Reviewer's report 
 A Connection between Chronic Sinusitis and Ulcerative Colitis Title: 
 1  24 November 2004 Version: Date: 
 Agesilao D'Arienzo Reviewer: 
Reviewer's report: 
This is an interesting study hypothesizing a connection between chronic sinusitis and ulcerative 
colitis after the observation of an improvement of intestinal symptoms following the surgical 
treatment of the infection of the sinuses. The presence of microbial products from sinuses swallowed to intestinal tract may suggest an action on the immune system of patients with UC. The first part of the study was prospectively conducted on human model whereas the second part 
was conducted on an animal model. 
The argument is interesting but the coexistence of an human and an animal model makes very 
diffucult to understand the real aim of the study and the argument appears not developed in deep in both sides. 
------------------------------------------------------------------------------- 
Major points 1. The title does not espress correctly the content of the manuscript (human and animal model) 2. The aim of the study is not clear. 
3. It is not clearly stated that 32 patients with both CS and UC were enrolled in the study. 
4. How were enrolled UC patients with and without CS and controls? Consecutively admitted or arbitrarily chosen? 5. UC clinical score (Truelove & Witts) on table 1 shows a 5 degree scale. What does represent this 
score scale? 0=remission, 1 mild, 2 moderate and 3 severe activity of the disease, â €¦â €¦.? The 
major part of the patients at baseline were with T&W score 3 and 4, and this is almost unusual if patients were not selected. It is surprising that CS surgery was performed in patient with high grade of severity of the intestinal disease. 
6. It is not described at all the treatment (steroids, mesalamine, immunosuppressors, surgery) for UC 
patients, that is very important especially for those with high T&W grade of the disease. The 
treatment, favorably affecting the clinical course of UC, may have biased the conclusions about the connection of CS and UC. 
7. Was this study completely approved by the local Ethical Commitee? Was the informed consent 
obtained from each patient? 8. Why table 2 was described before table 1? 
9. The chi-square test was used to compare the differences of clinical scores before and after FESS. 
The p values were omitted in the text. 
10. In the discussion session the authors conclude that in patients with UC and CS the treatment of CS significantly improved UC, but this is not supported by the results obtained from the human and the animal models. 
11. I suggest to eliminate the human model from the study that is inconsistent and needs to be better 
documented with an appropriate prospective study in which the sample size of patients should be 
calculated. The animal model is interesting and should be described as a comprehensive study to hypothesize 
the influence of superantigens able to â €œaffect intestinal barrier function to facilitate the intestinal 
mucosa to sensitize to food allergens and subsequently to initiate inflammation in the intestinal mucosa.â €
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of importance in its field Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
No to all of the above. 
Reviewer's report 
 A Connection between Chronic Sinusitis and Ulcerative Colitis Title: 
 1  24 November 2004 Version: Date: 
 Agesilao D'Arienzo Reviewer: 
Reviewer's report: 
This is an interesting study hypothesizing a connection between chronic sinusitis and ulcerative 
colitis after the observation of an improvement of intestinal symptoms following the surgical 
treatment of the infection of the sinuses. The presence of microbial products from sinuses swallowed to intestinal tract may suggest an action on the immune system of patients with UC. The first part of the study was prospectively conducted on human model whereas the second part 
was conducted on an animal model. 
The argument is interesting but the coexistence of an human and an animal model makes very 
diffucult to understand the real aim of the study and the argument appears not developed in deep in both sides. 
------------------------------------------------------------------------------- 
Major points 1. The title does not espress correctly the content of the manuscript (human and animal model) 2. The aim of the study is not clear. 
3. It is not clearly stated that 32 patients with both CS and UC were enrolled in the study. 
4. How were enrolled UC patients with and without CS and controls? Consecutively admitted or arbitrarily chosen? 5. UC clinical score (Truelove & Witts) on table 1 shows a 5 degree scale. What does represent this 
score scale? 0=remission, 1 mild, 2 moderate and 3 severe activity of the disease, â €¦â €¦.? The 
major part of the patients at baseline were with T&W score 3 and 4, and this is almost unusual if patients were not selected. It is surprising that CS surgery was performed in patient with high grade of severity of the intestinal disease. 
