Reviewer's report
Title:Delay to celiac disease diagnosis and its implications for health-related
quality of life
Version: 2Date:6 October 2011
Reviewer: Jeremy Woodward
Reviewer's report:
This is a large study that identified a significant delay in time from the onset of
symptoms in coeliac disease to the diagnosis of the condition. By demonstrating
an improvement in health-related quality of life after diagnosis and institution of
treatment, a preventable burden of ill health has been identified. The study is well
designed and executed with the authors aware of the major limitations of the
work. Potential sources of bias include the difficulty in recall of symptoms prior to
diagnosis - in some cases very many years prior to the study questionnaire being
sent. Whilst the authors suggest that recall bias is likely to underestimate the
symptoms, the opposite may in fact be the case given the likelihood of positive
reinforcement by health professionals encouraging dietary compliance, and
membership of a patient group. There is an unfortunate but unavoidable
response bias as well that probably explains the high rate of dietary compliance
(96%) of the 66% that did respond. This data does not support the idea of mass
screening for coeliac disease, but is further support for a low threshold in testing
for the condition in the presence of symptoms. In this regard a potential
opportunity has been missed by the investigators in determining which type of
symptoms were predominantly experienced by patients and whether this had any
impact on the delay in diagnosis. I would find figure 1 easier to understand with
the addition of the words 'prior to diagnosis' after 'duration of symptoms' on the
abscissa label.
Level of interest: An article of importance in its field
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:Delay to celiac disease diagnosis and its implications for health-related
quality of life
Version: 2Date:6 October 2011
Reviewer: Jeremy Woodward
Reviewer's report:
This is a large study that identified a significant delay in time from the onset of
symptoms in coeliac disease to the diagnosis of the condition. By demonstrating
an improvement in health-related quality of life after diagnosis and institution of
treatment, a preventable burden of ill health has been identified. The study is well
designed and executed with the authors aware of the major limitations of the
work. Potential sources of bias include the difficulty in recall of symptoms prior to
diagnosis - in some cases very many years prior to the study questionnaire being
sent. Whilst the authors suggest that recall bias is likely to underestimate the
symptoms, the opposite may in fact be the case given the likelihood of positive
reinforcement by health professionals encouraging dietary compliance, and
membership of a patient group. There is an unfortunate but unavoidable
response bias as well that probably explains the high rate of dietary compliance
(96%) of the 66% that did respond. This data does not support the idea of mass
screening for coeliac disease, but is further support for a low threshold in testing
for the condition in the presence of symptoms. In this regard a potential
opportunity has been missed by the investigators in determining which type of
symptoms were predominantly experienced by patients and whether this had any
impact on the delay in diagnosis. I would find figure 1 easier to understand with
the addition of the words 'prior to diagnosis' after 'duration of symptoms' on the
abscissa label.
Level of interest: An article of importance in its field
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:Delay to celiac disease diagnosis and its implications for health-related
quality of life
Version: 2Date:6 October 2011
Reviewer: Jeremy Woodward
Reviewer's report:
This is a large study that identified a significant delay in time from the onset of
symptoms in coeliac disease to the diagnosis of the condition. By demonstrating
an improvement in health-related quality of life after diagnosis and institution of
treatment, a preventable burden of ill health has been identified. The study is well
designed and executed with the authors aware of the major limitations of the
work. Potential sources of bias include the difficulty in recall of symptoms prior to
diagnosis - in some cases very many years prior to the study questionnaire being
sent. Whilst the authors suggest that recall bias is likely to underestimate the
symptoms, the opposite may in fact be the case given the likelihood of positive
reinforcement by health professionals encouraging dietary compliance, and
membership of a patient group. There is an unfortunate but unavoidable
response bias as well that probably explains the high rate of dietary compliance
(96%) of the 66% that did respond. This data does not support the idea of mass
screening for coeliac disease, but is further support for a low threshold in testing
for the condition in the presence of symptoms. In this regard a potential
opportunity has been missed by the investigators in determining which type of
symptoms were predominantly experienced by patients and whether this had any
impact on the delay in diagnosis. I would find figure 1 easier to understand with
the addition of the words 'prior to diagnosis' after 'duration of symptoms' on the
abscissa label.
Level of interest: An article of importance in its field
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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