Skip to Content
MDPIMDPI

Advanced

by
  • Xiaoliang Wang 1,
  • Zachary Wright 1 and
  • Gengqing Song 2,*
  • et al.

Reviewer 1: Sutonuka Bhar Reviewer 2: Marko Baralic Reviewer 3: Youakim Saliba

Round 1

Reviewer 1 Report

Wang et al. has discussed in the article about their findings from a study correlating chronic kidney disease with gastric diseases. Patient data from National Inpatient Sample data was used and patients with gastric diseases such as gastritis, gastric polyps, peptic ulcer disease, and H. pylori infection were used in this study. The authors found a significant association of CKD with gastric diseases and brings forward the importance of monitoring these two symptoms together. The article has well described introduction and discussion section where limitations were well pointed out and specific. Including the severity of the diseases as another distinguishing category in patients may have provided with more information regarding the correlation of CKD and gastric diseases.

 

Here are some minor comments to help improve the article:

1.     Please change to “H. pylori” (p in small case) and italicize “Helicobacter pylori” and “H. pylori” throughout the article.

2.     The caption of Figure 1 contains only figure title. Kindly add some more details in caption.

3.     Label the different figures as “a”, “b”, “c”, and “d” (for Fig 3) and then add caption for them separately.

4.     Expansion of some terms in specific lines are needed. For eg. “T2DM” in line 142, “ROS” in line 224, “SOD” and “MDA” in line 229, and “NIS” in line 245.

There are some grammatical errors in the article which can be improved by using any simple grammatical error detection software.

Author Response

  1. Please change to “H. pylori” (p in small case) and italicize “Helicobacter pylori” and “H. pylori” throughout the article.

-Thank you for the comments, fixed in revision.

  1. The caption of Figure 1 contains only figure title. Kindly add some more details in caption.

-More information was added in Figure 1 caption.

  1. Label the different figures as “a”, “b”, “c”, and “d” (for Fig 3) and then add caption for them separately.

-Thank you for this suggestion, added in the revised version.

  1. Expansion of some terms in specific lines are needed. For eg. “T2DM” in line 142, “ROS” in line 224, “SOD” and “MDA” in line 229, and “NIS” in line 245.

-Thank you for pointing out this mistake. Fixed in the revision. 

Reviewer 2 Report

1. In addition to antibiotics, Helicobacter pylori is also treated with the use of PPIs - corrected (corrected) ref 15.

2. PPIs, on the other hand, can worsen CKD

3. The use of NSAIDs that lead to reactive gastritis can lead to ATN and CKD

4. In each subpopulation there were significantly fewer patients with CKD -> which is not to be expected if it is known that CKD is a modern disease with an incidence in the existing population of 10%

5. Row 146 - did the patient have albuminuria or eGFR determined?

6. The same applies to CKD2

7. Nowhere is it mentioned how the diagnosis of gastritis was made? Is it based on PH findings after EGDS?

8. It is known that T2DM often leads to gastroparesis and that it is more pronounced in patients with CKD when DM is the most common cause of CKD in the world

9. It is expected that patients in ESRD have a higher incidence of peptic ulcer than in earlier stages of CKD due to acidosis!

10. It is known that the dialysis population has a significantly higher chance of developing a peptic or stress ulcer due to heparinization during a hemodialysis session!

11. They did not separate PD from HD patients in stage 5.

12. Reference 38 should be checked because it is unlikely that these are the main reasons for peptick! ulcer in dialysis patients? Refer to another reference!

13. From research to methodology! not getting the impression where the study was conducted?

/

Author Response

  1. In addition to antibiotics, Helicobacter pylori is also treated with the use of PPIs - corrected (corrected) ref 15.

-Agree, new reference and statement added in the revision

  1. PPIs, on the other hand, can worsen CKD

-Agreed, PPI is a risk factor for CKD, and this topic has been investigated by many researchers. Our focus is to study the potential effect of CKD on gastritis, peptic ulcer disease, or H. pylori infection.

  1. The use of NSAIDs that lead to reactive gastritis can lead to ATN and CKD

-Agreed, NSAIDs also a risk factor for CKD, however, our primary outcome is incidence and odds ratio of gastric diseases in patients with CKD.

  1. In each subpopulation there were significantly fewer patients with CKD -> which is not to be expected if it is known that CKD is a modern disease with an incidence in the existing population of 10%

-According to the 2022 USRDS data, the prevalence of CKD in the United States is approximately 14%. Furthermore, as the stages of CKD increased, the prevalence demonstrated a corresponding decrease.https://usrds-adr.niddk.nih.gov/2022/chronic-kidney-disease/1-ckd-in-the-general-population

 

  1. Row 146 - did the patient have albuminuria or eGFR determined?

- The diagnosis of different stages of CKD in this study was based on the ICD-10 code, assuming it was determined by the eGFR. However, it is important to note that this represents one of the limitations of our manuscript, as discussed in the corresponding section.

