Reviewer's report
Title:Importance of Duodenal Bulb Biopsies in the Diagnosis of Celiac Disease
in Clinical Practice
Version: 1Date:24 May 2009
Reviewer: Jeroen J Kolkman
Reviewer's report:
Major Compulsory Revisions (which the author must respond to before a
decision on publication can be reached)
1. This study includes only pediatric CD patients. This should be stated in title,
abstract, discussion and conclusion.
2. at p 9. the Hopper study is wrongly references to nr 14 (should be 15).
("Recognizing the patchy nature of the disorder, Hopper et al further studied the
number and location of biopsies required to make a definitive diagnosis of celiac
disease [14]".)
3. This study mainly confirms previous, larger studies. Although I agree the
importance of confrimatory studies in daily practice, the conclusion is therefore,
in my view, "overstated"
.
"In conclusion, villous atrophy can be patchy in patients with celiac disease with
duodenal
bulb mucosa being the only area showing histological changes in some cases. "
should in my view be:
"this study confirms previous reports that villous atrophy can be patchy in
pediatric patients with celiac disease with duodenal
bulb mucosa being the only area showing histological changes in some cases"
The remaining of the conclusion is not supported by the paper, but by other,
larger studies (Bonamico 2008 for example involves 665 patients, in contrast to
these 35 patients)
I would like to suggest to add that the current guideline may lead to
false-negative diagnosis with large implications for the patient (which would also
relate to the initial question of the paper).
Minor Essential Revisions (such as missing labels on figures, or the wrong use of
a term, which the author can be trusted to correct)
1. In the methods section I would like to suggest to explain the Marsh
classification, including the threshold for IEL's (the reference does cover this but
it makes the paper more easy to read).
2. on p4 the authors state that there question involved the outcome in daily
practice. A more precise definition of waht this sentence menas would be
helpfull.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Jeroen J Kolkman
Reviewer's report
Title:Importance of Duodenal Bulb Biopsies in the Diagnosis of Celiac Disease
in Clinical Practice
Version: 1Date:24 May 2009
Reviewer: Jeroen J Kolkman
Reviewer's report:
Major Compulsory Revisions (which the author must respond to before a
decision on publication can be reached)
1. This study includes only pediatric CD patients. This should be stated in title,
abstract, discussion and conclusion.
2. at p 9. the Hopper study is wrongly references to nr 14 (should be 15).
("Recognizing the patchy nature of the disorder, Hopper et al further studied the
number and location of biopsies required to make a definitive diagnosis of celiac
disease [14]".)
3. This study mainly confirms previous, larger studies. Although I agree the
importance of confrimatory studies in daily practice, the conclusion is therefore,
in my view, "overstated"
.
"In conclusion, villous atrophy can be patchy in patients with celiac disease with
duodenal
bulb mucosa being the only area showing histological changes in some cases. "
should in my view be:
"this study confirms previous reports that villous atrophy can be patchy in
pediatric patients with celiac disease with duodenal
bulb mucosa being the only area showing histological changes in some cases"
The remaining of the conclusion is not supported by the paper, but by other,
larger studies (Bonamico 2008 for example involves 665 patients, in contrast to
these 35 patients)
I would like to suggest to add that the current guideline may lead to
false-negative diagnosis with large implications for the patient (which would also
relate to the initial question of the paper).
Minor Essential Revisions (such as missing labels on figures, or the wrong use of
a term, which the author can be trusted to correct)
1. In the methods section I would like to suggest to explain the Marsh
classification, including the threshold for IEL's (the reference does cover this but
it makes the paper more easy to read).
2. on p4 the authors state that there question involved the outcome in daily
practice. A more precise definition of waht this sentence menas would be
helpfull.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Jeroen J Kolkman
Please review this paper.
user
Reviewer's report
Title:Importance of Duodenal Bulb Biopsies in the Diagnosis of Celiac Disease
in Clinical Practice
Version: 1Date:24 May 2009
Reviewer: Jeroen J Kolkman
Reviewer's report:
Major Compulsory Revisions (which the author must respond to before a
decision on publication can be reached)
1. This study includes only pediatric CD patients. This should be stated in title,
abstract, discussion and conclusion.
2. at p 9. the Hopper study is wrongly references to nr 14 (should be 15).
("Recognizing the patchy nature of the disorder, Hopper et al further studied the
number and location of biopsies required to make a definitive diagnosis of celiac
disease [14]".)
3. This study mainly confirms previous, larger studies. Although I agree the
importance of confrimatory studies in daily practice, the conclusion is therefore,
in my view, "overstated"
.
"In conclusion, villous atrophy can be patchy in patients with celiac disease with
duodenal
bulb mucosa being the only area showing histological changes in some cases. "
should in my view be:
"this study confirms previous reports that villous atrophy can be patchy in
pediatric patients with celiac disease with duodenal
bulb mucosa being the only area showing histological changes in some cases"
The remaining of the conclusion is not supported by the paper, but by other,
larger studies (Bonamico 2008 for example involves 665 patients, in contrast to
these 35 patients)
I would like to suggest to add that the current guideline may lead to
false-negative diagnosis with large implications for the patient (which would also
relate to the initial question of the paper).
Minor Essential Revisions (such as missing labels on figures, or the wrong use of
a term, which the author can be trusted to correct)
1. In the methods section I would like to suggest to explain the Marsh
classification, including the threshold for IEL's (the reference does cover this but
it makes the paper more easy to read).
2. on p4 the authors state that there question involved the outcome in daily
practice. A more precise definition of waht this sentence menas would be
helpfull.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'
Jeroen J Kolkman
assistant