Reviewer's report
Title:Intestinal biopsy to diagnose celiac disease is not always required:
Importance of combined antibody tests
Version: 2Date:13 October 2012
Reviewer: Xavier Bossuyt
Reviewer's report:
The authors present a study in which they claim that intestinal biopsy is not
always required to diagnose celiac disease. The disease can be diagnosed
based on combined antibody tests in patients with a high pretest probability.
Major comments
In this study, the prevelance of celiac disease was >50%. This is higher than the
prevalence of celiac disease in consecutive samples submitted to a routine
clinical laboratory for testing for celiac disease (and probably than the prevalence
of celiac disease in consecutive patients that undergo small bowel biopsy
because of suspicion of celiac disease).
Predictive values depend on the prevalence. Thus, the predictive values
presented in this paper were calculated for a high prevalence (pre-test
probability), and, therefore, may not be representative for settings in which the
prevalence is lower. This should be discussed. For example, the positive
predictive value would be 87% if the pretest probability was 7% (based on data in
Table 2).
Are the patients and controls consecutive patients that presented to the
gastroenterolgist? Given the importance of the pre-test probability (see above), it
woud be good if the authors could give a more detailed description of the clinical
presentation of the patients and controls. Particularly, how would the authors
estimate the pre-test probability for celiac disease in an individual patient? For
example, the authors mention iron deficiency. Is iron deficiency a condition that is
associated with a high (>50%) pretest probability for celiac disease?
A concern is that there might be a selection bias in this study. If the patients that
underwent biopsy were selected based on a positive serological test, then there
is a selection bias. This should be discussed.
Discretionary
There is a recently published report on the combination of tests for celiac disase:
Vermeersch P, Geboes K, Mariën G, Hoffman I, Hiele M, Bossuyt X. Serological
diagnosis of celiac disease: comparative analysis of different strategies. Clin
Chim Acta. 2012;413:1761-7
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I have no financial conflicts of interest.
Reviewer's report
Title:Intestinal biopsy to diagnose celiac disease is not always required:
Importance of combined antibody tests
Version: 2Date:13 October 2012
Reviewer: Xavier Bossuyt
Reviewer's report:
The authors present a study in which they claim that intestinal biopsy is not
always required to diagnose celiac disease. The disease can be diagnosed
based on combined antibody tests in patients with a high pretest probability.
Major comments
In this study, the prevelance of celiac disease was >50%. This is higher than the
prevalence of celiac disease in consecutive samples submitted to a routine
clinical laboratory for testing for celiac disease (and probably than the prevalence
of celiac disease in consecutive patients that undergo small bowel biopsy
because of suspicion of celiac disease).
Predictive values depend on the prevalence. Thus, the predictive values
presented in this paper were calculated for a high prevalence (pre-test
probability), and, therefore, may not be representative for settings in which the
prevalence is lower. This should be discussed. For example, the positive
predictive value would be 87% if the pretest probability was 7% (based on data in
Table 2).
Are the patients and controls consecutive patients that presented to the
gastroenterolgist? Given the importance of the pre-test probability (see above), it
woud be good if the authors could give a more detailed description of the clinical
presentation of the patients and controls. Particularly, how would the authors
estimate the pre-test probability for celiac disease in an individual patient? For
example, the authors mention iron deficiency. Is iron deficiency a condition that is
associated with a high (>50%) pretest probability for celiac disease?
A concern is that there might be a selection bias in this study. If the patients that
underwent biopsy were selected based on a positive serological test, then there
is a selection bias. This should be discussed.
Discretionary
There is a recently published report on the combination of tests for celiac disase:
Vermeersch P, Geboes K, Mariën G, Hoffman I, Hiele M, Bossuyt X. Serological
diagnosis of celiac disease: comparative analysis of different strategies. Clin
Chim Acta. 2012;413:1761-7
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I have no financial conflicts of interest.
Please review this paper.
user
Reviewer's report
Title:Intestinal biopsy to diagnose celiac disease is not always required:
Importance of combined antibody tests
Version: 2Date:13 October 2012
Reviewer: Xavier Bossuyt
Reviewer's report:
The authors present a study in which they claim that intestinal biopsy is not
always required to diagnose celiac disease. The disease can be diagnosed
based on combined antibody tests in patients with a high pretest probability.
Major comments
In this study, the prevelance of celiac disease was >50%. This is higher than the
prevalence of celiac disease in consecutive samples submitted to a routine
clinical laboratory for testing for celiac disease (and probably than the prevalence
of celiac disease in consecutive patients that undergo small bowel biopsy
because of suspicion of celiac disease).
Predictive values depend on the prevalence. Thus, the predictive values
presented in this paper were calculated for a high prevalence (pre-test
probability), and, therefore, may not be representative for settings in which the
prevalence is lower. This should be discussed. For example, the positive
predictive value would be 87% if the pretest probability was 7% (based on data in
Table 2).
Are the patients and controls consecutive patients that presented to the
gastroenterolgist? Given the importance of the pre-test probability (see above), it
woud be good if the authors could give a more detailed description of the clinical
presentation of the patients and controls. Particularly, how would the authors
estimate the pre-test probability for celiac disease in an individual patient? For
example, the authors mention iron deficiency. Is iron deficiency a condition that is
associated with a high (>50%) pretest probability for celiac disease?
A concern is that there might be a selection bias in this study. If the patients that
underwent biopsy were selected based on a positive serological test, then there
is a selection bias. This should be discussed.
Discretionary
There is a recently published report on the combination of tests for celiac disase:
Vermeersch P, Geboes K, Mariën G, Hoffman I, Hiele M, Bossuyt X. Serological
diagnosis of celiac disease: comparative analysis of different strategies. Clin
Chim Acta. 2012;413:1761-7
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I have no financial conflicts of interest.
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