Reviewer's report
Title:Gastric and intestinal barrier impairment in African adults: a randomised
controlled trial of micronutrient supplementation
Version: 2Date:20 January 2010
Reviewer: Giacomo Carlo Sturniolo
Reviewer's report:
The paper describes the effect of micronutrient supplementation on different
components of gastric and intestinal barrier in African patients with mixed
HIV-status.
Micronutrients seem to ameliorate hypochlorhydria but don’t affect intestinal
permeability and bacterial traslocation. Interestingly, the gastric mucosa in HIV
patients did not show severe atrophy at histology, so one can postulate that
mechanisms other than atrophy are involved in HIV-related hypochlorhydria.
The major limits of this works are: 1) the results have been published partially in
a previous work, 2) only one dose of micronutrients has been experimented,
whereas probably a higher dose could have different effects and 3) the number
of subjects varies greatly among the different tests.
MAJOR COMPULSORY REVISIONS
- The title should include HIV-status
- You should specify if the different number of subjects in the subgroups derives
from patients’ selection or spontaneous participatation
- Please explain or give the reference to explain the different role of the sugars
used for permeability test
- Page 7: "… antiretroviral therapy reverses hypochlorhydria". Unfortunately this
is not a randomized trial of antiretrovirals and therefore you can only observe the
difference among groups.
- Page 7: please give the statistical significance of the difference in gastric pH
among groups
- Page 8: Salmonella and Shigella infections have been mentioned in the results
but the method is not explained, and you should explain better the numbers
(198+357= 555 samples but the trial included 500 patients and gastric pH was
measured in 200 patients)
- Page 8: it would be interesting to know the proportion of patients with altered
intestinal permeability
- Page 9: it would be interesting to know more extensively the histological results,
apart from atrophy (normal mucosa? Gastritis? Others?)
MINOR ESSENTIAL REVISIONS
- Page 11: could you better explain the hypothesis of tropical enteropathy that
obscures the relationship between permeability and bacterial traslocation? You
should even specify if you found altered permeability and normal traslocation or
both normal
- Histological images in my opinion are not necessary.
Level of interest: An article of limited interest
Quality of written English: Acceptable
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:Gastric and intestinal barrier impairment in African adults: a randomised
controlled trial of micronutrient supplementation
Version: 2Date:20 January 2010
Reviewer: Giacomo Carlo Sturniolo
Reviewer's report:
The paper describes the effect of micronutrient supplementation on different
components of gastric and intestinal barrier in African patients with mixed
HIV-status.
Micronutrients seem to ameliorate hypochlorhydria but don’t affect intestinal
permeability and bacterial traslocation. Interestingly, the gastric mucosa in HIV
patients did not show severe atrophy at histology, so one can postulate that
mechanisms other than atrophy are involved in HIV-related hypochlorhydria.
The major limits of this works are: 1) the results have been published partially in
a previous work, 2) only one dose of micronutrients has been experimented,
whereas probably a higher dose could have different effects and 3) the number
of subjects varies greatly among the different tests.
MAJOR COMPULSORY REVISIONS
- The title should include HIV-status
- You should specify if the different number of subjects in the subgroups derives
from patients’ selection or spontaneous participatation
- Please explain or give the reference to explain the different role of the sugars
used for permeability test
- Page 7: "… antiretroviral therapy reverses hypochlorhydria". Unfortunately this
is not a randomized trial of antiretrovirals and therefore you can only observe the
difference among groups.
- Page 7: please give the statistical significance of the difference in gastric pH
among groups
- Page 8: Salmonella and Shigella infections have been mentioned in the results
but the method is not explained, and you should explain better the numbers
(198+357= 555 samples but the trial included 500 patients and gastric pH was
measured in 200 patients)
- Page 8: it would be interesting to know the proportion of patients with altered
intestinal permeability
- Page 9: it would be interesting to know more extensively the histological results,
apart from atrophy (normal mucosa? Gastritis? Others?)
MINOR ESSENTIAL REVISIONS
- Page 11: could you better explain the hypothesis of tropical enteropathy that
obscures the relationship between permeability and bacterial traslocation? You
should even specify if you found altered permeability and normal traslocation or
both normal
- Histological images in my opinion are not necessary.
Level of interest: An article of limited interest
Quality of written English: Acceptable
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:Gastric and intestinal barrier impairment in African adults: a randomised
controlled trial of micronutrient supplementation
Version: 2Date:20 January 2010
Reviewer: Giacomo Carlo Sturniolo
Reviewer's report:
The paper describes the effect of micronutrient supplementation on different
components of gastric and intestinal barrier in African patients with mixed
HIV-status.
Micronutrients seem to ameliorate hypochlorhydria but don’t affect intestinal
permeability and bacterial traslocation. Interestingly, the gastric mucosa in HIV
patients did not show severe atrophy at histology, so one can postulate that
mechanisms other than atrophy are involved in HIV-related hypochlorhydria.
The major limits of this works are: 1) the results have been published partially in
a previous work, 2) only one dose of micronutrients has been experimented,
whereas probably a higher dose could have different effects and 3) the number
of subjects varies greatly among the different tests.
MAJOR COMPULSORY REVISIONS
- The title should include HIV-status
- You should specify if the different number of subjects in the subgroups derives
from patients’ selection or spontaneous participatation
- Please explain or give the reference to explain the different role of the sugars
used for permeability test
- Page 7: "… antiretroviral therapy reverses hypochlorhydria". Unfortunately this
is not a randomized trial of antiretrovirals and therefore you can only observe the
difference among groups.
- Page 7: please give the statistical significance of the difference in gastric pH
among groups
- Page 8: Salmonella and Shigella infections have been mentioned in the results
but the method is not explained, and you should explain better the numbers
(198+357= 555 samples but the trial included 500 patients and gastric pH was
measured in 200 patients)
- Page 8: it would be interesting to know the proportion of patients with altered
intestinal permeability
- Page 9: it would be interesting to know more extensively the histological results,
apart from atrophy (normal mucosa? Gastritis? Others?)
MINOR ESSENTIAL REVISIONS
- Page 11: could you better explain the hypothesis of tropical enteropathy that
obscures the relationship between permeability and bacterial traslocation? You
should even specify if you found altered permeability and normal traslocation or
both normal
- Histological images in my opinion are not necessary.
Level of interest: An article of limited interest
Quality of written English: Acceptable
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
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