Rehabilitation for Chronic Constipation: Integrative Approaches to Diagnosis and Treatment

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

• In this paper entitled “Rehabilitation in Chronic Constipation: Integrative Approaches to Diagnosis and Treatment”, the authors conducted a comprehensive review of the diagnosis and treatment of chronic constipation. I would like to add a comment.

   

  Major comment

  1.      The section "3.2. Pharmacological rehabilitation" lacks a sufficient review of citations and appears to be biased. There should be more evidence available for each drug, so please add additional references.

  2.      In "Table 2: Summary of pharmacological agents for constipation," only a few of the listed drugs are discussed in the main text. Please provide explanations for the drugs that are not mentioned in the main text.

  3.      While "3.2. Pharmacological rehabilitation" provides descriptions of each drug, it does not address how to differentiate their use. Please include information on the differentiation and appropriate use of these drugs based on the current understanding.

  Minor comment

  1.      There is no description of Section 4 in the main text. Please include a detailed explanation of this chapter in the manuscript.

Author Response

Dear Reviewer,

Thank you for your valuable feedback on our manuscript. We appreciate your time and effort in reviewing our work and for your insightful suggestions. Below, we have provided detailed responses to your comments and outlined the revisions made to the manuscript.

Major comment

1. The section "3.2. Pharmacological rehabilitation" lacks a sufficient review of citations and appears to be biased. There should be more evidence available for each drug, so please add additional references.

We acknowledge the need for a more comprehensive review of citations. We have thoroughly reviewed the relevant literature and included additional references for the pharmacological agents discussed in Section 3.2. These references highlight recent clinical trials, meta-analyses, and systematic reviews.

2. In "Table 2: Summary of pharmacological agents for constipation," only a few of the listed drugs are discussed in the main text. Please provide explanations for the drugs that are not mentioned in the main text.

We have expanded the main text to discuss all the drugs listed in Table 2. Each drug is now briefly described with its mechanism of action, clinical applications, and relevant outcomes.

3. While "3.2. Pharmacological rehabilitation" provides descriptions of each drug, it does not address how to differentiate their use. Please include information on the differentiation and appropriate use of these drugs based on the current understanding.

We have added a new subsection in Section 3.2 that provides guidance on differentiating the use of pharmacological agents. This includes considerations based on patient-specific factors and drug profiles.

Minor comment

1. There is no description of Section 4 in the main text. Please include a detailed explanation of this chapter in the manuscript.

We have renumbered the sections. Thus, Conclusion is now at number 4.

Thank you once again for your thoughtful review and for taking the time to provide this feedback.

Dr. Ionut Eduard Iordache

Reviewer 2 Report

Comments and Suggestions for Authors The main topic is the approach to constipation and the manuscript outlines a detailed review of the approach to the diagnosis and management with not only the pharmacological aspect but the surgical as well. Though this is not an original topic, it is quite relevant to the field and is one that is very commonly encountered in daily practice for both general clinicians as well as gastroenterologists. It outlines the diagnosis and approach to treatment in an easy-to-follow manner. Though it does not contribute additionally to the field itself, it is a great review and well-written. The authors have used reputable sources as well and the illustrations they create as well as the tables used help to make the manuscript more presentable.

Author Response

Dear Reviewer,

Thank you for your kind and constructive feedback regarding our manuscript. We are pleased that you found the manuscript to be a comprehensive and well-written review on the approach to the diagnosis and management of constipation.

While we recognize that the topic is not novel, our aim was to provide a thorough and accessible review that could serve as a practical resource for healthcare providers encountering constipation in daily practice. Your positive assessment of the manuscript’s readability and utility validates this intent, and we are grateful for your endorsement of the manuscript's quality.

We also appreciate your acknowledgment of our use of reputable sources and attention to detail in presenting the information. Your comments encourage us to continue prioritizing clarity and evidence-based content in our work.

If there are any additional improvements or suggestions you believe could further enhance the manuscript’s quality and value, we would be happy to address them.

Thank you once again for your thoughtful review and for taking the time to provide this feedback.

Dr. Ionut Eduard Iordache

Reviewer 3 Report

Comments and Suggestions for Authors

The authors provide a comprehensive overview of the chronic constipation and its management. I have the following comments:

1. Consider including a clear clinical framework for integrating discussed treatments.
2. Strengthen the evidence base for key therapeutic claims using high-quality, recent studies.
3. Expand discussions on emerging therapies, such as serotoninergic agonists, to provide more actionable insights.
4. Enhance the manuscript's structure and visual aids for better clarity and reader engagement.

Author Response

Dear Reviewer,

Thank you for your valuable feedback on our manuscript. We appreciate your insightful suggestions, which have provided us with a clear path to improve the quality and clarity of our work. Below, we address your comments in detail:

1. Consider including a clear clinical framework for integrating discussed treatments.

We appreciate this suggestion and have more information to outline a clear clinical framework for integrating the various treatment modalities discussed. This framework emphasizes a stepwise, patient-centered approach that incorporates diagnostic findings, patient-specific factors, and treatment goals.

2. Strengthen the evidence base for key therapeutic claims using high-quality, recent studies.

We have reviewed the recent literature and included additional references to strengthen the evidence base for the therapeutic claims made in the manuscript. These references include randomized controlled trials, systematic reviews, and meta-analyses, ensuring that our recommendations are robust and up to date.

3. Expand discussions on emerging therapies, such as serotoninergic agonists, to provide more actionable insights.

We have expanded the section on serotoninergic agonists. Additionally, we have incorporated insights from recent studies to highlight their emerging role in the management of chronic constipation, particularly in patients with refractory symptoms.

4. Enhance the manuscript's structure and visual aids for better clarity and reader engagement.

We have revised the manuscript to improve its structure by reorganizing sections for better flow and readability.

We are grateful for your thoughtful comments, which have helped us refine and improve the manuscript. We believe these revisions have significantly enhanced the manuscript's clarity, clinical relevance, and scientific rigor. Please let us know if you have any additional suggestions or require further clarifications.

Thank you once again for your time and effort in reviewing our work.

Sincerely,

Dr. Ionut Eduard Iordache

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I appreciate the thoroughness of the revisions. The manuscript is now more concise and coherent, making it easier to follow for the readers.

Comments on the Quality of English Language

I appreciate the thoroughness of the revisions. The manuscript is now more concise and coherent, making it easier to follow for the readers.

Reviewer 3 Report

Comments and Suggestions for Authors

Authors addressed my comments.