6. It is not described at all the treatment (steroids, mesalamine, immunosuppressors, surgery) for UC 
patients, that is very important especially for those with high T&W grade of the disease. The 
treatment, favorably affecting the clinical course of UC, may have biased the conclusions about the connection of CS and UC. 
7. Was this study completely approved by the local Ethical Commitee? Was the informed consent 
obtained from each patient? 8. Why table 2 was described before table 1? 
9. The chi-square test was used to compare the differences of clinical scores before and after FESS. 
The p values were omitted in the text. 
10. In the discussion session the authors conclude that in patients with UC and CS the treatment of CS significantly improved UC, but this is not supported by the results obtained from the human and the animal models. 
11. I suggest to eliminate the human model from the study that is inconsistent and needs to be better 
documented with an appropriate prospective study in which the sample size of patients should be 
calculated. The animal model is interesting and should be described as a comprehensive study to hypothesize 
the influence of superantigens able to â €œaffect intestinal barrier function to facilitate the intestinal 
mucosa to sensitize to food allergens and subsequently to initiate inflammation in the intestinal mucosa.â €
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of importance in its field Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
No to all of the above. 
Please review this paper.
user
Reviewer's report 
 A Connection between Chronic Sinusitis and Ulcerative Colitis Title: 
 1  24 November 2004 Version: Date: 
 Agesilao D'Arienzo Reviewer: 
Reviewer's report: 
This is an interesting study hypothesizing a connection between chronic sinusitis and ulcerative 
colitis after the observation of an improvement of intestinal symptoms following the surgical 
treatment of the infection of the sinuses. The presence of microbial products from sinuses swallowed to intestinal tract may suggest an action on the immune system of patients with UC. The first part of the study was prospectively conducted on human model whereas the second part 
was conducted on an animal model. 
The argument is interesting but the coexistence of an human and an animal model makes very 
diffucult to understand the real aim of the study and the argument appears not developed in deep in both sides. 
------------------------------------------------------------------------------- 
Major points 1. The title does not espress correctly the content of the manuscript (human and animal model) 2. The aim of the study is not clear. 
3. It is not clearly stated that 32 patients with both CS and UC were enrolled in the study. 
4. How were enrolled UC patients with and without CS and controls? Consecutively admitted or arbitrarily chosen? 5. UC clinical score (Truelove & Witts) on table 1 shows a 5 degree scale. What does represent this 
score scale? 0=remission, 1 mild, 2 moderate and 3 severe activity of the disease, â €¦â €¦.? The 
major part of the patients at baseline were with T&W score 3 and 4, and this is almost unusual if patients were not selected. It is surprising that CS surgery was performed in patient with high grade of severity of the intestinal disease. 
6. It is not described at all the treatment (steroids, mesalamine, immunosuppressors, surgery) for UC 
patients, that is very important especially for those with high T&W grade of the disease. The 
treatment, favorably affecting the clinical course of UC, may have biased the conclusions about the connection of CS and UC. 
7. Was this study completely approved by the local Ethical Commitee? Was the informed consent 
obtained from each patient? 8. Why table 2 was described before table 1? 
9. The chi-square test was used to compare the differences of clinical scores before and after FESS. 
The p values were omitted in the text. 
10. In the discussion session the authors conclude that in patients with UC and CS the treatment of CS significantly improved UC, but this is not supported by the results obtained from the human and the animal models. 
11. I suggest to eliminate the human model from the study that is inconsistent and needs to be better 
documented with an appropriate prospective study in which the sample size of patients should be 
calculated. The animal model is interesting and should be described as a comprehensive study to hypothesize 
the influence of superantigens able to â €œaffect intestinal barrier function to facilitate the intestinal 
mucosa to sensitize to food allergens and subsequently to initiate inflammation in the intestinal mucosa.â €
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article of importance in its field Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
No to all of the above. 
assistant