Reviewer ’s report  
 
Title: Interactive Decision Support for Esophageal Adenocarcinoma Screening and Surveillance  
 
Version: 0 Date: 25 Apr 2019  
 
Reviewer: Irene Cacciola  
 
Reviewer's report:  
 
The paper proposes an educational tool that provides a simple and rapid tool to graphically 
evaluat e the risk of Esophageal adenocarcinoma (EAC). The topic is certainly important and falls 
within the topic of the journal.  However, in the reviewer opinion the paper as it now stands is 
not ready to be published, but requires additional work to validate t he tool.  
At present, the Barrett's esophagus (BE) is the only known precursor of EAC and 
gastroesophageal reflux disease (GERD) is the most recognized risk factors for EAC. In this 
contest ,the American College of Gastroenterology states that "screening c an be considered in 
men with chronic (>5 years) and/or frequent (weekly or more) gastroesophageal reflux disease 
(GERD) symptoms and two or more risk factors for BE or EAC, including age >50, Caucasian 
race, central obesity, current or past history of smok ing, and family history (first -degree relative) 
with BE or EAC".  
However, an important limitation of screening is that > 40% of patients diagnosed with EAC 
have no history of typical GERD symptoms, such as heartburn.  
In the reviewer opinion, it would be important focus the attention on this 40 % of patients who 
have not typical GERD symptoms or family history of BE or EAC.  
Therefore, it should be assessed whether the proposed tool remains valid by excluding patients 
who do not have symptoms of GERD and including as variables: Race, Sex, Age,  central 
obesity, current or past history of smoking, use of aspirin and nonsteroida l antiinflammatory 
drugs (NSAIDs), Statins o Proton pump inhibitors (PPIs), and  the alcohol intake.  
According to the above major comments the paper is not recommended for publication in this 
form, but the authors are invited to address the above comments  in the reviewed version of the 
paper.  
Are the methods appropriate and well described?  
If not, please specify what is requir ed 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 e xplain 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 recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of compe ting 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 publication 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 currently applying for any patents relatin g 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.  
 
I declare that I have no competing interests' below  
 
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 wis h 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: Interactive Decision Support for Esophageal Adenocarcinoma Screening and Surveillance  
 
Version: 0 Date: 25 Apr 2019  
 
Reviewer: Irene Cacciola  
 
Reviewer's report:  
 
The paper proposes an educational tool that provides a simple and rapid tool to graphically 
evaluat e the risk of Esophageal adenocarcinoma (EAC). The topic is certainly important and falls 
within the topic of the journal.  However, in the reviewer opinion the paper as it now stands is 
not ready to be published, but requires additional work to validate t he tool.  
At present, the Barrett's esophagus (BE) is the only known precursor of EAC and 
gastroesophageal reflux disease (GERD) is the most recognized risk factors for EAC. In this 
contest ,the American College of Gastroenterology states that "screening c an be considered in 
men with chronic (>5 years) and/or frequent (weekly or more) gastroesophageal reflux disease 
(GERD) symptoms and two or more risk factors for BE or EAC, including age >50, Caucasian 
race, central obesity, current or past history of smok ing, and family history (first -degree relative) 
with BE or EAC".  
However, an important limitation of screening is that > 40% of patients diagnosed with EAC 
have no history of typical GERD symptoms, such as heartburn.  
In the reviewer opinion, it would be important focus the attention on this 40 % of patients who 
have not typical GERD symptoms or family history of BE or EAC.  
Therefore, it should be assessed whether the proposed tool remains valid by excluding patients 
who do not have symptoms of GERD and including as variables: Race, Sex, Age,  central 
obesity, current or past history of smoking, use of aspirin and nonsteroida l antiinflammatory 
drugs (NSAIDs), Statins o Proton pump inhibitors (PPIs), and  the alcohol intake.  
According to the above major comments the paper is not recommended for publication in this 
form, but the authors are invited to address the above comments  in the reviewed version of the 
paper.  
Are the methods appropriate and well described?  
If not, please specify what is requir ed 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 e xplain 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 recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of compe ting 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 publication 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 currently applying for any patents relatin g 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.  
 
I declare that I have no competing interests' below  
 
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 wis h 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: Interactive Decision Support for Esophageal Adenocarcinoma Screening and Surveillance  
 
Version: 0 Date: 25 Apr 2019  
 
Reviewer: Irene Cacciola  
 
Reviewer's report:  
 
The paper proposes an educational tool that provides a simple and rapid tool to graphically 
evaluat e the risk of Esophageal adenocarcinoma (EAC). The topic is certainly important and falls 
within the topic of the journal.  However, in the reviewer opinion the paper as it now stands is 
not ready to be published, but requires additional work to validate t he tool.  
At present, the Barrett's esophagus (BE) is the only known precursor of EAC and 
gastroesophageal reflux disease (GERD) is the most recognized risk factors for EAC. In this 
contest ,the American College of Gastroenterology states that "screening c an be considered in 
men with chronic (>5 years) and/or frequent (weekly or more) gastroesophageal reflux disease 
(GERD) symptoms and two or more risk factors for BE or EAC, including age >50, Caucasian 
race, central obesity, current or past history of smok ing, and family history (first -degree relative) 
with BE or EAC".  
However, an important limitation of screening is that > 40% of patients diagnosed with EAC 
have no history of typical GERD symptoms, such as heartburn.  
In the reviewer opinion, it would be important focus the attention on this 40 % of patients who 
have not typical GERD symptoms or family history of BE or EAC.  
Therefore, it should be assessed whether the proposed tool remains valid by excluding patients 
who do not have symptoms of GERD and including as variables: Race, Sex, Age,  central 
obesity, current or past history of smoking, use of aspirin and nonsteroida l antiinflammatory 
drugs (NSAIDs), Statins o Proton pump inhibitors (PPIs), and  the alcohol intake.  
According to the above major comments the paper is not recommended for publication in this 
form, but the authors are invited to address the above comments  in the reviewed version of the 
paper.  
Are the methods appropriate and well described?  
If not, please specify what is requir ed 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 e xplain 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 recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of compe ting 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 publication 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 currently applying for any patents relatin g 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.  
 
I declare that I have no competing interests' below  
 
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 wis h 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