Title: SOMATIZATION IN PATIENTS WITH PREDOMINANT DIARRHEA IRRITABLE
BOWEL SYNDROME: THE ROLE OF THE INTESTINAL BARRIER FUNCTION AND
INTEGRITY
Version: 1 Date: 10 Apr 2021
Reviewer's report:
This is a very interesting paper dealing with the complex interplay between GI and  psychological
symptoms, changes of mucosal barrier and dysbiosis in IBS-D patients
The aim of the study and methods are clearly described.
The statistical analysis appears to have been carried out correctly
The results are clearly shown and widely discussed
BACKGROUND
The reference 1 should be changed because it refers to  Rome III criteria. Conversely the
classification, correctly reported by the authors, is available in:
“BE. Lacy, F. Mearin, L. Chang, WD Chey, AJ Lembo, M Simren, and R Spiller.  Bowel
Disorders. Gastroenterology 2016…”.
(Rome IV criteria)
METHODS
Line 105: Insert the reference Lacy BE…. about Rome IV criteria
RESULTS
-Were IBS mean age (42.8 ± 10.3 yrs.); and HC mean age (32.5 ± 14.1 yrs) significantly
different? If so the authors should briefly discuss this issue
-“Faecal zonulin concentrations were significantly higher in the HS group than the LS one”.
Were serum zonulin levels increased, too? The authors should briefly discuss this topic
DISCUSSION
Lines 320-335: the authors could profitably use to enlarge this interesting topic some papers
coming  from the same country cases to find out similarities and/or  differences  i.e.
-Soncini M et al. IBS clinical management in Italy…”. DLD 2018
-Stasi C et al. The complex interplay between gastrointestinal and psychiatric symptoms in
irritable bowel syndrome…” JGH 2018
The authors used non-invasive, “indirect” methods ( urinary indole and skatole) for gut dysbiosis
evaluation.  Could a direct assessment  of the microbiome and metabolome have provided further
(different) information?
What’s their opinion? Could be another point of weakness?
Title: SOMATIZATION IN PATIENTS WITH PREDOMINANT DIARRHEA IRRITABLE
BOWEL SYNDROME: THE ROLE OF THE INTESTINAL BARRIER FUNCTION AND
INTEGRITY
Version: 1 Date: 10 Apr 2021
Reviewer's report:
This is a very interesting paper dealing with the complex interplay between GI and  psychological
symptoms, changes of mucosal barrier and dysbiosis in IBS-D patients
The aim of the study and methods are clearly described.
The statistical analysis appears to have been carried out correctly
The results are clearly shown and widely discussed
BACKGROUND
The reference 1 should be changed because it refers to  Rome III criteria. Conversely the
classification, correctly reported by the authors, is available in:
“BE. Lacy, F. Mearin, L. Chang, WD Chey, AJ Lembo, M Simren, and R Spiller.  Bowel
Disorders. Gastroenterology 2016…”.
(Rome IV criteria)
METHODS
Line 105: Insert the reference Lacy BE…. about Rome IV criteria
RESULTS
-Were IBS mean age (42.8 ± 10.3 yrs.); and HC mean age (32.5 ± 14.1 yrs) significantly
different? If so the authors should briefly discuss this issue
-“Faecal zonulin concentrations were significantly higher in the HS group than the LS one”.
Were serum zonulin levels increased, too? The authors should briefly discuss this topic
DISCUSSION
Lines 320-335: the authors could profitably use to enlarge this interesting topic some papers
coming  from the same country cases to find out similarities and/or  differences  i.e.
-Soncini M et al. IBS clinical management in Italy…”. DLD 2018
-Stasi C et al. The complex interplay between gastrointestinal and psychiatric symptoms in
irritable bowel syndrome…” JGH 2018
The authors used non-invasive, “indirect” methods ( urinary indole and skatole) for gut dysbiosis
evaluation.  Could a direct assessment  of the microbiome and metabolome have provided further
(different) information?
What’s their opinion? Could be another point of weakness?
Please review this paper.
user
Title: SOMATIZATION IN PATIENTS WITH PREDOMINANT DIARRHEA IRRITABLE
BOWEL SYNDROME: THE ROLE OF THE INTESTINAL BARRIER FUNCTION AND
INTEGRITY
Version: 1 Date: 10 Apr 2021
Reviewer's report:
This is a very interesting paper dealing with the complex interplay between GI and  psychological
symptoms, changes of mucosal barrier and dysbiosis in IBS-D patients
The aim of the study and methods are clearly described.
The statistical analysis appears to have been carried out correctly
The results are clearly shown and widely discussed
BACKGROUND
The reference 1 should be changed because it refers to  Rome III criteria. Conversely the
classification, correctly reported by the authors, is available in:
“BE. Lacy, F. Mearin, L. Chang, WD Chey, AJ Lembo, M Simren, and R Spiller.  Bowel
Disorders. Gastroenterology 2016…”.
(Rome IV criteria)
METHODS
Line 105: Insert the reference Lacy BE…. about Rome IV criteria
RESULTS
-Were IBS mean age (42.8 ± 10.3 yrs.); and HC mean age (32.5 ± 14.1 yrs) significantly
different? If so the authors should briefly discuss this issue
-“Faecal zonulin concentrations were significantly higher in the HS group than the LS one”.
Were serum zonulin levels increased, too? The authors should briefly discuss this topic
DISCUSSION
Lines 320-335: the authors could profitably use to enlarge this interesting topic some papers
coming  from the same country cases to find out similarities and/or  differences  i.e.
-Soncini M et al. IBS clinical management in Italy…”. DLD 2018
-Stasi C et al. The complex interplay between gastrointestinal and psychiatric symptoms in
irritable bowel syndrome…” JGH 2018
The authors used non-invasive, “indirect” methods ( urinary indole and skatole) for gut dysbiosis
evaluation.  Could a direct assessment  of the microbiome and metabolome have provided further
(different) information?
What’s their opinion? Could be another point of weakness?
assistant