Reviewer's report 
 Esophageal and Small Bowel Obstruction by Occupational Bezoar: Report of a Case Title: 
Authors: 
Michail Pitiakoudis ( mpitiak@med.duth.gr )
Dr Alexandra K Tsaroucha ( tsihrin@otenet.gr )
Konstantinos Mimidis ( mpitiak@med.duth.gr )
Theodoros Constantinidis ( tconstan@med.duth.gr )
Stavros Anagnostoulis ( atsarouc@med.duth.gr )
George Stathopoulos ( stathg@otenet.gr )
Constandinos Simopoulos ( simop@med.duth.gr )
 1  27 Feb 2003 Version: Date: 
 Basil J J Ammori Reviewer: 
 A paper of limited interest Level of interest: 
 Accept after discretionary revisions Advice on publication: 
Interesting case report! 
MAJOR COMMENT: 
The authors suggested in their concluding paragraph the avoidance of 'certain kinds of fibre'. Which kinds of fibre? Please specify. MINOR COMMENTS: 
The following alterations are suggested to improve the English and readability of the article: 
- ABSTRACT: - Background-Last sentence: Intestinal obstruction .... "has" (instead of 'have')not been reported. -Case Presentation-Third sentence: 'He had undergone a vagotomy and pyloroplasty 10 years 
earlier.' 
- CASE PRESENTATION: - First sentence: ..... complained "of" (instead of 'about') - First paragraph-Last sentence: ..... 'vagotomy and pyloroplasty'. (instead of 'pyloroplasty and 
vagotomy') 
- Second paragraph-Third sentence: Vomiting continued and 'the' dysphagia 'worsened'. - Second paragarph- join and shorthen the 4th & 5th sentences: The patient then underwent 'an' upper gastrointestinal endoscopy, 'which' showed ..... (Fig 1). 
- Third paragraph- 1st sentence: delete 'so he was kept in the hospital for further examination'. 
- Third paragraph-2nd sentence: 'developed' instead of 'felt', 'repeat X-ray' instead of 'new X-ray'. The remainder of the 3rd paragraph may read better as follows: 'He was then transefrred to the surgical team, where failure of a few days of conservative treatment necessitated an exploratory 
laparotomy. The laparotomy revealed a complete distal ileal obstruction secondary to a solid 
intrluminal foreign body (dimensions ....), which was removed through an enterotomy (Figs. 3 and 4). Pathological examination of the foreign body revealed a composition similar to that removed from the oesophagus (Fig. 2b). The patient was discharged on the 8th postoperative day, and has 
remained well at 18 months follow up.' 
- DISCUSSION: - 1st paragarph-Line 6: 'into' the bowel, rather than 'in' the bowel. - The remainder of the 1st paragarph may better read as follows: 'Obstruction from phytobezoars 
usually occurs in the ileum or jejunum, and it is unusual for reverse migration of the bezoar to the 
oesophagus to occur and result in obstruction as occurred in our patient [5,6]. Some of the 
pathogenic mechanisms responsible for bezoar formation in patients with previous vagotomy and 
pyloroplasty include decreased secretion of hydrochoric acid, decreased gastric motility (atonic 
stomach), and occupational exposure [1,2,4].' - 2nd paragarph- 1st & 2nd sentences might read better as follows: 'Whilst bezoars located in the esophagus or stomach should be treated conservatively in the first instance [3], those causing acute 
intestinal obstruction clearly require surgical intervention [1,3,4].' 
- Page 6, line 21: while the rest "migrated" from the stomach ... - Page 6, Line 22: replace 'moved to the' with 'and into' ... - Page 7-Line 3: Delete the first sentence of the paragarph 'This is a rare case ....', as this has been 
stated earlier in the Discussion. 
- Page 7, Line 8: 'workers' instead of 'worker'. - Page 7, Line 11: replace 'also' with 'are advised to'. 
Competing interests: 
None declared. 
