Title: The Reflux Symptom Score has good screening value for Laryngopharyngeal Reflux
Version: 2 Date: 25 Aug 2024
Reviewer's report:
Dear editors,
Thank you for inviting me to review this interesting report correlating results of multi-temporal
salivary pepsin assay with the reflux symptom scale. The authors have made appropriate
modifications in response to the prior reviewers’ recommendations. The authors adequately
acknowledge the limitations of their study design and contextualize the findings. I do have
several minor points to address.
Page 3, line 41: use of etc. is inappropriate.
Page 3, line 50: MII-pH testing does not use visual documentation of reflux
Page 4, line 64: it is not appropriate or correct to say RSS is scored in a more scientific manner
Page 6, line 111: “occurred every day in the” is repeated unnecessarily
Page 7-10: The discussion section should be better referenced. I generally agree with the
assertions made throughout much of the discussion, but many are unsupported by references to
the literature. There is ample prior work to reference with respect to timing of salivary pepsin
analysis, for example, but none are cited by the authors.
Page 10, line 204: I am not clear on what the authors mean by “multisite” pepsin test.
Page 10, line 207: I am not clear on why the sample size is considered a major limitation,
as the study showed a significant finding and clear predictive value between RSS and pepsin
positivity. Perhaps it would be more accurate to say that the population studied was not diverse
(e.g. included very few women)?
Page 10, line 207-212: the authors mix punctuation between different “bullet points” (semi-
colons and full-stops). It would be preferable to pick one or the other, and may be easier to
follow if the numerals were eliminated or followed by a close parenthesis instead of a full-stop.
Table 2: The authors report the RSI, an earlier, well-validated alternative to the newer RSS which
is falling out of favor based on data supporting the RSS's superiority for screening for LPR as
confirmed by MII-pH. Prior work has demonstrated a correlation of the RSI to salivary pepsin.
The authors should perform a similar analysis of the RSI’s predictive power for diagnosis of
LPR (with salivary pepsin as the “standard”) and compare this to the RSS.
Title: The Reflux Symptom Score has good screening value for Laryngopharyngeal Reflux
Version: 2 Date: 25 Aug 2024
Reviewer's report:
Dear editors,
Thank you for inviting me to review this interesting report correlating results of multi-temporal
salivary pepsin assay with the reflux symptom scale. The authors have made appropriate
modifications in response to the prior reviewers’ recommendations. The authors adequately
acknowledge the limitations of their study design and contextualize the findings. I do have
several minor points to address.
Page 3, line 41: use of etc. is inappropriate.
Page 3, line 50: MII-pH testing does not use visual documentation of reflux
Page 4, line 64: it is not appropriate or correct to say RSS is scored in a more scientific manner
Page 6, line 111: “occurred every day in the” is repeated unnecessarily
Page 7-10: The discussion section should be better referenced. I generally agree with the
assertions made throughout much of the discussion, but many are unsupported by references to
the literature. There is ample prior work to reference with respect to timing of salivary pepsin
analysis, for example, but none are cited by the authors.
Page 10, line 204: I am not clear on what the authors mean by “multisite” pepsin test.
Page 10, line 207: I am not clear on why the sample size is considered a major limitation,
as the study showed a significant finding and clear predictive value between RSS and pepsin
positivity. Perhaps it would be more accurate to say that the population studied was not diverse
(e.g. included very few women)?
Page 10, line 207-212: the authors mix punctuation between different “bullet points” (semi-
colons and full-stops). It would be preferable to pick one or the other, and may be easier to
follow if the numerals were eliminated or followed by a close parenthesis instead of a full-stop.
Table 2: The authors report the RSI, an earlier, well-validated alternative to the newer RSS which
is falling out of favor based on data supporting the RSS's superiority for screening for LPR as
confirmed by MII-pH. Prior work has demonstrated a correlation of the RSI to salivary pepsin.
The authors should perform a similar analysis of the RSI’s predictive power for diagnosis of
LPR (with salivary pepsin as the “standard”) and compare this to the RSS.
Please review this paper.
user
Title: The Reflux Symptom Score has good screening value for Laryngopharyngeal Reflux
Version: 2 Date: 25 Aug 2024
Reviewer's report:
Dear editors,
Thank you for inviting me to review this interesting report correlating results of multi-temporal
salivary pepsin assay with the reflux symptom scale. The authors have made appropriate
modifications in response to the prior reviewers’ recommendations. The authors adequately
acknowledge the limitations of their study design and contextualize the findings. I do have
several minor points to address.
Page 3, line 41: use of etc. is inappropriate.
Page 3, line 50: MII-pH testing does not use visual documentation of reflux
Page 4, line 64: it is not appropriate or correct to say RSS is scored in a more scientific manner
Page 6, line 111: “occurred every day in the” is repeated unnecessarily
Page 7-10: The discussion section should be better referenced. I generally agree with the
assertions made throughout much of the discussion, but many are unsupported by references to
the literature. There is ample prior work to reference with respect to timing of salivary pepsin
analysis, for example, but none are cited by the authors.
Page 10, line 204: I am not clear on what the authors mean by “multisite” pepsin test.
Page 10, line 207: I am not clear on why the sample size is considered a major limitation,
as the study showed a significant finding and clear predictive value between RSS and pepsin
positivity. Perhaps it would be more accurate to say that the population studied was not diverse
(e.g. included very few women)?
Page 10, line 207-212: the authors mix punctuation between different “bullet points” (semi-
colons and full-stops). It would be preferable to pick one or the other, and may be easier to
follow if the numerals were eliminated or followed by a close parenthesis instead of a full-stop.
Table 2: The authors report the RSI, an earlier, well-validated alternative to the newer RSS which
is falling out of favor based on data supporting the RSS's superiority for screening for LPR as
confirmed by MII-pH. Prior work has demonstrated a correlation of the RSI to salivary pepsin.
The authors should perform a similar analysis of the RSI’s predictive power for diagnosis of
LPR (with salivary pepsin as the “standard”) and compare this to the RSS.
assistant