Reviewer's report
Title:Erythromycin Lacks Colon Prokinetic Effect in Children with Functional
Gastrointestinal Disorders, A Retrospective Study
Version: 2Date:6 February 2008
Reviewer: Menachem Hanani
Reviewer's report:
General
The potential novelty of this work is in showing that erythromycin has no effect on
colonic motility in constipated children. This result may be important as it
indicates that that erythromycin and related substances have no therapeutic
potential as prokinetic drugs in the colon. However, there are several issues in
the analysis and discussion that need to be addressed.
Major Compulsory Revisions
1. Colonic mechanical activity was assessed by measuring the area under the
curve (AUC), which was calculated by assuming that the response is triangular.
However, there is no evidence that this is so. The authors should present several
original recordings to confirm this point. I suggest that they measure the actual
AUC.
2. The authors concluded that erythromycin has no prokinetic effects on the
colon. They do not address the question whether or not motilin receptors are
present in this tissue, although from their discussion it might appear that they
expect that this is the case. They should look in the literature for evidence for
motilin receptors in the human colon.
A more serious point is the lack of a control group, i.e. children with no
constipation. It might be argued that the abnormal motility in the patients is due to
reduced expression of motilin receptors, or some other defect in the function of
these receptors.
Minor Essential Revisions
1. Ref. 4 is not on motilin
2. The units for the AUC should be mmHgâ#¢s not mmHg/s.
3. P. 4, patients with normal colonic motility were selected for this study. But
these patients suffered from chronic constipation. Please explain
3. The authors ignore published work that indicated that erythromycin has no
prokinetic influence on humans colon; for example: Jameson JS et al., Oral or
intravenous erythromycin has no effect on human distal colonic motility. Aliment
Pharmacol Ther.;6:589-595, 1992.
In another study on the human colon in vitro, erythromycin had an inhibitory
action, see, Nissan A et al., Direct inhibitory effect of erythromycin on human
alimentary tract smooth muscle. Am. J. Surgery 183:413-418, 2002.
4. Style corrections:
P. 2, ".. patients with normal (what?).."
P. 3, "observational studies" (?)
P. 3, "Dataâ#¦ is".
What next?: Unable to decide on acceptance or rejection until the authors have
responded to the major compulsory revisions
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Erythromycin Lacks Colon Prokinetic Effect in Children with Functional
Gastrointestinal Disorders, A Retrospective Study
Version: 2Date:6 February 2008
Reviewer: Menachem Hanani
Reviewer's report:
General
The potential novelty of this work is in showing that erythromycin has no effect on
colonic motility in constipated children. This result may be important as it
indicates that that erythromycin and related substances have no therapeutic
potential as prokinetic drugs in the colon. However, there are several issues in
the analysis and discussion that need to be addressed.
Major Compulsory Revisions
1. Colonic mechanical activity was assessed by measuring the area under the
curve (AUC), which was calculated by assuming that the response is triangular.
However, there is no evidence that this is so. The authors should present several
original recordings to confirm this point. I suggest that they measure the actual
AUC.
2. The authors concluded that erythromycin has no prokinetic effects on the
colon. They do not address the question whether or not motilin receptors are
present in this tissue, although from their discussion it might appear that they
expect that this is the case. They should look in the literature for evidence for
motilin receptors in the human colon.
A more serious point is the lack of a control group, i.e. children with no
constipation. It might be argued that the abnormal motility in the patients is due to
reduced expression of motilin receptors, or some other defect in the function of
these receptors.
Minor Essential Revisions
1. Ref. 4 is not on motilin
2. The units for the AUC should be mmHgâ#¢s not mmHg/s.
3. P. 4, patients with normal colonic motility were selected for this study. But
these patients suffered from chronic constipation. Please explain
3. The authors ignore published work that indicated that erythromycin has no
prokinetic influence on humans colon; for example: Jameson JS et al., Oral or
intravenous erythromycin has no effect on human distal colonic motility. Aliment
Pharmacol Ther.;6:589-595, 1992.
In another study on the human colon in vitro, erythromycin had an inhibitory
action, see, Nissan A et al., Direct inhibitory effect of erythromycin on human
alimentary tract smooth muscle. Am. J. Surgery 183:413-418, 2002.
4. Style corrections:
P. 2, ".. patients with normal (what?).."
P. 3, "observational studies" (?)
P. 3, "Dataâ#¦ is".
What next?: Unable to decide on acceptance or rejection until the authors have
responded to the major compulsory revisions
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Erythromycin Lacks Colon Prokinetic Effect in Children with Functional
Gastrointestinal Disorders, A Retrospective Study
Version: 2Date:6 February 2008
Reviewer: Menachem Hanani
Reviewer's report:
General
The potential novelty of this work is in showing that erythromycin has no effect on
colonic motility in constipated children. This result may be important as it
indicates that that erythromycin and related substances have no therapeutic
potential as prokinetic drugs in the colon. However, there are several issues in
the analysis and discussion that need to be addressed.
Major Compulsory Revisions
1. Colonic mechanical activity was assessed by measuring the area under the
curve (AUC), which was calculated by assuming that the response is triangular.
However, there is no evidence that this is so. The authors should present several
original recordings to confirm this point. I suggest that they measure the actual
AUC.
2. The authors concluded that erythromycin has no prokinetic effects on the
colon. They do not address the question whether or not motilin receptors are
present in this tissue, although from their discussion it might appear that they
expect that this is the case. They should look in the literature for evidence for
motilin receptors in the human colon.
A more serious point is the lack of a control group, i.e. children with no
constipation. It might be argued that the abnormal motility in the patients is due to
reduced expression of motilin receptors, or some other defect in the function of
these receptors.
Minor Essential Revisions
1. Ref. 4 is not on motilin
2. The units for the AUC should be mmHgâ#¢s not mmHg/s.
3. P. 4, patients with normal colonic motility were selected for this study. But
these patients suffered from chronic constipation. Please explain
3. The authors ignore published work that indicated that erythromycin has no
prokinetic influence on humans colon; for example: Jameson JS et al., Oral or
intravenous erythromycin has no effect on human distal colonic motility. Aliment
Pharmacol Ther.;6:589-595, 1992.
In another study on the human colon in vitro, erythromycin had an inhibitory
action, see, Nissan A et al., Direct inhibitory effect of erythromycin on human
alimentary tract smooth muscle. Am. J. Surgery 183:413-418, 2002.
4. Style corrections:
P. 2, ".. patients with normal (what?).."
P. 3, "observational studies" (?)
P. 3, "Dataâ#¦ is".
What next?: Unable to decide on acceptance or rejection until the authors have
responded to the major compulsory revisions
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
assistant