Reviewer ’s report  
 
Title:  Pneumatosis cystoides intestinalis: six case reports and a rev iew of the literature  
 
Version: 1 Date: 01 Dec 2017 
 
Reviewer : Ridhi  Gupta  
 
Reviewer’s report:  
 
Reviewer comments: BMC Gastroenterology  
 
Major grammatical errors need to be rectified and english improved to be ready for publication  
 
 
Abstract:  
 
Good summary of the case series. Only thing missing is the presenting symptoms to suspe ct PCI 
(very minor change)  
 
- Please reference all the short forms used in the article later. Eg. Trichloroethylene (TCE) 
etc. I choose this example specifically as this is used later in the article with no prior 
reference. All short forms need to be refere nced in the article first before being used.  
 
 
Background:  
 
Multiple grammatical and semantic errors:  
 
- Line 5: year mentioned as 19522 -? to be corrected  
 
- 4 mechanisms mentioned in the pathophysiology but 6 are mentioned. Either consolidate 
to 4 or cha nge the number to 6   
 
- line 32: reference number - 910 reference or [9,10]  
 
 
Case presentation -  
 
Case 1 -  
 
- please mention the full term before using as a short form -? NBI.  
 
- Endoscopic examination disclosed scattered bubble -like or cystoid nodules and  the lesion 
distributed in transverse colon - what is 'the lesion' - PCI or some other lesions. Needs 
clarity  
- The patient was symptom -free at that time and the lesions disappeared completely - clarity 
needed on this statement. When was the patient symptom  free post procedure?  
 
 
Case 2 -  
 
- Colonoscopic examination disclosed Grape -like or beaded subepithelial lesions and some 
with erythematous mucosa and the lesion distributed in sigmoid and due to narrowing of 
the lumen, colonoscopy failed to complete. - please rephrase, grammatically incorrect and 
incomprehensible.  Could say: Colonoscopy revealed grape - like or beaded subepithelial 
lesions, some with erythematous mucosa distributed in the sigmoid. Given the narrowing 
of the lumen secondary to these lesions  the colonoscopy was incomplete.  
 
 
Case 3 -  
 
- The biochemical tests revealed that one case had cytopenia due to AA, while the other 
cases were hemodynamically stable without any obvious abnormality in stool culture for 
pathogens. - please rephrase.  What is the mention of one case had cytopenias whi le the 
other cases were HD stable. If this is a mention for a patient in case 3 - please refer only 
to that patient's findings. The comparison of cases can be done in the discussion portions. 
Also, unclear if biochemical tests are being discussed, what is the reason for mention of 
hemodynamic stability i.e vital signs. This disrupts the flow of the case and interrupts 
readability of the article.  
 
- Line 57 - replace word relieved by resolved.  
 
 
Case 4 -  
 
- Physical examination revealed no abnormality except a  tender obese abdomen. Physical 
examination at admission revealed extensive abdominal tenderness. - duplicate mention 
of physical exam.  
 
- Line 10: word colon after ascending is missing  
 
- Colonoscopy showed irregular forms lesions that were covered with mu cosa of normal 
appearance in sigmoid and ascending and due to narrowing of the lumen, colonoscopy 
failed to complete. (Fig.1e,1f), which should be distinguished from malignant tumor and 
Crohn's disease. - very unclear statement.  Please rephrase. Please cl arify what 
characteristic in these lesions needs to be distinguished from malignant tumors.  
 
 
Case 5 -  
 
- Multiple grammatical errors. Please read and rectify. Multiple spelling mistakes  
- He had no abdominal symptoms, except that bubbling sound was occasio nally noticeable. 
- unclear sentence. Was the bubbling sound audible on exam?  
 
- He was treated successfully with treated with intensive (but not hyperbaric) oxygen 
therapy and triplex viable bacteria. The findings at endoscopy were improved after eight 
months of followup (Fig.3g). - grammatically incorrect statement.  
 
