Reviewer ’s report  
 
Title: A randomized placebo -controll ed clinical trial of a multi -strain probiotic formulation (Bio -
Kult®) in the management of diarrhea -predominant irritable bowel syndrome  
 
Version: 0 Date: 23 Feb 2018  
 
Reviewer: Bhavana Bhagya Rao  
 
Reviewer's report:  
 
An interesting RCT that evaluated the effect of probiotics on IBS -d symptoms. The RCT was 
well structured and executed.  
 
Major comments:  
- The duration of treatment is quite short hence it is challenging to comment on the durability 
of response to probiotic treatment.  
 
- Could the authors comment on the price of probiotics in their healthcare setting?  
 
- What percentage of the st udy patients had undergone a colonoscopy within 2 -3 years of the 
study? Based on the exclusion criteria they describe,the diagnosis of microscopic colitis is 
not ruled out.  
 
- It is quite remarkable that Half the patients in the placebo group noted an impro vement in 
abdominal pain.  
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.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
  
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
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, 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 from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents re lating 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 y es to any, please give details below.  
 
I declare 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 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  editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: A randomized placebo -controll ed clinical trial of a multi -strain probiotic formulation (Bio -
Kult®) in the management of diarrhea -predominant irritable bowel syndrome  
 
Version: 0 Date: 23 Feb 2018  
 
Reviewer: Bhavana Bhagya Rao  
 
Reviewer's report:  
 
An interesting RCT that evaluated the effect of probiotics on IBS -d symptoms. The RCT was 
well structured and executed.  
 
Major comments:  
- The duration of treatment is quite short hence it is challenging to comment on the durability 
of response to probiotic treatment.  
 
- Could the authors comment on the price of probiotics in their healthcare setting?  
 
- What percentage of the st udy patients had undergone a colonoscopy within 2 -3 years of the 
study? Based on the exclusion criteria they describe,the diagnosis of microscopic colitis is 
not ruled out.  
 
- It is quite remarkable that Half the patients in the placebo group noted an impro vement in 
abdominal pain.  
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.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
  
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
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, 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 from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents re lating 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 y es to any, please give details below.  
 
I declare 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 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  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: A randomized placebo -controll ed clinical trial of a multi -strain probiotic formulation (Bio -
Kult®) in the management of diarrhea -predominant irritable bowel syndrome  
 
Version: 0 Date: 23 Feb 2018  
 
Reviewer: Bhavana Bhagya Rao  
 
Reviewer's report:  
 
An interesting RCT that evaluated the effect of probiotics on IBS -d symptoms. The RCT was 
well structured and executed.  
 
Major comments:  
- The duration of treatment is quite short hence it is challenging to comment on the durability 
of response to probiotic treatment.  
 
- Could the authors comment on the price of probiotics in their healthcare setting?  
 
- What percentage of the st udy patients had undergone a colonoscopy within 2 -3 years of the 
study? Based on the exclusion criteria they describe,the diagnosis of microscopic colitis is 
not ruled out.  
 
- It is quite remarkable that Half the patients in the placebo group noted an impro vement in 
abdominal pain.  
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.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
  
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
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, 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 from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents re lating 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 y es to any, please give details below.  
 
I declare 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 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  editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant