Context.-Reviewers increasingly are asked to review manuscripts from o
utside their own country, but whether they are more likely to recommen
d acceptance of such manuscripts is not known. Objective.-To assess wh
ether US reviewers or non-US reviewers evaluate manuscripts differentl
y, depending on whether the manuscripts are submitted from outside the
United States or from the United States. Design and Setting.-A retros
pective analysis of all original submissions received by Gastroenterol
ogy in 1995 and 1996. Reviewers ranked manuscripts in 4 decision categ
ories: accept, provisionally accept, reject with resubmission, or reje
ct. Main Outcome Measure.-Ranking of papers based on nationality of au
thors and reviewers. Results.-The percentage of non-US manuscripts pla
ced in each decision category by US (n=2355) and non-US reviewers (n=1
297) was nearly identical (P=.31). However, US reviewers recommended a
cceptance of papers submitted by US authors more often than did non-US
reviewers (P=.001). Non-US reviewers ranked US papers slightly more f
avorably than non-US papers (P=.09), while US reviewers ranked US pape
rs much more favorably (P=.001). Conclusions.-Reviewers from the Unite
d States and outside the United States evaluate non-US papers similarl
y and evaluate papers submitted by US authors more favorably, with US
reviewers having a significant preference for US papers.