Cases: Please ensure that all the cases have a pattern of presentation and follow that for all the 6 
cases. As a scheme this can be potentially followed - Pt characteristics followed by present ing 
symptoms followed by physical exam findings followed by laboratory exam finding followed by 
Radiological imaging findings and EGD/Colonoscopy findings followed by Intervention 
performed/procedure done/treatment given and lastly the current status of th e patient on follow 
up.  
 
 
Discussion and Conclusion:  
 
- PCI has been associated with pulmonary disease in the absence of gastrointestinal 
disorder - reference is missing.  
 
- chemotherapy drugs in patients with colorectal cancer were suggested to be associate d 
with the development of PCI - please mention the chemotherapy drugs used in colon 
cancer that can cause PCI. Please be specific. There are 10 or more drugs used in the 
treatment of colon cancer.  
 
- Alexander J found that surgical treatment of PI patients with PVG could decrease the risk 
of death as compared to other PI patients, so he recommended that surgical treatment was 
needed if the patient was not responsive to conservative treatment or had developed 
serious adverse events. - is PI the same as PCI ? please keep abbreviations consistent  
 
 
Conclusion:  
 
- The heading is for discussion and conclusions but the conclusion is missing. Please 
 dedicate a paragraph or a few lines to conclude your findings.  
 
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 your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would yo u recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please  indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially fro m 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 for 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 competing 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 understand that my name will  be included 
on my report to the authors and, if the manuscript is accepted for 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 unde r 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:  Pneumatosis cystoides intestinalis: six case reports and a rev iew of the literature  
 
Version: 1 Date: 01 Dec 2017 
 
Reviewer : Ridhi  Gupta  
 
Reviewer’s report:  
 
Reviewer comments: BMC Gastroenterology  
 
Major grammatical errors need to be rectified and english improved to be ready for publication  
 
 
Abstract:  
 
Good summary of the case series. Only thing missing is the presenting symptoms to suspe ct PCI 
(very minor change)  
 
- Please reference all the short forms used in the article later. Eg. Trichloroethylene (TCE) 
etc. I choose this example specifically as this is used later in the article with no prior 
reference. All short forms need to be refere nced in the article first before being used.  
 
 
Background:  
 
Multiple grammatical and semantic errors:  
 
- Line 5: year mentioned as 19522 -? to be corrected  
 
- 4 mechanisms mentioned in the pathophysiology but 6 are mentioned. Either consolidate 
to 4 or cha nge the number to 6   
 
- line 32: reference number - 910 reference or [9,10]  
 
 
Case presentation -  
 
Case 1 -  
 
- please mention the full term before using as a short form -? NBI.  
 
- Endoscopic examination disclosed scattered bubble -like or cystoid nodules and  the lesion 
distributed in transverse colon - what is 'the lesion' - PCI or some other lesions. Needs 
clarity  
- The patient was symptom -free at that time and the lesions disappeared completely - clarity 
needed on this statement. When was the patient symptom  free post procedure?  
 
 
Case 2 -  
 
- Colonoscopic examination disclosed Grape -like or beaded subepithelial lesions and some 
with erythematous mucosa and the lesion distributed in sigmoid and due to narrowing of 
the lumen, colonoscopy failed to complete. - please rephrase, grammatically incorrect and 
incomprehensible.  Could say: Colonoscopy revealed grape - like or beaded subepithelial 
lesions, some with erythematous mucosa distributed in the sigmoid. Given the narrowing 
of the lumen secondary to these lesions  the colonoscopy was incomplete.  
 
 
Case 3 -  
 
- The biochemical tests revealed that one case had cytopenia due to AA, while the other 
cases were hemodynamically stable without any obvious abnormality in stool culture for 
pathogens. - please rephrase.  What is the mention of one case had cytopenias whi le the 
other cases were HD stable. If this is a mention for a patient in case 3 - please refer only 
to that patient's findings. The comparison of cases can be done in the discussion portions. 
Also, unclear if biochemical tests are being discussed, what is the reason for mention of 
hemodynamic stability i.e vital signs. This disrupts the flow of the case and interrupts 
readability of the article.  
 
