PONE-D-20-23688Global epidemiology of aerophagia in children and adolescents: A systematic review and meta-analysisPLOS ONE

Dear Dr. Rajindrajith,

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This manuscript is based on a systematic review and meta analysis of studies reporting aerophagia in children and adolescents. The systematic review appears to have been well conducted. I have a major concern regarding the manuscript and I have found several minor inaccuracies.

Major concern -

it is not appropriate to undertake a systematic review and meta analysis of the studies reporting the prevalence of aerophagia and to include data on risk factors and consequences. Studies on prevalence need samples representative of a defined population but representativeness is not an essential requirement to look at risk factors or consequences. It is likely that there is more literature reporting data on risk factors and consequences but these would not have met the inclusion criteria used in this review. In the manuscript there had been no synthesis of data related to the risk factors for aerophagia or its influence on the lives of children. Suggest confining the manuscript to the prevalence of aerophagia

Minor issues -

1. I think "Global epidemiology" is rather misleading in the title for a review of the prevalence of a condition.

2. Israel, Jordan, and Lebanon are listed under Europe in Table 1 but all three are in Asia.

3. Reference number 27 is stated as the source of some of the data in Table 1, but this data has been extracted from reference number 16.

4. Line 187 "There are five studies from four Asian countries[1-3, 13-15]' ...". This not correct.

There are six references (1, 2, 3, 13, 14, & 15) and in Table 1 under Asia six studies from four countries have been listed.

5. Line 196 in the manuscript mentions 14 studies but Table 2 has 19 studies.

6. How was the data for figure 3 obtained? Is figure 3 really necessary?

Reviewer #2: Although aerophagia in children is clinically less important comparing to other medical conditions, underlying pathophysiology can be important and needs further investigation. This study describes prevalence of aerophagia in children across the world, and discuss its effects on their life and possible underlying causes, such as stress and maltreatments. This study sends a message that aerophagia in children might have underlying causes and it should be investigated accordingly to prevent children from unnecessary stress and/or maltreatments.

I would suggest a further research to assess super-gastric belching in children. Because supra-gastric belching in children has not been well documented yet, and it can also be related to stress factors.

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Reviewer #1: Yes: Arunasalam Pathmeswaran

Reviewer #2: No

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Epidemiology of aerophagia in children and adolescents: A systematic review and meta-analysis

PONE-D-20-23688R1

Dear Dr. Rajindrajith,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Hugh Cowley

Staff Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: Much improved by responding other reviewer's comments.

As I made comments on the previous occasion, this manuscript sends a message that aerophagia in children might have underlying clinical/psychological causes and it should be investigated accordingly. I would suggest a further study to assess supra-gastric belching in children.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

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