Reviewer ’s report  
 
Title: Long -term Outcomes and Quality of Life of Patien ts with Hirschsprung Disease: A 
Systematic Revi ew and Meta -analysis  
 
Version: 0 Date: 21 Mar 2019  
 
Reviewer: Rishi Bolia  
 
Reviewer's report:  
 
The authors have conducted a systemic review on the Long -term Outcome and quality of life of 
Patients with Hirschsprung's Disease. As the authors have pointed out there is a paucity of data, 
mostly limited to single - centre ob servational studies and this meta -analysis provides useful 
information in this regard. The meta -analysis appears to be well -conducted and is 
methodologically sound.  
 
 
Here are my comments -  
 
Title  
 
The title "Prevalence of long term outcome…." sounds gram matically incorrect to me. I'll 
suggest rephrasing it to simply "Long - term outcomes and ….."  
 
 
Abstract  
 
Include total number of references yielded in the search.  
 
The conclusion "Hirschsprung's disease were generally have higher prevalence…" is 
grammatically incorrect. Kindly re - write the conclusions to highlight the important findings of 
the meta - analysis.  
 
 
Introduction  
 
The introduction lacks coherence. I sugge st re - writing the introduction clearly describing the 
rationale for the review in the context of what is already known.  
 
Kindly re - phrase the line - Surgery is  "most common" treatment for HD ( makes one think that 
there are other non - surgical treatm ent available )  It is rather the principal treatment of HD.  
 
 
Methods  
Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if 
available, provide registration information including registration number.  
 
For the dat a collection process - were there any processes for obtaining and confirming data from 
individual investigators? If yes, please mention it.  
 
Did you search the reference lists / bibliographies of included studies?  
 
Kindly provide a list of all potentially r elevant studies that were read in full -text form but 
excluded from the review  
 
Spelling mistake - synmax  
 
The authors conclude from their analysis that the prevalence of GI problems are higher in these 
patients as compared to the "general population", but da ta regarding the general population ( 
controls ) is conspicuously absent.  
 
 
Discussion  
 
The main findings, strengths, limitations and implications for future research have been aptly 
discussed.  
 
As mentioned above the concluding remark about the prevalence b eing higher than that of the 
general population is not supported by data.  
 
 
Figures  
 
Forest plots - I believe that in a forest plot for prevalence studies  the estimates that are plotted 
over the  x-axis, extend from 0 (no members of the population have th e condition) to 1 (all 
members of the population have the condition). But these plots have a "negative" scale as well. 
why ?  
 
Are the methods appropriate and well described?  
If not, please specify what is required 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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in yo ur comments to the authors.  
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in yo ur comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please com plete 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 financial ly from the 
publication of 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 applying 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 f or 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 compe ting interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that i have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the a uthors and, if the manuscript is accepted f or 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 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: Long -term Outcomes and Quality of Life of Patien ts with Hirschsprung Disease: A 
Systematic Revi ew and Meta -analysis  
 
Version: 0 Date: 21 Mar 2019  
 
Reviewer: Rishi Bolia  
 
Reviewer's report:  
 
The authors have conducted a systemic review on the Long -term Outcome and quality of life of 
Patients with Hirschsprung's Disease. As the authors have pointed out there is a paucity of data, 
mostly limited to single - centre ob servational studies and this meta -analysis provides useful 
information in this regard. The meta -analysis appears to be well -conducted and is 
methodologically sound.  
 
 
Here are my comments -  
 
Title  
 
The title "Prevalence of long term outcome…." sounds gram matically incorrect to me. I'll 
suggest rephrasing it to simply "Long - term outcomes and ….."  
 
 
Abstract  
 
Include total number of references yielded in the search.  
 
The conclusion "Hirschsprung's disease were generally have higher prevalence…" is 
grammatically incorrect. Kindly re - write the conclusions to highlight the important findings of 
the meta - analysis.  
 
 
Introduction  
 
The introduction lacks coherence. I sugge st re - writing the introduction clearly describing the 
rationale for the review in the context of what is already known.  
 
Kindly re - phrase the line - Surgery is  "most common" treatment for HD ( makes one think that 
there are other non - surgical treatm ent available )  It is rather the principal treatment of HD.  
 
