Reviewer's report
Title:A Systematic Review and Meta-Analysis: Probiotics in the treatment of
Irritable Bowel Syndrome
Version: 2Date:5 July 2008
Reviewer: Eamonn M M Quigley
Reviewer's report:
Major Compulsory Revisions
1. Page 5 and elsewhere. "Flatulence" is NOT a primary or secondary symptom
of IBS and is not included in any of the definitions of IBS for the very good reason
that bloating (which is an IBS symptom) and flatulence are very different in
pathophysiology. The inclusion of flatulence in this discussion of IBS is
misleading and symptom scores that incorporate flatulence should be
discounted. In contrast, symptoms related to difficulty with bowel movements
(urgency, difficult defecation) which ARE major IBS symptoms are not discussed
or included in the analysis (page 8).
2. Page 12. Incorrectly refer to the O'Mahony study as a cross-over study which it
is not.
3. Page 12. Here refer to the studies referred to as refs 20 and 30 as
non-significant yet go on on page 14 to detail the issues related to ref 30
(Whorwell et al) and thr fact that one dose in ref 30 was significant. Specifically,
this meta-analysis does not take account of the fact that this particular study was
a dose-ranging study and would have been deliberately designed to include a
lower dose that would not work!
4. Table 2. I am surprised by the low scores for Kim (from the Mayo clinic) and
Whorwell (the largest study). What issues did these studies have with
randomization and concealment of allocation?
5. Figure 3. Which dose from the Whorwell study was included here?
6. Figs 4-6. Why were all studies not included here?
Minor Essential Revisions
O'Mahony is mis-spelt in a number of locations.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I have received honoraria and research support from Procter and Gamble, the
manufacturers of Align and am President of the World Gastroenterology
Organisation which has received unrestricted support from Danone.
Reviewer's report
Title:A Systematic Review and Meta-Analysis: Probiotics in the treatment of
Irritable Bowel Syndrome
Version: 2Date:5 July 2008
Reviewer: Eamonn M M Quigley
Reviewer's report:
Major Compulsory Revisions
1. Page 5 and elsewhere. "Flatulence" is NOT a primary or secondary symptom
of IBS and is not included in any of the definitions of IBS for the very good reason
that bloating (which is an IBS symptom) and flatulence are very different in
pathophysiology. The inclusion of flatulence in this discussion of IBS is
misleading and symptom scores that incorporate flatulence should be
discounted. In contrast, symptoms related to difficulty with bowel movements
(urgency, difficult defecation) which ARE major IBS symptoms are not discussed
or included in the analysis (page 8).
2. Page 12. Incorrectly refer to the O'Mahony study as a cross-over study which it
is not.
3. Page 12. Here refer to the studies referred to as refs 20 and 30 as
non-significant yet go on on page 14 to detail the issues related to ref 30
(Whorwell et al) and thr fact that one dose in ref 30 was significant. Specifically,
this meta-analysis does not take account of the fact that this particular study was
a dose-ranging study and would have been deliberately designed to include a
lower dose that would not work!
4. Table 2. I am surprised by the low scores for Kim (from the Mayo clinic) and
Whorwell (the largest study). What issues did these studies have with
randomization and concealment of allocation?
5. Figure 3. Which dose from the Whorwell study was included here?
6. Figs 4-6. Why were all studies not included here?
Minor Essential Revisions
O'Mahony is mis-spelt in a number of locations.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I have received honoraria and research support from Procter and Gamble, the
manufacturers of Align and am President of the World Gastroenterology
Organisation which has received unrestricted support from Danone.
Please review this paper.
user
Reviewer's report
Title:A Systematic Review and Meta-Analysis: Probiotics in the treatment of
Irritable Bowel Syndrome
Version: 2Date:5 July 2008
Reviewer: Eamonn M M Quigley
Reviewer's report:
Major Compulsory Revisions
1. Page 5 and elsewhere. "Flatulence" is NOT a primary or secondary symptom
of IBS and is not included in any of the definitions of IBS for the very good reason
that bloating (which is an IBS symptom) and flatulence are very different in
pathophysiology. The inclusion of flatulence in this discussion of IBS is
misleading and symptom scores that incorporate flatulence should be
discounted. In contrast, symptoms related to difficulty with bowel movements
(urgency, difficult defecation) which ARE major IBS symptoms are not discussed
or included in the analysis (page 8).
2. Page 12. Incorrectly refer to the O'Mahony study as a cross-over study which it
is not.
3. Page 12. Here refer to the studies referred to as refs 20 and 30 as
non-significant yet go on on page 14 to detail the issues related to ref 30
(Whorwell et al) and thr fact that one dose in ref 30 was significant. Specifically,
this meta-analysis does not take account of the fact that this particular study was
a dose-ranging study and would have been deliberately designed to include a
lower dose that would not work!
4. Table 2. I am surprised by the low scores for Kim (from the Mayo clinic) and
Whorwell (the largest study). What issues did these studies have with
randomization and concealment of allocation?
5. Figure 3. Which dose from the Whorwell study was included here?
6. Figs 4-6. Why were all studies not included here?
Minor Essential Revisions
O'Mahony is mis-spelt in a number of locations.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I have received honoraria and research support from Procter and Gamble, the
manufacturers of Align and am President of the World Gastroenterology
Organisation which has received unrestricted support from Danone.
assistant