Reviewer ’s report  
 
Title: Case Report of Patient with Cronkhite -Canada Syndrome: Sustained Remission after 
Treatment with Corticosteroids and Mesalazine  
 
Version: 0 Date: 21 Nov 2018  
 
Reviewer: Kwangwoo Nam  
 
Reviewer's report:  
 
This is a case report about Cronkhite -Canada syndrome (CCS) in Germany. CCS is rare disease, 
and steroid is known as the mainstay of the treatment.  
The str ength of this article is its long -term follow -up. After the diagnosis, the patient was treated 
with steroid with mesalazine for 3 years, following mesalazine for 4 years, and then there was no 
recurrence without any medication.  
 
However, I have some queries about this article.  
1. CCS can involve the entire gastrointestinal tract, but the esophagus is seen to be rarely 
involved (2 -12%). Is there no symptom or sign of esophageal involvement in this patient at 
diagnosis or during t he follow -up? 
 
2. Steroid is the first treatment option in CCS, and Watanabe et al. [J Gastroenterol 
2016;51:327 -336.] suggested that optimal dose is 30 -49 mg/day. However, authors used only 
low-dose steroid (15 mg/day or less). Is it due to the patient's fracture, or mild 
gastrointestinal symptoms?  
 
3. Some authors reported that H. pylori eradication can bring clinical remission in CCS. Was 
there consideration of H. pylori infection in this patient?  
 
4. According to the clinical course, all polyps had disa ppeared three years after mesalazine 
administration, and then mesalazine was tapered. What is the tapered dose of mesalazine? In 
addition, was it necessary to maintain mesalazine for four years? In other words, was there 
consideration of other option? (e.g ., follow -up without medication, follow -up with outher 
medication, shorter maintenance period)?  
 
5. In CCS, due to the possibility of concomitant malignancy (e.g., colon cancer, stomach 
cancer), regular endoscopic surveillance is recommended during the fol low-up. Did the 
patient undergo regular endoscopic surveillance (especially after endoscopic remission)?  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data s hown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
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 aspect s require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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, eit her 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 relating 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 you r reply is yes to any, please give details below.  
 
I declare that 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 c omments  
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: Case Report of Patient with Cronkhite -Canada Syndrome: Sustained Remission after 
Treatment with Corticosteroids and Mesalazine  
 
Version: 0 Date: 21 Nov 2018  
 
Reviewer: Kwangwoo Nam  
 
Reviewer's report:  
 
This is a case report about Cronkhite -Canada syndrome (CCS) in Germany. CCS is rare disease, 
and steroid is known as the mainstay of the treatment.  
The str ength of this article is its long -term follow -up. After the diagnosis, the patient was treated 
with steroid with mesalazine for 3 years, following mesalazine for 4 years, and then there was no 
recurrence without any medication.  
 
However, I have some queries about this article.  
1. CCS can involve the entire gastrointestinal tract, but the esophagus is seen to be rarely 
involved (2 -12%). Is there no symptom or sign of esophageal involvement in this patient at 
diagnosis or during t he follow -up? 
 
2. Steroid is the first treatment option in CCS, and Watanabe et al. [J Gastroenterol 
2016;51:327 -336.] suggested that optimal dose is 30 -49 mg/day. However, authors used only 
low-dose steroid (15 mg/day or less). Is it due to the patient's fracture, or mild 
gastrointestinal symptoms?  
 
3. Some authors reported that H. pylori eradication can bring clinical remission in CCS. Was 
there consideration of H. pylori infection in this patient?  
 
4. According to the clinical course, all polyps had disa ppeared three years after mesalazine 
administration, and then mesalazine was tapered. What is the tapered dose of mesalazine? In 
addition, was it necessary to maintain mesalazine for four years? In other words, was there 
consideration of other option? (e.g ., follow -up without medication, follow -up with outher 
medication, shorter maintenance period)?  
 
5. In CCS, due to the possibility of concomitant malignancy (e.g., colon cancer, stomach 
cancer), regular endoscopic surveillance is recommended during the fol low-up. Did the 
patient undergo regular endoscopic surveillance (especially after endoscopic remission)?  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data s hown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
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 aspect s require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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, eit her 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 relating 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 you r reply is yes to any, please give details below.  
 
I declare that 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 c omments  
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: Case Report of Patient with Cronkhite -Canada Syndrome: Sustained Remission after 
Treatment with Corticosteroids and Mesalazine  
 
Version: 0 Date: 21 Nov 2018  
 
Reviewer: Kwangwoo Nam  
 
Reviewer's report:  
 
This is a case report about Cronkhite -Canada syndrome (CCS) in Germany. CCS is rare disease, 
and steroid is known as the mainstay of the treatment.  
The str ength of this article is its long -term follow -up. After the diagnosis, the patient was treated 
with steroid with mesalazine for 3 years, following mesalazine for 4 years, and then there was no 
recurrence without any medication.  
 
However, I have some queries about this article.  
1. CCS can involve the entire gastrointestinal tract, but the esophagus is seen to be rarely 
involved (2 -12%). Is there no symptom or sign of esophageal involvement in this patient at 
diagnosis or during t he follow -up? 
 
2. Steroid is the first treatment option in CCS, and Watanabe et al. [J Gastroenterol 
2016;51:327 -336.] suggested that optimal dose is 30 -49 mg/day. However, authors used only 
low-dose steroid (15 mg/day or less). Is it due to the patient's fracture, or mild 
gastrointestinal symptoms?  
 
3. Some authors reported that H. pylori eradication can bring clinical remission in CCS. Was 
there consideration of H. pylori infection in this patient?  
 
4. According to the clinical course, all polyps had disa ppeared three years after mesalazine 
administration, and then mesalazine was tapered. What is the tapered dose of mesalazine? In 
addition, was it necessary to maintain mesalazine for four years? In other words, was there 
consideration of other option? (e.g ., follow -up without medication, follow -up with outher 
medication, shorter maintenance period)?  
 
5. In CCS, due to the possibility of concomitant malignancy (e.g., colon cancer, stomach 
cancer), regular endoscopic surveillance is recommended during the fol low-up. Did the 
patient undergo regular endoscopic surveillance (especially after endoscopic remission)?  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data s hown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
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 aspect s require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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, eit her 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 relating 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 you r reply is yes to any, please give details below.  
 
I declare that 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 c omments  
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