Celiac Disease in Conjunction with Hereditary Fructose Intolerance as a Rare Cause of Liver Steatosis with Mild Hypertransaminasemia—A Case Report
Round 1
Reviewer 1 Report
Dear Authors,
I found your case report about the concurrence of Cd and HFI very interesting.
I would like to suggest some minor corrections, that I hope could improve the quality of your manuscript.
Title: “Celica Disease in conjunction with Hereditary Fructose Intolerance…” may be more appropriate than using the term “coincidence”.
Abstract: last line: I suggest changing “coincidence” with “concurrence”
Line42: Maybe “concurrence” better than “coincidence”
Line 45: A 5-year old…; in which Department was admitted?
Line 46: “were decreasing”
Line 63: could you report the exact number of weeks?
Line 65: At which follow-up time the liver US was performed?
Line 66: which symptoms did not improve? At what time point?
Line 123: “gluten free diet in treating CD”
I suggest to check punctuation through the text.
Best regards.
Author Response
Dear Editor,
Thank you for the time and effort you expend considering my work. Here is my point-by-point respond to your valuable comments:
- Title: “Celica Disease in conjunction with Hereditary Fructose Intolerance…” may be more appropriate than using the term “coincidence”.
The title was change from” Coincidence of celiac disease…” to “Celiac disease in conjunction with…” according to the suggestion.
- Abstract: last line: I suggest changing “coincidence” with “concurrence”
Abstract: the term “coincidence” was substituted by “concurrence”.
- Line 42: Maybe “concurrence” better than “coincidence”
The term “coincidence” was substituted by “concurrence”.
- Line 45: A 5-year old…; in which Department was admitted?
The full name of the Department was added: Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Białystok.
- Line 46: “were decreasing”
The term “decreased” was changed to “ were decreasing”.
- Line 63: could you report the exact number of weeks?
The exact number of weeks was added (eight).
- Line 65: At which follow-up time the liver US was performed?
The time the liver US was performed was added (two months).
- Line 66: which symptoms did not improve? At what time point?
The symptoms were added (poor appetite, failure to thrive) and the time point (8 weeks).
- Line 123: “gluten free diet in treating CD”
The sentence was modified from “gluten-free diet used after confirmation of CD” to “gluten free diet in treating CD”.
- I suggest to check punctuation through the text.
Punctuation was checked through the text and errors have been corrected.
Sincerely yours,
Anna Bobrus- Chociej
Reviewer 2 Report
In the article, Bobrus-Chociej et al. present a case of a patient with a rare coincidence of celiac disease (CD) with hereditary fructose intolerance (HFI). The patient was first diagnosed with CD based on symptoms, physical examination, ultrasonography, and hematology. After the diagnosis of CD, the patient was put on a gluten-free diet. This diet change improved the health, but still, some symptoms and liver steatosis persisted. Upon further examination, the patient was also diagnosed with HFI and was hence put on a fructose-free diet. This change decreased liver steatosis and other symptoms as well. This is an important study since it shows the importance of testing for HFI if symptoms persist after CD diagnosis and diet change.
The manuscript is well presented. However, the authors need to resolve the following minor concerns-
- In the introduction, the authors should add a more detailed description of the genetic aspects of CD and HFI.
- The result (Fig 1) should be described in detail.
- There are minor grammatical errors throughout the manuscript – spacing, spelling, punctuations, etc. I highly recommend professional proofreading of the article.
Author Response
Dear Editor,
Thank you for the time and effort you expend considering my work. Here is my point-by –point respond to your valuable comments:
- In the introduction, the authors should add a more detailed description of the genetic aspects of CD and HFI.
A more detailed description of the genetic aspects of CD and HFI was added in the introduction.
- The result (Fig 1) should be described in detail.
Apart from the caption under Figure 1 the result of genetic examination was thoroughly described in the text (lines 82- 100).
- There are minor grammatical errors throughout the manuscript – spacing, spelling, punctuations, etc. I highly recommend professional proofreading of the article.