Reviewer's report 
 Esophageal and Small Bowel Obstruction by Occupational Bezoar: Report of a Case Title: 
Authors: 
Michail Pitiakoudis ( mpitiak@med.duth.gr )
Dr Alexandra K Tsaroucha ( tsihrin@otenet.gr )
Konstantinos Mimidis ( mpitiak@med.duth.gr )
Theodoros Constantinidis ( tconstan@med.duth.gr )
Stavros Anagnostoulis ( atsarouc@med.duth.gr )
George Stathopoulos ( stathg@otenet.gr )
Constandinos Simopoulos ( simop@med.duth.gr )
 1  27 Feb 2003 Version: Date: 
 Basil J J Ammori Reviewer: 
 A paper of limited interest Level of interest: 
 Accept after discretionary revisions Advice on publication: 
Interesting case report! 
MAJOR COMMENT: 
The authors suggested in their concluding paragraph the avoidance of 'certain kinds of fibre'. Which kinds of fibre? Please specify. MINOR COMMENTS: 
The following alterations are suggested to improve the English and readability of the article: 
- ABSTRACT: - Background-Last sentence: Intestinal obstruction .... "has" (instead of 'have')not been reported. -Case Presentation-Third sentence: 'He had undergone a vagotomy and pyloroplasty 10 years 
earlier.' 
- CASE PRESENTATION: - First sentence: ..... complained "of" (instead of 'about') - First paragraph-Last sentence: ..... 'vagotomy and pyloroplasty'. (instead of 'pyloroplasty and 
vagotomy') 
- Second paragraph-Third sentence: Vomiting continued and 'the' dysphagia 'worsened'. - Second paragarph- join and shorthen the 4th & 5th sentences: The patient then underwent 'an' upper gastrointestinal endoscopy, 'which' showed ..... (Fig 1). 
- Third paragraph- 1st sentence: delete 'so he was kept in the hospital for further examination'. 
- Third paragraph-2nd sentence: 'developed' instead of 'felt', 'repeat X-ray' instead of 'new X-ray'. The remainder of the 3rd paragraph may read better as follows: 'He was then transefrred to the surgical team, where failure of a few days of conservative treatment necessitated an exploratory 
laparotomy. The laparotomy revealed a complete distal ileal obstruction secondary to a solid 
intrluminal foreign body (dimensions ....), which was removed through an enterotomy (Figs. 3 and 4). Pathological examination of the foreign body revealed a composition similar to that removed from the oesophagus (Fig. 2b). The patient was discharged on the 8th postoperative day, and has 
remained well at 18 months follow up.' 
- DISCUSSION: - 1st paragarph-Line 6: 'into' the bowel, rather than 'in' the bowel. - The remainder of the 1st paragarph may better read as follows: 'Obstruction from phytobezoars 
usually occurs in the ileum or jejunum, and it is unusual for reverse migration of the bezoar to the 
oesophagus to occur and result in obstruction as occurred in our patient [5,6]. Some of the 
pathogenic mechanisms responsible for bezoar formation in patients with previous vagotomy and 
pyloroplasty include decreased secretion of hydrochoric acid, decreased gastric motility (atonic 
stomach), and occupational exposure [1,2,4].' - 2nd paragarph- 1st & 2nd sentences might read better as follows: 'Whilst bezoars located in the esophagus or stomach should be treated conservatively in the first instance [3], those causing acute 
intestinal obstruction clearly require surgical intervention [1,3,4].' 
- Page 6, line 21: while the rest "migrated" from the stomach ... - Page 6, Line 22: replace 'moved to the' with 'and into' ... - Page 7-Line 3: Delete the first sentence of the paragarph 'This is a rare case ....', as this has been 
stated earlier in the Discussion. 
- Page 7, Line 8: 'workers' instead of 'worker'. - Page 7, Line 11: replace 'also' with 'are advised to'. 
Competing interests: 
None declared. 