 
Methods  
Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if 
available, provide registration information including registration number.  
 
For the dat a collection process - were there any processes for obtaining and confirming data from 
individual investigators? If yes, please mention it.  
 
Did you search the reference lists / bibliographies of included studies?  
 
Kindly provide a list of all potentially r elevant studies that were read in full -text form but 
excluded from the review  
 
Spelling mistake - synmax  
 
The authors conclude from their analysis that the prevalence of GI problems are higher in these 
patients as compared to the "general population", but da ta regarding the general population ( 
controls ) is conspicuously absent.  
 
 
Discussion  
 
The main findings, strengths, limitations and implications for future research have been aptly 
discussed.  
 
As mentioned above the concluding remark about the prevalence b eing higher than that of the 
general population is not supported by data.  
 
 
Figures  
 
Forest plots - I believe that in a forest plot for prevalence studies  the estimates that are plotted 
over the  x-axis, extend from 0 (no members of the population have th e condition) to 1 (all 
members of the population have the condition). But these plots have a "negative" scale as well. 
why ?  
 
Are the methods appropriate and well described?  
If not, please specify what is required 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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in yo ur comments to the authors.  
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in yo ur comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please com plete 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 financial ly from the 
publication of 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 applying 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 f or 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 compe ting interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that i have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the a uthors and, if the manuscript is accepted f or 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 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: Long -term Outcomes and Quality of Life of Patien ts with Hirschsprung Disease: A 
Systematic Revi ew and Meta -analysis  
 
Version: 0 Date: 21 Mar 2019  
 
Reviewer: Rishi Bolia  
 
Reviewer's report:  
 
The authors have conducted a systemic review on the Long -term Outcome and quality of life of 
Patients with Hirschsprung's Disease. As the authors have pointed out there is a paucity of data, 
mostly limited to single - centre ob servational studies and this meta -analysis provides useful 
information in this regard. The meta -analysis appears to be well -conducted and is 
methodologically sound.  
 
 
Here are my comments -  
 
Title  
 
The title "Prevalence of long term outcome…." sounds gram matically incorrect to me. I'll 
suggest rephrasing it to simply "Long - term outcomes and ….."  
 
 
Abstract  
 
Include total number of references yielded in the search.  
 
The conclusion "Hirschsprung's disease were generally have higher prevalence…" is 
grammatically incorrect. Kindly re - write the conclusions to highlight the important findings of 
the meta - analysis.  
 
 
Introduction  
 
The introduction lacks coherence. I sugge st re - writing the introduction clearly describing the 
rationale for the review in the context of what is already known.  
 
Kindly re - phrase the line - Surgery is  "most common" treatment for HD ( makes one think that 
there are other non - surgical treatm ent available )  It is rather the principal treatment of HD.  
 
 
Methods  
Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if 
available, provide registration information including registration number.  
 
For the dat a collection process - were there any processes for obtaining and confirming data from 
individual investigators? If yes, please mention it.  
 
Did you search the reference lists / bibliographies of included studies?  
 
Kindly provide a list of all potentially r elevant studies that were read in full -text form but 
excluded from the review  
 
Spelling mistake - synmax  
 
The authors conclude from their analysis that the prevalence of GI problems are higher in these 
patients as compared to the "general population", but da ta regarding the general population ( 
controls ) is conspicuously absent.  
 
 
Discussion  
 
The main findings, strengths, limitations and implications for future research have been aptly 
discussed.  
 
As mentioned above the concluding remark about the prevalence b eing higher than that of the 
general population is not supported by data.  
 
 
Figures  
 
Forest plots - I believe that in a forest plot for prevalence studies  the estimates that are plotted 
over the  x-axis, extend from 0 (no members of the population have th e condition) to 1 (all 
members of the population have the condition). But these plots have a "negative" scale as well. 
why ?  
 
Are the methods appropriate and well described?  
If not, please specify what is required 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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in yo ur comments to the authors.  
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in yo ur comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please com plete 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 financial ly from the 
publication of 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 applying 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 f or 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 compe ting interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that i have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the a uthors and, if the manuscript is accepted f or 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 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