Reviewer ’s report  
 
Title: Can microscopic ileitis in patients with clinically suspe cted inflammatory bowel disease 
predict the future?  
 
Version: 1 Date: 07 Nov 2019  
 
Reviewer: Francisco Bravo  
 
Reviewer's report:  
Baker et. Al. restrospectively included patients referred for IBD suspicion who had a complete, 
macroscopically normal colonoscopy and where biopsies were taken from the terminal ileum. 
The rates of Crohn's disease diagnosis in the subgroup of patients with microscopic ileitis was 
then recorded on the basis of subsequent  gastroenterologist's follow -up reports.  
 
Major comments:  
- There are only limited study setting informations avilable to make an informed evaluation 
of the current results.  
- Were the patients followed in the investigator's clinic? I assume not since (pa ge 11, lines 
32-34) the authors state that they were unable to acces many patient's information. In regard to 
this, it would be worth knowing how many of the "MI" patients actually had a follow -up 
appointment (and with whom, IBD expert gastroenterologist v s general gastroenterologist vs 
GP?) and also how many of those were lost to follow -up as this might significantly impact the 
interpretation of the results.  
- Since follow -up reports of GI specialists seem to be available, how and when (time from 
microsco pic ileitis to Crohn's diagnosis) was Crohn diagnosed? At what age? How were the 
follow -up reports "tracked"? Do we know how much patients had follow -up endoscopies?  
- It also would be worth to know the severity and extent of the subsequently diagnosed CD 
(is the MI finding associated with more indolent outcomes since index endoscopy?)  
- Also, were alternative diagnosis with ileal/colonic involvement in followed -up patie nts 
available (TB, vasculitis and so on?). In what portion of patients?  
- Page 11 lines 32 -34: "… and apparently received similar care". How was care compared 
across the 2 groups?  
 
 
Minor comments  
- Page 6, line 18: "ass suspicious" might be relevant is t his context but is most likely a 
typing error  
- Page 7, lines 33 -36: unclear sentence?  
- Page 6: were the groups actually prospectively followed -up (and how/where/by whom? 
Follow -up appointments? Where specific measurements required during these follow -ups?)  
 
General comments:  
The authors conclude that in their patient cohort and significant amount of patients with 
microscopic ileitis at index colonoscopy progress to diagnosed crohn's disease. The finding of a 
microscopic ileitis is not a rarity in daily clinical practice and laeds to incertainty given its 
unclear significance. Hence, this report adresses a clinically important question for which no 
clear guidelines are available. However, the lack of clear informations on the setting and the 
diagnosis of Crohn's disease limit a comprehensive intepretation of the current results.  
 
 
 
 
Are the methods appropriate and well desc ribed?  
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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical 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:  
 
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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication 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 futu re? 
 
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.  
 
none 
 
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 f or publication, my named report 
including any attachments I upload will be posted on the website along with th e authors' 
responses. I agree for my report to be made available under an Open Acc ess Creative 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 in cluded 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: Can microscopic ileitis in patients with clinically suspe cted inflammatory bowel disease 
predict the future?  
 
Version: 1 Date: 07 Nov 2019  
 
Reviewer: Francisco Bravo  
 
Reviewer's report:  
Baker et. Al. restrospectively included patients referred for IBD suspicion who had a complete, 
macroscopically normal colonoscopy and where biopsies were taken from the terminal ileum. 
The rates of Crohn's disease diagnosis in the subgroup of patients with microscopic ileitis was 
then recorded on the basis of subsequent  gastroenterologist's follow -up reports.  
 
Major comments:  
- There are only limited study setting informations avilable to make an informed evaluation 
of the current results.  
- Were the patients followed in the investigator's clinic? I assume not since (pa ge 11, lines 
32-34) the authors state that they were unable to acces many patient's information. In regard to 
this, it would be worth knowing how many of the "MI" patients actually had a follow -up 
appointment (and with whom, IBD expert gastroenterologist v s general gastroenterologist vs 
GP?) and also how many of those were lost to follow -up as this might significantly impact the 
interpretation of the results.  
- Since follow -up reports of GI specialists seem to be available, how and when (time from 
microsco pic ileitis to Crohn's diagnosis) was Crohn diagnosed? At what age? How were the 
follow -up reports "tracked"? Do we know how much patients had follow -up endoscopies?  
- It also would be worth to know the severity and extent of the subsequently diagnosed CD 
(is the MI finding associated with more indolent outcomes since index endoscopy?)  
- Also, were alternative diagnosis with ileal/colonic involvement in followed -up patie nts 
available (TB, vasculitis and so on?). In what portion of patients?  
- Page 11 lines 32 -34: "… and apparently received similar care". How was care compared 
across the 2 groups?  
 
