Reviewer ’s report  
Title: The prevalence and phenotype in Brazilian patients with inflammatory bowel disease.  
 
Version: 0 Date: 30 Nov 2017  
 
Reviewer: Kevan Jacobson  
 
Reviewer's report:  
The authors determi ned the incidence and prevalence, described the clinical characteristics, 
disease behaviour and drug prescription/ usage amongst IBD patients (paediatric an adults) in the 
state of Espirito, Brazil, for years 2013 and 2014. Patients with IBD were identifie d through the 
Public Medication Dispensing System of the Department of Health of Espirito Santo between 
August 2012 and July 2014. 71% of active patients identified (1048/1484) were included.  
 
The article is well written and easy to read. Moreover this work adds to the body of literature 
emerging from South America and specifically Brazil. However there are a number of 
methodological limitations and some minor grammatical errors.  
 
The authors s tate that a gastroenterologist was responsible for dispensing the medications for 
IBD. This implies that only one GI physician was involved? The authors should elaborate on the 
this and indicate whether one physician or a group pf physicians were involved in the care of the 
patients. How did the authors confirm IBD cases, i.e what were the case definitions,  how many 
IBD codes were required for an IBD case? What duration of therapy and /or number of 
prescription dispensed were required to confirm IBD treatm ent and how did the authors link the 
clinical and pharmacologic data? Are the medical reports, endoscopic exams, histology and 
radiologic studies part of centralized government managed admin data? if so was this centrally 
linked and then provided to the au thors as de -identified data or was this data all linked by a 
gastroenterologist? The authors indicate that some patients in the private system obtain their 
medications directly from drugstores without utilizing the public system. This will obviously 
lead t o an underestimation of incidence and prevalence. Is it possible for the authors to give an 
estimate of the size of this population?  
Did all CD patient included in the study have an upper GI endoscopy and biopsy?. If not the 
authors should indicate the pe rcentage of patients who underwent an UGI endoscopy and 
biopsies (as this obviously will impact on the UGI findings). In addition, did all CD patients 
included have an MRE? Again this will impact on the percentage of patients identified with 
small bowel di sease.  
 
The authors should indicate the number patients in whom an endoscopy report was unavailable 
(and only the histological report). The authors may want to indicate the number of patients in 
whom complete data was available.  
 
The authors may want to co nsider further separation of the paediatric population beyond that 
currently provided in the manuscript i.e providing incidence and prevalence data in IBD patients 
16 years of age and under and the rest of the population over 16 years of age.  
 
The authors may want to indicate which biologics were used in the patients in the current study.  
 
Minor comments:  
 
The authors compare the data in the current manuscript with that of the 2 previous Brazilian 
studies. However it is important for the authors to indicate  the methodological differences 
between the studies - e.g. the 2 previous Brazilian studies are single centre studies which 
underestimate incidence and prevalence, in contrast to the current study which utilized admin 
data....  
 
Page 6, line 151 - sentence 2.  Replace At the UC from all the patients ... with For UC patients 
treated with oral aminosalicylates...  
Page 6, line 152 - add in or after left -sided colitis  
Page 6, Line 153 - remove and and after pancolitis replace and the ones that had for those who 
had.. 
Page 6, line 154 - replace being with .. patients with UC with 21 ...  
Page 7, line 155/ 156 - replace On the with For CD patients, immunomodulators were prescribed 
in ... 
Page 7, line 157 after cases remove the  
Page 7, line 157 - after mainly replace vi wit h due to perianal..  
Page 7, line 161 to 164 the wording needs to be corrected - higher that in the two... analyzing 
University Hospital data in the northern region found a prevalence of 12.8/100,000 and in 
Victoria..., also analyzing University hospital da ta between 2001 and 2005 found a prevalence 
of.. 
 
Table 4 - Disease behaviour percentages exceed 100% for A2, A3 and gender and doesn't add up 
to 100% for A1. In addition numbers also exceed 100% for perianal involvement.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional s tatistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
I am able to assess the statistics  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Acceptable  
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 publi cation of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 your reply is yes to any, please give details below.  
 