The manuscript was reviewed by a native English- speaker and the minor
grammatical errors were corrected.
Sincerely yours,
Anna Bobrus- Chociej
Reviewer 3 Report
The case report titled “Coincidence of celiac disease with hereditary fructose intolerance as a rare cause of liver steatosis with mild hypertransaminasemia-case report” showcased a very rare albeit interesting case with concurrent CD and HFI.
However, careful editing is required to improve clarity and readability. Also, the title could be drastically shortened!
For Figure 1, all the exons in both the proband and the control sample should be clearly numbered to highlight the missing ones.
Proper usage of articles of “a” and “the”! A lot of cases where “a” should be “the” and “the” is missing. Professional editing is recommended.
Line 14: What does “unfavorable evolution” mean?
Line 117: lactic academia should be lactic academia
Line 63/76: Couple months should be two months
Line 86: “mendelian” should be “Mendelian”.
Awkward wording that hampers comprehension in multiple cases, such as line 57/58, 65/66, and 103/104.
Author Response
Dear Editor,
Thank you for the time and effort you expend considering my work. Here is my point-by –point respond to your valuable comments:
- careful editing is required to improve clarity and readability. Also, the title could be drastically shortened! The manuscript was reviewed by a native English speaker. The title was modified according to the Reviewer suggestion: “Celiac disease in conjunction with hereditary fructose intolerance as a rare cause of liver steatosis with mild hypertransaminasemia-case report”. For editorial reasons the title can be shortened to "Celiac disease in conjunction with hereditary fructose intolerance- case report".- For Figure 1, all the exons in both the proband and the control sample
should be clearly numbered to highlight the missing ones. The Figure was modified accoring to the suggestion.
- Proper usage of articles of “a” and “the”! A lot of cases where “a” should be “the” and “the” is missing. Professional editing is recommended. The manuscript was reviewed by a native English speaker and mistakes were corrected.
- Line 14: What does “unfavorable evolution” mean? The term "unfavorable evolution" was changed to "lack of improvement after gluten-free diet".
- Line 117: lactic academia should be lactic academia The mistake was corrected.
- line 63/76: Couple months should be two months
The term "couple" was changed to "two".
- Line 86: “mendelian” should be “Mendelian”. The mistake was corrected.
- Awkward wording that hampers comprehension in multiple cases, such as
line 57/58, 65/66, and 103/104. The unfortunate expressions were changed.
Reviewer 4 Report
This case report by Bobrus-Chociej et el describes a 5 yo F presenting with abdominal pain. The authors present the findings observed on admission which led to establishing a dx of celiac disease upon bx. Persisting steatosis and elevated liver enzymes prompted suspicion of a co-existing etiology. Dietary hx led the authors to consider hereditary fructose intolerance, a rare genetic disease.
this is an interesting case and adds to the existing literature on this topic, however, i have few comments:
1-Could the author consider adding US to show high liver echogenecity.
2- a morphological anonymized picture of the patients could also highlight the failure to thrive and could be helpful for clinicians if they encounter similar cases in practice.
3- although unlikely to develop liver fibrosis at this earlry age, did the authors check for liver stiffness (e.g., elastography).
Author Response
Dear Editor,
Thank you for the time and effort you expend considering my work. Here is my point-by –point respond to your valuable comments:
1-Could the author consider adding US to show high liver echogenecity.
Unfortunately the picture of US is not available (it is not archived in our Department).
2- a morphological anonymized picture of the patients could also highlight the failure to thrive and could be helpful for clinicians if they encounter similar cases in practice.
Since the patient didn’t present dysmorphic features we didn’t take a picture of her.
3- although unlikely to develop liver fibrosis at this earlry age, did the authors check for liver stiffness (e.g., elastography).
Information about initial elastography was added to the manuscript, as well as the result of control elastography- in the section: Case presentation.
Sincerely yours,
Anna Bobrus- Chociej
