Title: Extent of disease affects the usefulness of fecal biomarkers in ulcerative colitis
Version: 3 Date: 18 Mar 2021
Reviewer's report:
As the authors described, there are many studies using fecal biomarkers as a means of monitoring
the activity of ulcerative colitis instead of colonoscopy which is a burden for both patients and
physicians. The authors suggested in this article that the results of fecal biomarker tests needed
to be interpreted differently depending on the disease extent. This point of view was excellent
and very important.
However, there were several concerns as follows.
Major
1. If you intended to conclude that the fecal biomarker test results were unreliable for the proctitis
type, it is a non-negligible problem that the number of cases of proctitis type was extremely low
compared to the other two types. Moreover, the number of MES 2+3 of proctitis type was no
more than five, while the other two types had about thirty cases respectively. And proportion of
clinically severe cases was considerably low as well only in the proctitis type.
2. The comparison between clinical activity index (Lichtger index) and fecal biomarkers was
not necessary, I think. Because it is not clinically useful, unlike using them (fecal biomarkers)
as an alternative to colonoscopy. Rather, how was the correlation between Lichtger index and
Mayo endoscopic subscore?
3. We have often experienced the development of the disease extent, for example developing
from proctitis type to left hemicolitis type. Did you encounter such cases during proceeding
this study? When we would predict the activity from fecal tests, it is interesting issue how
the development affects the results. Similarly, do you think it is necessary to change the
interpretation of fecal test results if the former total colitis type temporarily changes to a mild
proctitis type-like due to remission? It was simple comparison between endoscopic findings and
fecal test results in this study. However, when we would predict the the disease status, proctitis
type is not always proctitis type and vice versa. Please indicate your opinion for this problem. I
do not think the results of this research alone could refer the issue of prediction.
Minor
1. It is recommended to specify the average value for each graph in Supplemental Figure 1.
2. According to the Supplemental Figure 1, the value of fecal biomarker tests in the proctitis
type seemed to remain high tendency regardless of Mayo endoscopic subscore. Regarding the
proctitis type, in addition to the small sample size, this tendency was somehow related to the
result of difficulty of distinguishing disease activity by fecal biomarker test, I think. If you agree
with my opinion, it is better to explain this in the text. If you disagree with my opinion, please
mention your opinion in the response letter.
Title: Extent of disease affects the usefulness of fecal biomarkers in ulcerative colitis
Version: 3 Date: 18 Mar 2021
Reviewer's report:
As the authors described, there are many studies using fecal biomarkers as a means of monitoring
the activity of ulcerative colitis instead of colonoscopy which is a burden for both patients and
physicians. The authors suggested in this article that the results of fecal biomarker tests needed
to be interpreted differently depending on the disease extent. This point of view was excellent
and very important.
However, there were several concerns as follows.
Major
1. If you intended to conclude that the fecal biomarker test results were unreliable for the proctitis
type, it is a non-negligible problem that the number of cases of proctitis type was extremely low
compared to the other two types. Moreover, the number of MES 2+3 of proctitis type was no
more than five, while the other two types had about thirty cases respectively. And proportion of
clinically severe cases was considerably low as well only in the proctitis type.
2. The comparison between clinical activity index (Lichtger index) and fecal biomarkers was
not necessary, I think. Because it is not clinically useful, unlike using them (fecal biomarkers)
as an alternative to colonoscopy. Rather, how was the correlation between Lichtger index and
Mayo endoscopic subscore?
3. We have often experienced the development of the disease extent, for example developing
from proctitis type to left hemicolitis type. Did you encounter such cases during proceeding
this study? When we would predict the activity from fecal tests, it is interesting issue how
the development affects the results. Similarly, do you think it is necessary to change the
interpretation of fecal test results if the former total colitis type temporarily changes to a mild
proctitis type-like due to remission? It was simple comparison between endoscopic findings and
fecal test results in this study. However, when we would predict the the disease status, proctitis
type is not always proctitis type and vice versa. Please indicate your opinion for this problem. I
do not think the results of this research alone could refer the issue of prediction.
Minor
1. It is recommended to specify the average value for each graph in Supplemental Figure 1.
2. According to the Supplemental Figure 1, the value of fecal biomarker tests in the proctitis
type seemed to remain high tendency regardless of Mayo endoscopic subscore. Regarding the
proctitis type, in addition to the small sample size, this tendency was somehow related to the
result of difficulty of distinguishing disease activity by fecal biomarker test, I think. If you agree
with my opinion, it is better to explain this in the text. If you disagree with my opinion, please
mention your opinion in the response letter.
Please review this paper.
user
Title: Extent of disease affects the usefulness of fecal biomarkers in ulcerative colitis
Version: 3 Date: 18 Mar 2021
Reviewer's report:
As the authors described, there are many studies using fecal biomarkers as a means of monitoring
the activity of ulcerative colitis instead of colonoscopy which is a burden for both patients and
physicians. The authors suggested in this article that the results of fecal biomarker tests needed
to be interpreted differently depending on the disease extent. This point of view was excellent
and very important.
However, there were several concerns as follows.
Major
1. If you intended to conclude that the fecal biomarker test results were unreliable for the proctitis
type, it is a non-negligible problem that the number of cases of proctitis type was extremely low
compared to the other two types. Moreover, the number of MES 2+3 of proctitis type was no
more than five, while the other two types had about thirty cases respectively. And proportion of
clinically severe cases was considerably low as well only in the proctitis type.
2. The comparison between clinical activity index (Lichtger index) and fecal biomarkers was
not necessary, I think. Because it is not clinically useful, unlike using them (fecal biomarkers)
as an alternative to colonoscopy. Rather, how was the correlation between Lichtger index and
Mayo endoscopic subscore?
3. We have often experienced the development of the disease extent, for example developing
from proctitis type to left hemicolitis type. Did you encounter such cases during proceeding
this study? When we would predict the activity from fecal tests, it is interesting issue how
the development affects the results. Similarly, do you think it is necessary to change the
interpretation of fecal test results if the former total colitis type temporarily changes to a mild
proctitis type-like due to remission? It was simple comparison between endoscopic findings and
fecal test results in this study. However, when we would predict the the disease status, proctitis
type is not always proctitis type and vice versa. Please indicate your opinion for this problem. I
do not think the results of this research alone could refer the issue of prediction.
Minor
1. It is recommended to specify the average value for each graph in Supplemental Figure 1.
2. According to the Supplemental Figure 1, the value of fecal biomarker tests in the proctitis
type seemed to remain high tendency regardless of Mayo endoscopic subscore. Regarding the
proctitis type, in addition to the small sample size, this tendency was somehow related to the
result of difficulty of distinguishing disease activity by fecal biomarker test, I think. If you agree
with my opinion, it is better to explain this in the text. If you disagree with my opinion, please
mention your opinion in the response letter.
assistant