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 Cr eative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
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: The prevalence and phenotype in Brazilian patients with inflammatory bowel disease.  
 
Version: 0 Date: 30 Nov 2017  
 
Reviewer: Kevan Jacobson  
 
Reviewer's report:  
The authors determi ned the incidence and prevalence, described the clinical characteristics, 
disease behaviour and drug prescription/ usage amongst IBD patients (paediatric an adults) in the 
state of Espirito, Brazil, for years 2013 and 2014. Patients with IBD were identifie d through the 
Public Medication Dispensing System of the Department of Health of Espirito Santo between 
August 2012 and July 2014. 71% of active patients identified (1048/1484) were included.  
 
The article is well written and easy to read. Moreover this work adds to the body of literature 
emerging from South America and specifically Brazil. However there are a number of 
methodological limitations and some minor grammatical errors.  
 
The authors s tate that a gastroenterologist was responsible for dispensing the medications for 
IBD. This implies that only one GI physician was involved? The authors should elaborate on the 
this and indicate whether one physician or a group pf physicians were involved in the care of the 
patients. How did the authors confirm IBD cases, i.e what were the case definitions,  how many 
IBD codes were required for an IBD case? What duration of therapy and /or number of 
prescription dispensed were required to confirm IBD treatm ent and how did the authors link the 
clinical and pharmacologic data? Are the medical reports, endoscopic exams, histology and 
radiologic studies part of centralized government managed admin data? if so was this centrally 
linked and then provided to the au thors as de -identified data or was this data all linked by a 
gastroenterologist? The authors indicate that some patients in the private system obtain their 
medications directly from drugstores without utilizing the public system. This will obviously 
lead t o an underestimation of incidence and prevalence. Is it possible for the authors to give an 
estimate of the size of this population?  
Did all CD patient included in the study have an upper GI endoscopy and biopsy?. If not the 
authors should indicate the pe rcentage of patients who underwent an UGI endoscopy and 
biopsies (as this obviously will impact on the UGI findings). In addition, did all CD patients 
included have an MRE? Again this will impact on the percentage of patients identified with 
small bowel di sease.  
 
The authors should indicate the number patients in whom an endoscopy report was unavailable 
(and only the histological report). The authors may want to indicate the number of patients in 
whom complete data was available.  
 
The authors may want to co nsider further separation of the paediatric population beyond that 
currently provided in the manuscript i.e providing incidence and prevalence data in IBD patients 
16 years of age and under and the rest of the population over 16 years of age.  
 
The authors may want to indicate which biologics were used in the patients in the current study.  
 
Minor comments:  
 
The authors compare the data in the current manuscript with that of the 2 previous Brazilian 
studies. However it is important for the authors to indicate  the methodological differences 
between the studies - e.g. the 2 previous Brazilian studies are single centre studies which 
underestimate incidence and prevalence, in contrast to the current study which utilized admin 
data....  
 
Page 6, line 151 - sentence 2.  Replace At the UC from all the patients ... with For UC patients 
treated with oral aminosalicylates...  
Page 6, line 152 - add in or after left -sided colitis  
Page 6, Line 153 - remove and and after pancolitis replace and the ones that had for those who 
had.. 
Page 6, line 154 - replace being with .. patients with UC with 21 ...  
Page 7, line 155/ 156 - replace On the with For CD patients, immunomodulators were prescribed 
in ... 
Page 7, line 157 after cases remove the  
Page 7, line 157 - after mainly replace vi wit h due to perianal..  
Page 7, line 161 to 164 the wording needs to be corrected - higher that in the two... analyzing 
University Hospital data in the northern region found a prevalence of 12.8/100,000 and in 
Victoria..., also analyzing University hospital da ta between 2001 and 2005 found a prevalence 
of.. 
 
Table 4 - Disease behaviour percentages exceed 100% for A2, A3 and gender and doesn't add up 
to 100% for A1. In addition numbers also exceed 100% for perianal involvement.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional s tatistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
I am able to assess the statistics  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Acceptable  
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 publi cation of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 your reply is yes to any, please give details below.  
 
