Title: Symptoms, burden, and unmet needs of patients living with exocrine pancreatic
insufficiency: a narrative review of the patient experience
Version: 2 Date: 23 Nov 2023
Reviewer's report:
In introduction, author state that EPI is caused by maldigestion but this is inaccurate and the
opposite is correct.
There is insufficient references for the long term consequences of EPI.
Need a reference to this statement  (many are not treated with appropriate dosages of pancreatic
enzyme replacement therapy (PERT)).
Methodology:
I have a major concern about the methodology used to obtain literature on the relevant questions.
The author restricted themselves on already predefined setting but the question is on patient
experience ie searching for abdominal pain is relevance but a short snapshot of patient symptoms
rather than experience. To qualify for patient experience you will need a period of observation
and this should be clearly stated whether those papers included were patients on PERT or before
initiating PERT. The title should be something like the most commonly reported symptoms of
PEI or something along these lines
Also authors included paediatric population and this has not been clearly mentioned in the
finding. Why they included paediatric population with PEI as this is most commonly associated
with CF.
Table 1 doesn’t show many exclusion criteria. PEI is included where it is the topic of interest.
The search included outcomes of interest which I am unsure if it should be in this table. I suggest
this table need redesigning with a clear set of inclusion and exclusion criteria. More importantly,
animal studies should’ve excluded from the outset.
Certainly there is extensive search criteria but someone understand the literature on PEI will be
applying less parameters because you put yourself at risk of excluding many relevant papers.
Most papers on PEI discuss methods of diagnosis, associated conditions and effect or PERT and
within the literature you can find symptoms.
What was the reason for including PERT- there has been a number of metanalyses showing
efficacy of PERT in PEI. The majority of papers included in this paper were on PERT which
is 70 and I don’t think you have covered it here extensively. You don’t need to include PERT
papers at all as the paper is describing patient living with PEI. If this chosen then the finding
should describe and differentiate those on PERT and without.
It is vital to include the other comorbidities of patients with PEI because it is relevant here and it
could be causing symptoms ie chronic pancreatitis cause pain. DM patient also have GI symptom
and other systemic symptoms.
This statement is inaccurate (For individuals with CP, EPI therapies include opioids, endoscopy,
and surgery). We don’t perform endoscopy or give opioid to treat PEI. I also disagree that opioid
is the treatment of choice for CP. Authors should read about the guidelines on managing CP
which can be different from PEI.
Again, irritable bowel syndrome doesn’t cause PEI but can be associated with
Title: Symptoms, burden, and unmet needs of patients living with exocrine pancreatic
insufficiency: a narrative review of the patient experience
Version: 2 Date: 23 Nov 2023
Reviewer's report:
In introduction, author state that EPI is caused by maldigestion but this is inaccurate and the
opposite is correct.
There is insufficient references for the long term consequences of EPI.
Need a reference to this statement  (many are not treated with appropriate dosages of pancreatic
enzyme replacement therapy (PERT)).
Methodology:
I have a major concern about the methodology used to obtain literature on the relevant questions.
The author restricted themselves on already predefined setting but the question is on patient
experience ie searching for abdominal pain is relevance but a short snapshot of patient symptoms
rather than experience. To qualify for patient experience you will need a period of observation
and this should be clearly stated whether those papers included were patients on PERT or before
initiating PERT. The title should be something like the most commonly reported symptoms of
PEI or something along these lines
Also authors included paediatric population and this has not been clearly mentioned in the
finding. Why they included paediatric population with PEI as this is most commonly associated
with CF.
Table 1 doesn’t show many exclusion criteria. PEI is included where it is the topic of interest.
The search included outcomes of interest which I am unsure if it should be in this table. I suggest
this table need redesigning with a clear set of inclusion and exclusion criteria. More importantly,
animal studies should’ve excluded from the outset.
Certainly there is extensive search criteria but someone understand the literature on PEI will be
applying less parameters because you put yourself at risk of excluding many relevant papers.
Most papers on PEI discuss methods of diagnosis, associated conditions and effect or PERT and
within the literature you can find symptoms.
What was the reason for including PERT- there has been a number of metanalyses showing
efficacy of PERT in PEI. The majority of papers included in this paper were on PERT which
is 70 and I don’t think you have covered it here extensively. You don’t need to include PERT
papers at all as the paper is describing patient living with PEI. If this chosen then the finding
should describe and differentiate those on PERT and without.
It is vital to include the other comorbidities of patients with PEI because it is relevant here and it
could be causing symptoms ie chronic pancreatitis cause pain. DM patient also have GI symptom
and other systemic symptoms.
This statement is inaccurate (For individuals with CP, EPI therapies include opioids, endoscopy,
and surgery). We don’t perform endoscopy or give opioid to treat PEI. I also disagree that opioid
is the treatment of choice for CP. Authors should read about the guidelines on managing CP
which can be different from PEI.
Again, irritable bowel syndrome doesn’t cause PEI but can be associated with
Please review this paper.
user
Title: Symptoms, burden, and unmet needs of patients living with exocrine pancreatic
insufficiency: a narrative review of the patient experience
Version: 2 Date: 23 Nov 2023
Reviewer's report:
In introduction, author state that EPI is caused by maldigestion but this is inaccurate and the
opposite is correct.
There is insufficient references for the long term consequences of EPI.
Need a reference to this statement  (many are not treated with appropriate dosages of pancreatic
enzyme replacement therapy (PERT)).
Methodology:
I have a major concern about the methodology used to obtain literature on the relevant questions.
The author restricted themselves on already predefined setting but the question is on patient
experience ie searching for abdominal pain is relevance but a short snapshot of patient symptoms
rather than experience. To qualify for patient experience you will need a period of observation
and this should be clearly stated whether those papers included were patients on PERT or before
initiating PERT. The title should be something like the most commonly reported symptoms of
PEI or something along these lines
Also authors included paediatric population and this has not been clearly mentioned in the
finding. Why they included paediatric population with PEI as this is most commonly associated
with CF.
Table 1 doesn’t show many exclusion criteria. PEI is included where it is the topic of interest.
The search included outcomes of interest which I am unsure if it should be in this table. I suggest
this table need redesigning with a clear set of inclusion and exclusion criteria. More importantly,
animal studies should’ve excluded from the outset.
Certainly there is extensive search criteria but someone understand the literature on PEI will be
applying less parameters because you put yourself at risk of excluding many relevant papers.
Most papers on PEI discuss methods of diagnosis, associated conditions and effect or PERT and
within the literature you can find symptoms.
What was the reason for including PERT- there has been a number of metanalyses showing
efficacy of PERT in PEI. The majority of papers included in this paper were on PERT which
is 70 and I don’t think you have covered it here extensively. You don’t need to include PERT
papers at all as the paper is describing patient living with PEI. If this chosen then the finding
should describe and differentiate those on PERT and without.
It is vital to include the other comorbidities of patients with PEI because it is relevant here and it
could be causing symptoms ie chronic pancreatitis cause pain. DM patient also have GI symptom
and other systemic symptoms.
This statement is inaccurate (For individuals with CP, EPI therapies include opioids, endoscopy,
and surgery). We don’t perform endoscopy or give opioid to treat PEI. I also disagree that opioid
is the treatment of choice for CP. Authors should read about the guidelines on managing CP
which can be different from PEI.
Again, irritable bowel syndrome doesn’t cause PEI but can be associated with
assistant