  1. The same applies to CKD2

-Thank you for bringing this comment. Please see above for explanation.

  1. Nowhere is it mentioned how the diagnosis of gastritis was made? Is it based on PH findings after EGDS?

-The diagnosis of gastritis in this study was determined based on the ICD-10 codes extracted from the database. We assume that the diagnosis of gastritis was established through procedures such as EGD (esophagogastroduodenoscopy) and biopsy. However, it is important to acknowledge that this represents a limitation of our study. To address this, we intend to conduct a retrospective study by thoroughly reviewing the hospitalization charts of each patient in our regional hospital. This will allow us to gather additional data and further validate our findings.

  1. It is known that T2DM often leads to gastroparesis and that it is more pronounced in patients with CKD when DM is the most common cause of CKD in the world

-Agreed, this study is focus on gastric organic disease, we have a separate study which assessed the relationship of gastroparesis and CKD. On the other hand, we analyzed T2DM prevalence between different groups as showed in Table 1.

  1. It is expected that patients in ESRD have a higher incidence of peptic ulcer than in earlier stages of CKD due to acidosis!

-A large-scale national study conducted in Asia revealed a high incidence of peptic ulcer disease among patients with CKD and those undergoing dialysis. However, no comparable large-scale patient study in the United States has suggested a similar trend, which is our main goal in this study. The exact cause of the increased incidence of peptic ulcer disease in patients with CKD remains unclear. However, potential mechanisms such as oxidative stress and endothelial cell dysfunction have been suggested as contributing factors.

  1. It is known that the dialysis population has a significantly higher chance of developing a peptic or stress ulcer due to heparinization during a hemodialysis session!

-Agreed, and this has been confirmed by similar study conducted in Asian.

  1. They did not separate PD from HD patients in stage 5.

-Thank you for raising this point. It is important to note that the database we used for this study does not provide differentiation between peritoneal dialysis and hemodialysis. To address this limitation, we are planning a retrospective study where we will review the inpatient charts of the patients involved.

  1. Reference 38 should be checked because it is unlikely that these are the main reasons for peptick! ulcer in dialysis patients? Refer to another reference!

-We appreciate the reviewer’s detailed reviewing. The reference [38] was cited in the paragraph discussing the potential mechanism of gastric polyps in patients with CKD.

  1. From research to methodology! not getting the impression where the study was conducted?

-As we mentioned in the methodology section, this study is retrospective study and utilizes a national inpatient database in the United States.

Reviewer 3 Report

Dear Editors,

 

The following study submitted to Gastrointestinal Disorders investigates the relationship between chronic kidney disease (CKD) and various gastric diseases, providing valuable insights into the prevalence and risk association in a large population-based analysis. By utilizing the National Inpatient Sample data, which offers a representative sample of the US population, the study provides a robust foundation for understanding the relationship between CKD and gastric diseases.

There are some concerns that arise.

 

Major issues

-        The introduction is well-structured with a smooth flow of literature; however, it is overly long and should be more succinct. Moreover, a large proportion of text seems to be AI-generated (detected by ZeroGPT and GPTZero). The same applies to the other manuscript sections. I do not know the stance of the journal toward this issue, but it had to be highlighted.

 

-        While the study adjusted for age, gender, and race, it would be helpful to assess other potential confounders such as comorbidities (e.g., obesity, smoking, medication use) that could influence the relationship between CKD and gastric diseases.

Author Response

1. Thank you for your positive comments and kind suggestions. We have revised/rewrite the manuscripts. We extended our manuscript based on the journal’s requirement.

 

2. Thank you for this suggestion. In the revised manuscript, we adjusted obesity, history of smoking, T2DM, hypertension and hyperlipidemia when we analysis the odds ratio of each gastric diseases. Briefly, the odds ratio was not affected by adding these adjustments.

Unfortunately, the database used for this study did not include information on medication use. To address this limitation, we have planned another retrospective study at our regional hospital.

Round 2

Reviewer 2 Report

No

No

Author Response

We have carefully revised the manuscript with the assistance of a native English speaker for editing

Reviewer 3 Report

Dear Editors,

The authors addressed my concerns related to the analysis.

For better readability, the authors are advised to further cut down the word count in the introduction. As for the English language structure, and although I acknowledge the importance of AI use, careful assessment should be made whenever AI-generated text is heavily detected in a manuscript.

 

Author Response

Thank you for your comment. We have rewritten the introduction to eliminate duplicated information and had the entire manuscript reviewed by a native English speaker for revision.