Splitting irritable bowel syndrome: from original Rome to Rome II criteria

OBJECTIVES: Diagnosis of irritable bowel syndrome (IBS) and other functional bowel disorders (FBD) is based on symptom evaluation. Clinical criteria have changed over time, yielding different proportions of subjects fulfilling diagnostic requirements. According to new diagnostic criteria (Rome II), subjects considered some years ago to have IBS no longer do so. The aim of this article is to evaluate how patients diagnosed as having IBS according to original Rome criteria have been split, and to which clinical diagnosis they belong today. METHODS: Two hundred and eleven subjects meeting original Rome IBS diagnostic criteria were studied: 65 also met Rome II criteria while 146 did not. Subjects were extracted from an epidemiological survey, using home-based personal interviews, on 2000 subjects randomly selected as representative of the Spanish population. Clinical complaints, personal well-being, resource utilization, and health-related quality of life (HRQOL) were compared. RESULTS: Of the subjects meeting original Rome but not Rome II criteria, the present diagnosis should be: 40%"minor" IBS (IBS symptoms of less than 12 wk duration), 37% functional constipation, 12% alternating bowel habit, 7% functional diarrhea, 3% functional abdominal bloating, and 1% unspecified functional bowel disorder (FBD). Thus, 52 subjects (36%) should not be diagnosed with IBS because they really had other FBD, 59 (40%) because of symptoms consistent with IBD diagnosis but not the required duration or frequency, and 35 (24%) because of symptoms consistent with some other FBD diagnosis but not meeting the required duration. Clinical complaints, personal well-being, resource utilization, and HRQOL were more severely affected in IBS than in other FBD as a group, and in "major" rather than in "minor" forms. CONCLUSIONS: Many subjects meeting original Rome criteria for IBS do not meet Rome II criteria: approximately one quarter of subjects do not have sufficient symptom duration or frequency to be diagnosed with IBS and almost half are now considered as having other ("major" or "minor") FBD.     

Prevalence of irritable bowel syndrome in Korea: population-based survey using the Rome II criteria

BACKGROUND: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder in the West. But information on the prevalence of IBS in Asia is still lacking, especially in Korea. Therefore, the aims of the present study were to estimate the prevalence of IBS in the general population of Korea and also to investigate characteristics of IBS and health-care-seeking behavior of IBS patients. METHODS: Telephone interview survey was conducted by Gallup, Korea using a validated questionnaire based on the Rome II criteria. The response rate of the telephone interview survey was 25.2% (n = 1066, 535 male and 531 female responders). A random sample of gender and age (between 18 and 60 years), based on a per capita ratio was obtained. RESULTS: Among 1066 subjects, the prevalence of IBS was 6.6% (70 subjects; 7.1%, male; 6.0%, female). The difference in IBS prevalence by gender was not significant. The prevalence was higher among those in their 20s (P = 0.036). Among 70 subjects with IBS, 10/20 IBS subjects sought health care due to abdominal pain. Among the risk factors of IBS, marital status had a significant difference; the following risk factors are arranged in descending order: age (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 0.85-2.25), alcohol intake (OR: 1.38, 95%CI: 0.81-2.35), gender (OR: 1.19, 95%CI: 0.73-1.94), demographics (OR: 1.09, 95%CI: 0.53-2.25), income (OR: 0.88, 95%CI: 0.54-1.45), education level (OR: 0.81, 95%CI: 0.46-1.40), smoking (OR: 0.64, 95%CI: 0.37-1.12), and marital status (OR: 0.59, 95%CI: 0.35-0.99). CONCLUSIONS: The prevalence of IBS in the Korean population is 6.6%, and the male:female ratio is similar. Also, IBS is more frequent in younger subjects. Irritable bowel syndrome subjects visited a physician mostly due to abdominal pain.     

Utility of the Rome I and Rome II criteria for irritable bowel syndrome in U.S. women

OBJECTIVES: Using interview data from a large, community-based sample of American women, we assessed the lifetime prevalence of irritable bowel syndrome (IBS) using questions consistent with the Rome II criteria, determined the sensitivity of Rome I and II in women diagnosed with IBS by their community physician, and identified whether there are differences in the patients identified by Rome I versus II. METHODS: A geographically diverse national probability sample of women diagnosed with IBS was identified and interviewed by telephone screening of a national, random digit dialing sample of households. A parallel national survey of adult females was conducted to determine the lifetime prevalence of IBS in U.S. women. Screening and interviews were conducted by experienced, female interviewers. IBS was defined by variations on the Rome I/II criteria. RESULTS: In the national community sample, lifetime IBS prevalence was 5.4% using Rome II. Full interviews were completed in 1,014 IBS patients. In the IBS sample, Rome I was significantly more sensitive than Rome II (84% vs 49%, p < 0.001). There was 47% agreement between Rome I and II. Of patients with IBS by Rome I, 58% met Rome II. Only 17.7% did not meet either Rome I or II. CONCLUSIONS: Rome I was more sensitive than Rome II in this community sample of female IBS patients. Rome I/II do not necessarily identify the same IBS patients. These findings have important implications for clinical research in IBS patients and raise questions about whether the Rome II criteria are sensitive enough to be useful in clinical practice.     

