Reviewer's report
Title:Images of colonic real-time tissue elastography correlate with those of
colonoscopy and may predict response to therapy in patients with ulcerative
colitis
Version: 1Date:14 December 2010
Reviewer: Govind Makharia
Reviewer's report:
Images of colonic real-time tissue elastography correlate with those of
colonoscopy
and may predict response to therapy in patients with ulcerative colitis
In this novel study, the authors have evaluated the utility of elastrography in
predicting activity of ulcerative colitis and have reported a correlation between
elastrographic types and colonoscopy findings and treatment outcome based on
elastographic findings.
While this study is novel, there are a few concerns:
1. Patient selection: The ulcerative colitis is a disease which involves generally
mucosa and may involve sub-mucosa also. The endoscopic characteristics are
features which are superficial (erythema, friability, granularity, ulcerations which
generally are superficial). Punched out ulcers and longitudinal ulcers are features
of deeper degree of inflammation which are seen more often in Crohn’s disease.
The image placed in this study shows longitudinal ulcer, which is a feature of
Crohn’s disease. Are these really patients with UC?
2. The interpretation of the response to treatment according to EG type is
premature. The treatment decision was taken as per the clinical indication and
number of patients is too small to derive any meaningful information on this
issue. Although, three of five patients with active disease with hard type EG
required colectomy, five patients with clinical remission also had hard type EG.
Therefore it is not appropriate to conclude that treatment outcome can be
predicted on the basis of EG findings. It will be better if the correlation between
the EG grade and treatment are deleted. The main focus of this paper may
highlight correlation between colonoscopic features and EG.
3. Correlation between clinical activity score and EG: Although there is an
association between the EG grades and clinical activity indices; however one can
see a lot of overlap between EG findings (normal, homogeneous and hard)
clinical activity status ( patients either having an active disease or their diseases
being in remission).
4. Since air is an important barrier to the transmission of US waves, did the
author find any difficulty in getting good EG images and B mode images in all
these patients? If so, that should be mentioned. Or only those having good
images were included in this study?
Minor:
The paragraph on the leukocyte therapy from the introduction may be deleted.
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
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:Images of colonic real-time tissue elastography correlate with those of
colonoscopy and may predict response to therapy in patients with ulcerative
colitis
Version: 1Date:14 December 2010
Reviewer: Govind Makharia
Reviewer's report:
Images of colonic real-time tissue elastography correlate with those of
colonoscopy
and may predict response to therapy in patients with ulcerative colitis
In this novel study, the authors have evaluated the utility of elastrography in
predicting activity of ulcerative colitis and have reported a correlation between
elastrographic types and colonoscopy findings and treatment outcome based on
elastographic findings.
While this study is novel, there are a few concerns:
1. Patient selection: The ulcerative colitis is a disease which involves generally
mucosa and may involve sub-mucosa also. The endoscopic characteristics are
features which are superficial (erythema, friability, granularity, ulcerations which
generally are superficial). Punched out ulcers and longitudinal ulcers are features
of deeper degree of inflammation which are seen more often in Crohn’s disease.
The image placed in this study shows longitudinal ulcer, which is a feature of
Crohn’s disease. Are these really patients with UC?
2. The interpretation of the response to treatment according to EG type is
premature. The treatment decision was taken as per the clinical indication and
number of patients is too small to derive any meaningful information on this
issue. Although, three of five patients with active disease with hard type EG
required colectomy, five patients with clinical remission also had hard type EG.
Therefore it is not appropriate to conclude that treatment outcome can be
predicted on the basis of EG findings. It will be better if the correlation between
the EG grade and treatment are deleted. The main focus of this paper may
highlight correlation between colonoscopic features and EG.
3. Correlation between clinical activity score and EG: Although there is an
association between the EG grades and clinical activity indices; however one can
see a lot of overlap between EG findings (normal, homogeneous and hard)
clinical activity status ( patients either having an active disease or their diseases
being in remission).
4. Since air is an important barrier to the transmission of US waves, did the
author find any difficulty in getting good EG images and B mode images in all
these patients? If so, that should be mentioned. Or only those having good
images were included in this study?
Minor:
The paragraph on the leukocyte therapy from the introduction may be deleted.
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
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:Images of colonic real-time tissue elastography correlate with those of
colonoscopy and may predict response to therapy in patients with ulcerative
colitis
Version: 1Date:14 December 2010
Reviewer: Govind Makharia
Reviewer's report:
Images of colonic real-time tissue elastography correlate with those of
colonoscopy
and may predict response to therapy in patients with ulcerative colitis
In this novel study, the authors have evaluated the utility of elastrography in
predicting activity of ulcerative colitis and have reported a correlation between
elastrographic types and colonoscopy findings and treatment outcome based on
elastographic findings.
While this study is novel, there are a few concerns:
1. Patient selection: The ulcerative colitis is a disease which involves generally
mucosa and may involve sub-mucosa also. The endoscopic characteristics are
features which are superficial (erythema, friability, granularity, ulcerations which
generally are superficial). Punched out ulcers and longitudinal ulcers are features
of deeper degree of inflammation which are seen more often in Crohn’s disease.
The image placed in this study shows longitudinal ulcer, which is a feature of
Crohn’s disease. Are these really patients with UC?
2. The interpretation of the response to treatment according to EG type is
premature. The treatment decision was taken as per the clinical indication and
number of patients is too small to derive any meaningful information on this
issue. Although, three of five patients with active disease with hard type EG
required colectomy, five patients with clinical remission also had hard type EG.
Therefore it is not appropriate to conclude that treatment outcome can be
predicted on the basis of EG findings. It will be better if the correlation between
the EG grade and treatment are deleted. The main focus of this paper may
highlight correlation between colonoscopic features and EG.
3. Correlation between clinical activity score and EG: Although there is an
association between the EG grades and clinical activity indices; however one can
see a lot of overlap between EG findings (normal, homogeneous and hard)
clinical activity status ( patients either having an active disease or their diseases
being in remission).
4. Since air is an important barrier to the transmission of US waves, did the
author find any difficulty in getting good EG images and B mode images in all
these patients? If so, that should be mentioned. Or only those having good
images were included in this study?
Minor:
The paragraph on the leukocyte therapy from the introduction may be deleted.
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
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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