- Line 57 - replace word relieved by resolved.  
 
 
Case 4 -  
 
- Physical examination revealed no abnormality except a  tender obese abdomen. Physical 
examination at admission revealed extensive abdominal tenderness. - duplicate mention 
of physical exam.  
 
- Line 10: word colon after ascending is missing  
 
- Colonoscopy showed irregular forms lesions that were covered with mu cosa of normal 
appearance in sigmoid and ascending and due to narrowing of the lumen, colonoscopy 
failed to complete. (Fig.1e,1f), which should be distinguished from malignant tumor and 
Crohn's disease. - very unclear statement.  Please rephrase. Please cl arify what 
characteristic in these lesions needs to be distinguished from malignant tumors.  
 
 
Case 5 -  
 
- Multiple grammatical errors. Please read and rectify. Multiple spelling mistakes  
- He had no abdominal symptoms, except that bubbling sound was occasio nally noticeable. 
- unclear sentence. Was the bubbling sound audible on exam?  
 
- He was treated successfully with treated with intensive (but not hyperbaric) oxygen 
therapy and triplex viable bacteria. The findings at endoscopy were improved after eight 
months of followup (Fig.3g). - grammatically incorrect statement.  
 
Cases: Please ensure that all the cases have a pattern of presentation and follow that for all the 6 
cases. As a scheme this can be potentially followed - Pt characteristics followed by present ing 
symptoms followed by physical exam findings followed by laboratory exam finding followed by 
Radiological imaging findings and EGD/Colonoscopy findings followed by Intervention 
performed/procedure done/treatment given and lastly the current status of th e patient on follow 
up.  
 
 
Discussion and Conclusion:  
 
- PCI has been associated with pulmonary disease in the absence of gastrointestinal 
disorder - reference is missing.  
 
- chemotherapy drugs in patients with colorectal cancer were suggested to be associate d 
with the development of PCI - please mention the chemotherapy drugs used in colon 
cancer that can cause PCI. Please be specific. There are 10 or more drugs used in the 
treatment of colon cancer.  
 
- Alexander J found that surgical treatment of PI patients with PVG could decrease the risk 
of death as compared to other PI patients, so he recommended that surgical treatment was 
needed if the patient was not responsive to conservative treatment or had developed 
serious adverse events. - is PI the same as PCI ? please keep abbreviations consistent  
 
 
Conclusion:  
 
- The heading is for discussion and conclusions but the conclusion is missing. Please 
 dedicate a paragraph or a few lines to conclude your findings.  
 
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 your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would yo u recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please  indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially fro m 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 for 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 competing 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 understand that my name will  be included 
on my report to the authors and, if the manuscript is accepted for 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 unde r 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:  Pneumatosis cystoides intestinalis: six case reports and a rev iew of the literature  
 
Version: 1 Date: 01 Dec 2017 
 
Reviewer : Ridhi  Gupta  
 
Reviewer’s report:  
 
Reviewer comments: BMC Gastroenterology  
 
Major grammatical errors need to be rectified and english improved to be ready for publication  
 
 
Abstract:  
 
Good summary of the case series. Only thing missing is the presenting symptoms to suspe ct PCI 
(very minor change)  
 
- Please reference all the short forms used in the article later. Eg. Trichloroethylene (TCE) 
etc. I choose this example specifically as this is used later in the article with no prior 
reference. All short forms need to be refere nced in the article first before being used.  
 
 
Background:  
 
Multiple grammatical and semantic errors:  
 
- Line 5: year mentioned as 19522 -? to be corrected  
 
- 4 mechanisms mentioned in the pathophysiology but 6 are mentioned. Either consolidate 
to 4 or cha nge the number to 6   
 
- line 32: reference number - 910 reference or [9,10]  
 
 
Case presentation -  
 
Case 1 -  
 
- please mention the full term before using as a short form -? NBI.  
 
