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The criteria used for a case definition of EVALI (See Table 1) include 1) use of an e-cigarette or related product within 90 days, 2) lung opacities on chest imaging, 3) exclusion of lung infection including viral polymerase chain reaction, basic urine antigen tests for Legionella and Streptococcus pneumoniae , blood cultures, and sputum culture, and 4) absence of a likely alternative diagnosis such as cardiac or neoplastic conditions [34]

However, the editorial board member wrote: I am not convinced that the authors response addresses the main issues and serious flaws raised by the authors of the Letter

It can be caused by a high-fat or high-carbohydrate diet and poor-quality ingredients that are hard to absorb, resulting in excess fermentation in the colon that generates gas

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