Please review this paper.
user
Reviewer's report 
 Esophageal and Small Bowel Obstruction by Occupational Bezoar: Report of a Case Title: 
Authors: 
Michail Pitiakoudis ( mpitiak@med.duth.gr )
Dr Alexandra K Tsaroucha ( tsihrin@otenet.gr )
Konstantinos Mimidis ( mpitiak@med.duth.gr )
Theodoros Constantinidis ( tconstan@med.duth.gr )
Stavros Anagnostoulis ( atsarouc@med.duth.gr )
George Stathopoulos ( stathg@otenet.gr )
Constandinos Simopoulos ( simop@med.duth.gr )
 1  27 Feb 2003 Version: Date: 
 Basil J J Ammori Reviewer: 
 A paper of limited interest Level of interest: 
 Accept after discretionary revisions Advice on publication: 
Interesting case report! 
MAJOR COMMENT: 
The authors suggested in their concluding paragraph the avoidance of 'certain kinds of fibre'. Which kinds of fibre? Please specify. MINOR COMMENTS: 
The following alterations are suggested to improve the English and readability of the article: 
- ABSTRACT: - Background-Last sentence: Intestinal obstruction .... "has" (instead of 'have')not been reported. -Case Presentation-Third sentence: 'He had undergone a vagotomy and pyloroplasty 10 years 
earlier.' 
- CASE PRESENTATION: - First sentence: ..... complained "of" (instead of 'about') - First paragraph-Last sentence: ..... 'vagotomy and pyloroplasty'. (instead of 'pyloroplasty and 
vagotomy') 
- Second paragraph-Third sentence: Vomiting continued and 'the' dysphagia 'worsened'. - Second paragarph- join and shorthen the 4th & 5th sentences: The patient then underwent 'an' upper gastrointestinal endoscopy, 'which' showed ..... (Fig 1). 
- Third paragraph- 1st sentence: delete 'so he was kept in the hospital for further examination'. 
- Third paragraph-2nd sentence: 'developed' instead of 'felt', 'repeat X-ray' instead of 'new X-ray'. The remainder of the 3rd paragraph may read better as follows: 'He was then transefrred to the surgical team, where failure of a few days of conservative treatment necessitated an exploratory 
laparotomy. The laparotomy revealed a complete distal ileal obstruction secondary to a solid 
intrluminal foreign body (dimensions ....), which was removed through an enterotomy (Figs. 3 and 4). Pathological examination of the foreign body revealed a composition similar to that removed from the oesophagus (Fig. 2b). The patient was discharged on the 8th postoperative day, and has 
remained well at 18 months follow up.' 
- DISCUSSION: - 1st paragarph-Line 6: 'into' the bowel, rather than 'in' the bowel. - The remainder of the 1st paragarph may better read as follows: 'Obstruction from phytobezoars 
usually occurs in the ileum or jejunum, and it is unusual for reverse migration of the bezoar to the 
oesophagus to occur and result in obstruction as occurred in our patient [5,6]. Some of the 
pathogenic mechanisms responsible for bezoar formation in patients with previous vagotomy and 
pyloroplasty include decreased secretion of hydrochoric acid, decreased gastric motility (atonic 
stomach), and occupational exposure [1,2,4].' - 2nd paragarph- 1st & 2nd sentences might read better as follows: 'Whilst bezoars located in the esophagus or stomach should be treated conservatively in the first instance [3], those causing acute 
intestinal obstruction clearly require surgical intervention [1,3,4].' 
- Page 6, line 21: while the rest "migrated" from the stomach ... - Page 6, Line 22: replace 'moved to the' with 'and into' ... - Page 7-Line 3: Delete the first sentence of the paragarph 'This is a rare case ....', as this has been 
stated earlier in the Discussion. 
- Page 7, Line 8: 'workers' instead of 'worker'. - Page 7, Line 11: replace 'also' with 'are advised to'. 
Competing interests: 
None declared. 
assistant