- Endoscopic examination disclosed scattered bubble -like or cystoid nodules and  the lesion 
distributed in transverse colon - what is 'the lesion' - PCI or some other lesions. Needs 
clarity  
- The patient was symptom -free at that time and the lesions disappeared completely - clarity 
needed on this statement. When was the patient symptom  free post procedure?  
 
 
Case 2 -  
 
- Colonoscopic examination disclosed Grape -like or beaded subepithelial lesions and some 
with erythematous mucosa and the lesion distributed in sigmoid and due to narrowing of 
the lumen, colonoscopy failed to complete. - please rephrase, grammatically incorrect and 
incomprehensible.  Could say: Colonoscopy revealed grape - like or beaded subepithelial 
lesions, some with erythematous mucosa distributed in the sigmoid. Given the narrowing 
of the lumen secondary to these lesions  the colonoscopy was incomplete.  
 
 
Case 3 -  
 
- The biochemical tests revealed that one case had cytopenia due to AA, while the other 
cases were hemodynamically stable without any obvious abnormality in stool culture for 
pathogens. - please rephrase.  What is the mention of one case had cytopenias whi le the 
other cases were HD stable. If this is a mention for a patient in case 3 - please refer only 
to that patient's findings. The comparison of cases can be done in the discussion portions. 
Also, unclear if biochemical tests are being discussed, what is the reason for mention of 
hemodynamic stability i.e vital signs. This disrupts the flow of the case and interrupts 
readability of the article.  
 
- Line 57 - replace word relieved by resolved.  
 
 
Case 4 -  
 
- Physical examination revealed no abnormality except a  tender obese abdomen. Physical 
examination at admission revealed extensive abdominal tenderness. - duplicate mention 
of physical exam.  
 
- Line 10: word colon after ascending is missing  
 
- Colonoscopy showed irregular forms lesions that were covered with mu cosa of normal 
appearance in sigmoid and ascending and due to narrowing of the lumen, colonoscopy 
failed to complete. (Fig.1e,1f), which should be distinguished from malignant tumor and 
Crohn's disease. - very unclear statement.  Please rephrase. Please cl arify what 
characteristic in these lesions needs to be distinguished from malignant tumors.  
 
 
Case 5 -  
 
- Multiple grammatical errors. Please read and rectify. Multiple spelling mistakes  
- He had no abdominal symptoms, except that bubbling sound was occasio nally noticeable. 
- unclear sentence. Was the bubbling sound audible on exam?  
 
- He was treated successfully with treated with intensive (but not hyperbaric) oxygen 
therapy and triplex viable bacteria. The findings at endoscopy were improved after eight 
months of followup (Fig.3g). - grammatically incorrect statement.  
 
Cases: Please ensure that all the cases have a pattern of presentation and follow that for all the 6 
cases. As a scheme this can be potentially followed - Pt characteristics followed by present ing 
symptoms followed by physical exam findings followed by laboratory exam finding followed by 
Radiological imaging findings and EGD/Colonoscopy findings followed by Intervention 
performed/procedure done/treatment given and lastly the current status of th e patient on follow 
up.  
 
 
Discussion and Conclusion:  
 
- PCI has been associated with pulmonary disease in the absence of gastrointestinal 
disorder - reference is missing.  
 
- chemotherapy drugs in patients with colorectal cancer were suggested to be associate d 
with the development of PCI - please mention the chemotherapy drugs used in colon 
cancer that can cause PCI. Please be specific. There are 10 or more drugs used in the 
treatment of colon cancer.  
 
- Alexander J found that surgical treatment of PI patients with PVG could decrease the risk 
of death as compared to other PI patients, so he recommended that surgical treatment was 
needed if the patient was not responsive to conservative treatment or had developed 
serious adverse events. - is PI the same as PCI ? please keep abbreviations consistent  
 
 
Conclusion:  
 
- The heading is for discussion and conclusions but the conclusion is missing. Please 
 dedicate a paragraph or a few lines to conclude your findings.  
 
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 your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would yo u recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please  indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially fro m 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 for 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 competing 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 understand that my name will  be included 
on my report to the authors and, if the manuscript is accepted for 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 unde r 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