03026651

July 17, 2025, 15:00

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The manuscript is well organized, written in clear language and using scientific terms. The information presented is accurate, but there are several gaps, including the very small sample size which makes the results not significant. For the medical treatment to be of an impact significance, the study should be conducted on an importantly significant sample size. Also, the factors studied are important, but a wider variety of factors should be taken into consideration to give a powerful significant for the study. Aswell, the recurrence rate of VAs after sirolimus treatment is a very crucial factor. This factor is important to determine the efficacy of the treatment and its impact on controlling the medical condition. Aswell, it is important to present the long-term adverse effects of sirolimus treatment and emphasize on gastrointestinal, cardiac, and pulmonary side effects based on its mechanism of action. In conclusion, sirolimus is an effective medically treatment of vascular anomalies, but the limitations of the study classify it as not significant due mainly to the very small sample size included.

First, thank you very much for your professional comments on the article published in World Journal of Gastroenterology. Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Gastroenterology at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.

05755618

July 07, 2025, 07:35

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This paper reports on a clinical trial assessing the efficacy and safety of sirolimus in the treatment of gastrointestinal angiodysplasia (GIAD). The results indicate that sirolimus is effective in reducing bleeding, improving hemoglobin levels, decreasing transfusion dependence, and improving lesion outcomes. Additionally, the adverse effects were mild and manageable. However, it should be noted that while patients with various underlying conditions were included, those with chronic kidney disease were not represented. This is a concern, as patients with chronic kidney disease often experience recurrent gastrointestinal bleeding due to angiodysplasia. Further studies involving a larger number of patients, including those with chronic kidney disease, are warranted.

Thank you very much for your comments.

Replied on July 08, 2025, 11:56

We thank the reviewer for their thoughtful comments and positive assessment of our study's findings regarding sirolimus efficacy and safety in treating gastrointestinal angiodysplasia (GIAD). We acknowledge the important limitation regarding the exclusion of patients with chronic kidney disease (CKD). This exclusion was implemented due to several considerations: (1) the potential for altered sirolimus pharmacokinetics in CKD patients, which could complicate dosing strategies and safety monitoring; (2) the increased baseline bleeding risk in this population, which might confound the assessment of treatment efficacy; and (3) concerns about additional nephrotoxic effects of sirolimus in patients with already compromised renal function. However, we fully agree with the reviewer's assessment that CKD patients represent a particularly vulnerable population who frequently experience recurrent gastrointestinal bleeding due to angiodysplasia, often with limited therapeutic options. This patient group would indeed benefit significantly from effective treatments like sirolimus. We are currently planning a follow-up study that will specifically address this gap by including CKD patients with appropriate safety monitoring protocols and adjusted dosing regimens. Additionally, we are collaborating with nephrology specialists to develop guidelines for sirolimus use in this high-risk population. We appreciate the reviewer's constructive feedback, which will help guide future research directions to better serve all patients with GIAD.