 
Minor comments  
- Page 6, line 18: "ass suspicious" might be relevant is t his context but is most likely a 
typing error  
- Page 7, lines 33 -36: unclear sentence?  
- Page 6: were the groups actually prospectively followed -up (and how/where/by whom? 
Follow -up appointments? Where specific measurements required during these follow -ups?)  
 
General comments:  
The authors conclude that in their patient cohort and significant amount of patients with 
microscopic ileitis at index colonoscopy progress to diagnosed crohn's disease. The finding of a 
microscopic ileitis is not a rarity in daily clinical practice and laeds to incertainty given its 
unclear significance. Hence, this report adresses a clinically important question for which no 
clear guidelines are available. However, the lack of clear informations on the setting and the 
diagnosis of Crohn's disease limit a comprehensive intepretation of the current results.  
 
 
 
 
Are the methods appropriate and well desc ribed?  
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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical 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:  
 
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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication 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 futu re? 
 
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.  
 
none 
 
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 f or publication, my named report 
including any attachments I upload will be posted on the website along with th e authors' 
responses. I agree for my report to be made available under an Open Acc ess Creative 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 in cluded 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: Can microscopic ileitis in patients with clinically suspe cted inflammatory bowel disease 
predict the future?  
 
Version: 1 Date: 07 Nov 2019  
 
Reviewer: Francisco Bravo  
 
Reviewer's report:  
Baker et. Al. restrospectively included patients referred for IBD suspicion who had a complete, 
macroscopically normal colonoscopy and where biopsies were taken from the terminal ileum. 
The rates of Crohn's disease diagnosis in the subgroup of patients with microscopic ileitis was 
then recorded on the basis of subsequent  gastroenterologist's follow -up reports.  
 
Major comments:  
- There are only limited study setting informations avilable to make an informed evaluation 
of the current results.  
- Were the patients followed in the investigator's clinic? I assume not since (pa ge 11, lines 
32-34) the authors state that they were unable to acces many patient's information. In regard to 
this, it would be worth knowing how many of the "MI" patients actually had a follow -up 
appointment (and with whom, IBD expert gastroenterologist v s general gastroenterologist vs 
GP?) and also how many of those were lost to follow -up as this might significantly impact the 
interpretation of the results.  
- Since follow -up reports of GI specialists seem to be available, how and when (time from 
microsco pic ileitis to Crohn's diagnosis) was Crohn diagnosed? At what age? How were the 
follow -up reports "tracked"? Do we know how much patients had follow -up endoscopies?  
- It also would be worth to know the severity and extent of the subsequently diagnosed CD 
(is the MI finding associated with more indolent outcomes since index endoscopy?)  
- Also, were alternative diagnosis with ileal/colonic involvement in followed -up patie nts 
available (TB, vasculitis and so on?). In what portion of patients?  
- Page 11 lines 32 -34: "… and apparently received similar care". How was care compared 
across the 2 groups?  
 
 
Minor comments  
- Page 6, line 18: "ass suspicious" might be relevant is t his context but is most likely a 
typing error  
- Page 7, lines 33 -36: unclear sentence?  
- Page 6: were the groups actually prospectively followed -up (and how/where/by whom? 
Follow -up appointments? Where specific measurements required during these follow -ups?)  
 
General comments:  
The authors conclude that in their patient cohort and significant amount of patients with 
microscopic ileitis at index colonoscopy progress to diagnosed crohn's disease. The finding of a 
microscopic ileitis is not a rarity in daily clinical practice and laeds to incertainty given its 
unclear significance. Hence, this report adresses a clinically important question for which no 
clear guidelines are available. However, the lack of clear informations on the setting and the 
diagnosis of Crohn's disease limit a comprehensive intepretation of the current results.  
 
 
 
 
Are the methods appropriate and well desc ribed?  
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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical 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:  
 
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, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication 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 futu re? 
 
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.  
 
none 
 
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 f or publication, my named report 
including any attachments I upload will be posted on the website along with th e authors' 
responses. I agree for my report to be made available under an Open Acc ess Creative 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 in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant