Reviewer's report 
 Factors associated with disease evolution in Greek patients with inflammatory bowel disease. Title: 
 1  17 May 2006 Version: Date: 
 Peter Laszlo Lakatos Reviewer: 
Reviewer's report: 
This study is investigating the changes in disease phenotype during the course IBD in a relatively small 
cohort of Greek patients. Major finding of the study was that in concordance with previous reports patients 
with non-stricturing-non-penetrating disease (B1) were progressing during time, thus this phenotype is 
temporary in some patients. Smoking non-colonic disease were identified as risk factors for behavioral 
change in B1 Crohnâ €™s disease patients. Proximal extension is more common in ulcerative colitis 
patients with proctitis than in those with left-sided colitis. 
Compulsory Comments; 
1. A major limitation of the study is that the patient number (especially in CD) was relatively small to study 
these associations. Based on previous data (e.g Louis et al) a power calculation could be done to demonstrate, how many patients were needed to study these changes. 
2. The follow-up â €œprotocolâ € of the patients is also not defined. Authors should include more details on 
the re-assessment protocol of the patients: when and how were patients re-examined after the diagnosis to 
ensure that no or only limited behavioralâ €“location or extent changes will be missed. By now it seems the 
re-assessment of the patients was only done accidentally. 3. The chapters â €œResultsâ € and â €œDiscussionâ € are way too long. These should be shortened 
significantly (at least by 50%) and focused more on the most important findings. The number of Tables 
should be also lowered. 4. Authors write about 10- and 20-year probability of changing disease phenotype, however this should be interpreted with caution, as only limited number of patients from this cohort were followed-up for long-term. 
In addition no data are available on patient numbers after a specific duration (see comment to Figures 1-3). 
5. Patient numbers should be included to Figures 1-3 at 5-, 10-, 15 and 20 years after IBD diagnosis, also 
the Y-axis should be renamed as â €œProbability of change in disease behaviourâ €, â €œProbability to 
avoid surgeryâ € and â €œProbability of change in disease extentâ € also the X axis to â €œYears from 
IBD diagnosisâ € 
Minor essential revisions; 
1. In the results authors write on the actual risk for cancer. This should be described more precisely, was 
this risk for colorectal cancers? 
Discretionary Revisions; 
1. The expression actuarial is usually not used in this context (actuarial riskâ €¦) 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article of limited interest Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests' 
Reviewer's report 
 Factors associated with disease evolution in Greek patients with inflammatory bowel disease. Title: 
 1  17 May 2006 Version: Date: 
 Peter Laszlo Lakatos Reviewer: 
Reviewer's report: 
This study is investigating the changes in disease phenotype during the course IBD in a relatively small 
cohort of Greek patients. Major finding of the study was that in concordance with previous reports patients 
with non-stricturing-non-penetrating disease (B1) were progressing during time, thus this phenotype is 
temporary in some patients. Smoking non-colonic disease were identified as risk factors for behavioral 
change in B1 Crohnâ €™s disease patients. Proximal extension is more common in ulcerative colitis 
patients with proctitis than in those with left-sided colitis. 
Compulsory Comments; 
1. A major limitation of the study is that the patient number (especially in CD) was relatively small to study 
these associations. Based on previous data (e.g Louis et al) a power calculation could be done to demonstrate, how many patients were needed to study these changes. 
2. The follow-up â €œprotocolâ € of the patients is also not defined. Authors should include more details on 
the re-assessment protocol of the patients: when and how were patients re-examined after the diagnosis to 
ensure that no or only limited behavioralâ €“location or extent changes will be missed. By now it seems the 
re-assessment of the patients was only done accidentally. 3. The chapters â €œResultsâ € and â €œDiscussionâ € are way too long. These should be shortened 
significantly (at least by 50%) and focused more on the most important findings. The number of Tables 
should be also lowered. 4. Authors write about 10- and 20-year probability of changing disease phenotype, however this should be interpreted with caution, as only limited number of patients from this cohort were followed-up for long-term. 
In addition no data are available on patient numbers after a specific duration (see comment to Figures 1-3). 
5. Patient numbers should be included to Figures 1-3 at 5-, 10-, 15 and 20 years after IBD diagnosis, also 
the Y-axis should be renamed as â €œProbability of change in disease behaviourâ €, â €œProbability to 
avoid surgeryâ € and â €œProbability of change in disease extentâ € also the X axis to â €œYears from 
IBD diagnosisâ € 
Minor essential revisions; 
1. In the results authors write on the actual risk for cancer. This should be described more precisely, was 
this risk for colorectal cancers? 
Discretionary Revisions; 
1. The expression actuarial is usually not used in this context (actuarial riskâ €¦) 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article of limited interest Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests' 
Please review this paper.
user
Reviewer's report 
 Factors associated with disease evolution in Greek patients with inflammatory bowel disease. Title: 
 1  17 May 2006 Version: Date: 
 Peter Laszlo Lakatos Reviewer: 
Reviewer's report: 
This study is investigating the changes in disease phenotype during the course IBD in a relatively small 
cohort of Greek patients. Major finding of the study was that in concordance with previous reports patients 
with non-stricturing-non-penetrating disease (B1) were progressing during time, thus this phenotype is 
temporary in some patients. Smoking non-colonic disease were identified as risk factors for behavioral 
change in B1 Crohnâ €™s disease patients. Proximal extension is more common in ulcerative colitis 
patients with proctitis than in those with left-sided colitis. 
Compulsory Comments; 
1. A major limitation of the study is that the patient number (especially in CD) was relatively small to study 
these associations. Based on previous data (e.g Louis et al) a power calculation could be done to demonstrate, how many patients were needed to study these changes. 
2. The follow-up â €œprotocolâ € of the patients is also not defined. Authors should include more details on 
the re-assessment protocol of the patients: when and how were patients re-examined after the diagnosis to 
ensure that no or only limited behavioralâ €“location or extent changes will be missed. By now it seems the 
re-assessment of the patients was only done accidentally. 3. The chapters â €œResultsâ € and â €œDiscussionâ € are way too long. These should be shortened 
significantly (at least by 50%) and focused more on the most important findings. The number of Tables 
should be also lowered. 4. Authors write about 10- and 20-year probability of changing disease phenotype, however this should be interpreted with caution, as only limited number of patients from this cohort were followed-up for long-term. 
In addition no data are available on patient numbers after a specific duration (see comment to Figures 1-3). 
5. Patient numbers should be included to Figures 1-3 at 5-, 10-, 15 and 20 years after IBD diagnosis, also 
the Y-axis should be renamed as â €œProbability of change in disease behaviourâ €, â €œProbability to 
avoid surgeryâ € and â €œProbability of change in disease extentâ € also the X axis to â €œYears from 
IBD diagnosisâ € 
Minor essential revisions; 
1. In the results authors write on the actual risk for cancer. This should be described more precisely, was 
this risk for colorectal cancers? 
Discretionary Revisions; 
1. The expression actuarial is usually not used in this context (actuarial riskâ €¦) 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article of limited interest Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests' 
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