Reviewer ’s report  
 
Title: Impact of symptom severity in patients with diarrh oea-predominant irritable bowel 
syndrome (IBS -D): results from two separate surveys of HCPs and patients with IB S-D 
 
Version: 0 Date: 26 Jul 2019  
 
Reviewer: Paola Iovino  
 
Reviewer's report:  
 
Thank you for the opportunity to review this manuscript.  
In their paper, Emmanuel A et al. assessed HCPs' attitudes towards the classification of severity  
in IBS -D based on 2 web survey data of healthcare professionals and patients from Australia, 
Canada, and Europe.  
The former study surveyed (a) patients receiving treatment for IBS -D and (b) treating 
gastroenterologists and primary care physicians (PCPs) to assess the health burden of IBS -D on 
patients and the attitudes and perspectives of treating healthcare professionals (HCPs) towards 
IBS-D. Their primary analysis found that many patients are dissatisfied with their current 
treatment and feel under -supp orted by their HCPs, whilst the physicians themselves find IBS -D 
to be a challenging condition to manage [16].  
In this post -hoc subanalysis, their results showed that the majority of HCPs surveyed did not 
routinely assess severity in their patients with I BS. Patient characteristics and attitudes differ 
substantially according to the severity of their IBS -D symptoms.  
The authors stated that although IBS severity has been identified as the main target in IBS to set 
a proper treatment, there is a lack of wel l-validated symptom severity scales of IBS -D beyond 
those available for IBS as a whole, There is, therefore, a need for a standardized, 
multidimensional scale to assess severity in IBS -D. 
 
I have a few comments.  
 
Survey statements were not extensively described in this paper. I believe that the survey needs to 
be enclosed as a supplementary file to better understand the process underlying the inclusion of 
selected variables and the definition of severity.  
 
Did you  have also IBS -SSS at least in a subset of patients? In my opinion, a  correlation of this 
new proposal with a validated one is really important although I agree with Authors that IBS -
SSS lacks substantial symptoms such as urgency or bloating.  
 
The discus sion should be more focusing on the limitations of the study taking into account also 
the limitations of the former study [16] (for example participants self -identified as having been 
diagnosed with IBS -D by an HCP, then, this is all patient -reported data) .  
 
 
 
Are th e methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary co ntrols?  
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 asses s 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 your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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, 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 recei ved 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 understan d that my name will be included 
on my report to the authors 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 author s' 
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 editor s, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Impact of symptom severity in patients with diarrh oea-predominant irritable bowel 
syndrome (IBS -D): results from two separate surveys of HCPs and patients with IB S-D 
 
Version: 0 Date: 26 Jul 2019  
 
Reviewer: Paola Iovino  
 
Reviewer's report:  
 
Thank you for the opportunity to review this manuscript.  
In their paper, Emmanuel A et al. assessed HCPs' attitudes towards the classification of severity  
in IBS -D based on 2 web survey data of healthcare professionals and patients from Australia, 
Canada, and Europe.  
The former study surveyed (a) patients receiving treatment for IBS -D and (b) treating 
gastroenterologists and primary care physicians (PCPs) to assess the health burden of IBS -D on 
patients and the attitudes and perspectives of treating healthcare professionals (HCPs) towards 
IBS-D. Their primary analysis found that many patients are dissatisfied with their current 
treatment and feel under -supp orted by their HCPs, whilst the physicians themselves find IBS -D 
to be a challenging condition to manage [16].  
In this post -hoc subanalysis, their results showed that the majority of HCPs surveyed did not 
routinely assess severity in their patients with I BS. Patient characteristics and attitudes differ 
substantially according to the severity of their IBS -D symptoms.  
The authors stated that although IBS severity has been identified as the main target in IBS to set 
a proper treatment, there is a lack of wel l-validated symptom severity scales of IBS -D beyond 
those available for IBS as a whole, There is, therefore, a need for a standardized, 
multidimensional scale to assess severity in IBS -D. 
 
I have a few comments.  
 
Survey statements were not extensively described in this paper. I believe that the survey needs to 
be enclosed as a supplementary file to better understand the process underlying the inclusion of 
selected variables and the definition of severity.  
 
Did you  have also IBS -SSS at least in a subset of patients? In my opinion, a  correlation of this 
new proposal with a validated one is really important although I agree with Authors that IBS -
SSS lacks substantial symptoms such as urgency or bloating.  
 
The discus sion should be more focusing on the limitations of the study taking into account also 
the limitations of the former study [16] (for example participants self -identified as having been 
diagnosed with IBS -D by an HCP, then, this is all patient -reported data) .  
 
 
 
Are th e methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary co ntrols?  
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 asses s 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 your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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, 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 recei ved 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 understan d that my name will be included 
on my report to the authors 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 author s' 
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 editor s, 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: Impact of symptom severity in patients with diarrh oea-predominant irritable bowel 
syndrome (IBS -D): results from two separate surveys of HCPs and patients with IB S-D 
 
Version: 0 Date: 26 Jul 2019  
 
Reviewer: Paola Iovino  
 
Reviewer's report:  
 
Thank you for the opportunity to review this manuscript.  
In their paper, Emmanuel A et al. assessed HCPs' attitudes towards the classification of severity  
in IBS -D based on 2 web survey data of healthcare professionals and patients from Australia, 
Canada, and Europe.  
The former study surveyed (a) patients receiving treatment for IBS -D and (b) treating 
gastroenterologists and primary care physicians (PCPs) to assess the health burden of IBS -D on 
patients and the attitudes and perspectives of treating healthcare professionals (HCPs) towards 
IBS-D. Their primary analysis found that many patients are dissatisfied with their current 
treatment and feel under -supp orted by their HCPs, whilst the physicians themselves find IBS -D 
to be a challenging condition to manage [16].  
In this post -hoc subanalysis, their results showed that the majority of HCPs surveyed did not 
routinely assess severity in their patients with I BS. Patient characteristics and attitudes differ 
substantially according to the severity of their IBS -D symptoms.  
The authors stated that although IBS severity has been identified as the main target in IBS to set 
a proper treatment, there is a lack of wel l-validated symptom severity scales of IBS -D beyond 
those available for IBS as a whole, There is, therefore, a need for a standardized, 
multidimensional scale to assess severity in IBS -D. 
 
I have a few comments.  
 
Survey statements were not extensively described in this paper. I believe that the survey needs to 
be enclosed as a supplementary file to better understand the process underlying the inclusion of 
selected variables and the definition of severity.  
 
Did you  have also IBS -SSS at least in a subset of patients? In my opinion, a  correlation of this 
new proposal with a validated one is really important although I agree with Authors that IBS -
SSS lacks substantial symptoms such as urgency or bloating.  
 
The discus sion should be more focusing on the limitations of the study taking into account also 
the limitations of the former study [16] (for example participants self -identified as having been 
diagnosed with IBS -D by an HCP, then, this is all patient -reported data) .  
 
 
 
Are th e methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary co ntrols?  
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 asses s 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 your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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, 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 recei ved 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 understan d that my name will be included 
on my report to the authors 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 author s' 
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 editor s, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant