefly so that reader can follow the article 
more clearly. Currently, it is difficult to follow the article without independently reading 
about AGREII.  
4. Authors mentioned in one place that there was no restriction as per language though in the 
other place they mentioned that only English and Chinese literature were reviewed.  
5. For some abbreviations, full forms are missing  
6. English needs substantial editing  
7. When was AGREII developed? Authors  evaluated the guidelines published from 2000 and 
onwards. Was AGREII available before that?  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
No 
Does the work include the necessary contro ls? 
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.  
Yes 
Are you able to assess any s tatistics 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 recommend additional statistica l review  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Not suitable for publication unless extensively edited  
Declaration of competing interests  
Please c omplete 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 publication o f 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 currently ap plying 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 no competing interests' 
below. If your reply is yes to any, please give details below.  
None  
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 co mments 
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:  An Appraisal of Clinical Practice Guidelines for Constipat ion:a Right Attitude Towards to 
Guidelines  
 
Version:  0 Date:  31 Aug 2015  
 
Reviewer:  Uday Ghoshal  
 
Reviewer's report:  
In this review, the authors evaluated the quality of the guidelines on constipation using Appraisal 
of Guidelines and Res earch and Evaluation (AGREEII) instrument. Though this is an important 
paper, there are several issues that require attention.  
1. Authors mentioned that the population prevalence of constipation is 16%. This may not be 
entirely correct as the prevalence w ould be variable in different population. Hence, it is 
important to review the prevalence in different population and give range rather than a 
single value.  
2. "Constipation is often associated with infrequent and/or painful defecation, fecal  
incontinence,  and abdominal pain; causes significant distress to the child and family" - 
authors should rather define constipation here remembering that frequency is less 
important in defining constipation currently; difficulty in passing stool and stool forms are 
more  important.  
3. Authors should more clearly present AGREII briefly so that reader can follow the article 
more clearly. Currently, it is difficult to follow the article without independently reading 
about AGREII.  
4. Authors mentioned in one place that there was no restriction as per language though in the 
other place they mentioned that only English and Chinese literature were reviewed.  
5. For some abbreviations, full forms are missing  
6. English needs substantial editing  
7. When was AGREII developed? Authors  evaluated the guidelines published from 2000 and 
onwards. Was AGREII available before that?  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
No 
Does the work include the necessary contro ls? 
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.  
Yes 
Are you able to assess any s tatistics 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 recommend additional statistica l review  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Not suitable for publication unless extensively edited  
Declaration of competing interests  
Please c omplete 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 publication o f 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 currently ap plying 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 no competing interests' 
below. If your reply is yes to any, please give details below.  
None  
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 co mments 
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