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 Cr eative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
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: The prevalence and phenotype in Brazilian patients with inflammatory bowel disease.  
 
Version: 0 Date: 30 Nov 2017  
 
Reviewer: Kevan Jacobson  
 
Reviewer's report:  
The authors determi ned the incidence and prevalence, described the clinical characteristics, 
disease behaviour and drug prescription/ usage amongst IBD patients (paediatric an adults) in the 
state of Espirito, Brazil, for years 2013 and 2014. Patients with IBD were identifie d through the 
Public Medication Dispensing System of the Department of Health of Espirito Santo between 
August 2012 and July 2014. 71% of active patients identified (1048/1484) were included.  
 
The article is well written and easy to read. Moreover this work adds to the body of literature 
emerging from South America and specifically Brazil. However there are a number of 
methodological limitations and some minor grammatical errors.  
 
The authors s tate that a gastroenterologist was responsible for dispensing the medications for 
IBD. This implies that only one GI physician was involved? The authors should elaborate on the 
this and indicate whether one physician or a group pf physicians were involved in the care of the 
patients. How did the authors confirm IBD cases, i.e what were the case definitions,  how many 
IBD codes were required for an IBD case? What duration of therapy and /or number of 
prescription dispensed were required to confirm IBD treatm ent and how did the authors link the 
clinical and pharmacologic data? Are the medical reports, endoscopic exams, histology and 
radiologic studies part of centralized government managed admin data? if so was this centrally 
linked and then provided to the au thors as de -identified data or was this data all linked by a 
gastroenterologist? The authors indicate that some patients in the private system obtain their 
medications directly from drugstores without utilizing the public system. This will obviously 
lead t o an underestimation of incidence and prevalence. Is it possible for the authors to give an 
estimate of the size of this population?  
Did all CD patient included in the study have an upper GI endoscopy and biopsy?. If not the 
authors should indicate the pe rcentage of patients who underwent an UGI endoscopy and 
biopsies (as this obviously will impact on the UGI findings). In addition, did all CD patients 
included have an MRE? Again this will impact on the percentage of patients identified with 
small bowel di sease.  
 
The authors should indicate the number patients in whom an endoscopy report was unavailable 
(and only the histological report). The authors may want to indicate the number of patients in 
whom complete data was available.  
 
The authors may want to co nsider further separation of the paediatric population beyond that 
currently provided in the manuscript i.e providing incidence and prevalence data in IBD patients 
16 years of age and under and the rest of the population over 16 years of age.  
 
The authors may want to indicate which biologics were used in the patients in the current study.  
 
Minor comments:  
 
The authors compare the data in the current manuscript with that of the 2 previous Brazilian 
studies. However it is important for the authors to indicate  the methodological differences 
between the studies - e.g. the 2 previous Brazilian studies are single centre studies which 
underestimate incidence and prevalence, in contrast to the current study which utilized admin 
data....  
 
Page 6, line 151 - sentence 2.  Replace At the UC from all the patients ... with For UC patients 
treated with oral aminosalicylates...  
Page 6, line 152 - add in or after left -sided colitis  
Page 6, Line 153 - remove and and after pancolitis replace and the ones that had for those who 
had.. 
Page 6, line 154 - replace being with .. patients with UC with 21 ...  
Page 7, line 155/ 156 - replace On the with For CD patients, immunomodulators were prescribed 
in ... 
Page 7, line 157 after cases remove the  
Page 7, line 157 - after mainly replace vi wit h due to perianal..  
Page 7, line 161 to 164 the wording needs to be corrected - higher that in the two... analyzing 
University Hospital data in the northern region found a prevalence of 12.8/100,000 and in 
Victoria..., also analyzing University hospital da ta between 2001 and 2005 found a prevalence 
of.. 
 
Table 4 - Disease behaviour percentages exceed 100% for A2, A3 and gender and doesn't add up 
to 100% for A1. In addition numbers also exceed 100% for perianal involvement.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional s tatistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
I am able to assess the statistics  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Acceptable  
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 publi cation of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 your reply is yes to any, please give details below.  
 
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 Cr eative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
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