罗马Ⅲ和罗马Ⅱ标准诊断肠易激综合征的比较

目的比较罗马Ⅲ和罗马Ⅱ标准诊断肠易激综合征（IBS）的符合情况和患者的临床特点。方法面访式问卷调查消化内科门诊连续就诊病例3014例。结果（1）符合罗马Ⅲ标准的IBS患者480例,检出率15．9％（480／3014）。其中便秘型IBS（C—IBS）27．9％（134／480）,腹泻型IBS（D-IBS）32．7％（157／480）,混合型IBS（M-IBS）6．7％（32／480）,未分型IBS（U-IBS）32．7％（157／480）,检出率在各年龄组和性别间差异无统计学意义（P〉0．05）。符合罗马Ⅱ标准的IBS患者558例,检出率为18．5％（558／3014）,其中便秘主导型33．2％（185／558）,腹泻主导型38．2％（213／558）,其他占28．7％（160／558）,女性检出率显著高于男性（P=0．002）,各年龄组间检出率差异无统计学意义。罗马Ⅲ标准对IBS的检出率低于罗马Ⅱ标准（P=0．008）,但两者诊断IBS有较好的一致性。（2）与罗马Ⅱ标准的IBS患者相比,罗马Ⅲ标准的IBS患者腹部症状（P=0．04）和异常排便习惯（P〈0．001）均较严重,最近3个月患者的就诊率也较高（26．5％、35．6％,P=0．02）。（3）罗马Ⅲ标准各亚型的IBS患者的异常排便习惯严重程度差异有统计学意义（C-IBS、M-IBS〉D-IBS〉U-IBS,P〈0．005）,但腹部症状严重程度和患者最近3个月的就诊率之间差异无统计学意义（P〉0．05）。结论罗马Ⅲ和罗马Ⅱ标准诊断IBS具有较好的一致性。与罗马Ⅱ标准相比,罗马Ⅲ标准对IBS的检出率较低,症状频率定义和分型方法相对简单,在临床中更实用,符合其诊断标准的患者症状相对较重,就诊率较高,也较适合于临床试验。     

Rome I criteria are more sensitive than Rome II for diagnosis of irritable bowel syndrome in Indian patients.

AIM: To assess the utility and efficacy of Rome I and Rome II criteria for the diagnosis of irritable bowel syndrome (IBS) in India. METHODS: Patients referred with a diagnosis of IBS by general practitioners answered a questionnaire about clinical features, including those listed in the Rome I and Rome II criteria. All patients underwent investigations to determine the cause of their symptoms. Sensitivity, positive predictive value and percent agreement of final diagnosis with Rome I and II criteria were calculated. RESULTS: Among 138 patients studied, 6 patients had organic disease . Amongst 132 patients with functional bowel disease, Rome I criteria diagnosed more patients as IBS than Rome II criteria (110 [83.3%] vs. 41 [31.1%]); 36 patients fulfilled both the criteria. Of the patients positive by Rome I, 32.7% fulfilled Rome II criteria, and of those diagnosed by Rome II criteria, 87.8% fulfilled Rome I criteria. Seventeen patients did not fulfill either Rome I or Rome II criteria, and were classified as functional abdominal bloating, functional diarrhea or functional constipation. CONCLUSION: Rome I criteria are more sensitive than Rome II criteria for the diagnosis of IBS in the Indian population.     

Additional investigations fail to alter the diagnosis of irritable bowel syndrome in subjects fulfilling the Rome criteria

OBJECTIVE: Irritable bowel syndrome (IBS) is diagnosed by the presence of a constellation of symptoms fulfilling the Manning or Rome Criteria, after exclusion of organic disease. To exclude other diagnoses that might contribute to the abdominal pain or bowel symptoms experienced by subjects with IBS, numerous screening algorithms have been advocated, incorporating lactose hydrogen breath tests, thyroid function tests, fecal ova and parasite determination, and colonic endoscopy/radiography. The utility of these tests in uncovering alternative diagnoses, other than IBS, was examined in 1452 patients. METHODS: Data were combined from two large multinational studies of IBS patients. All patients exhibited symptoms meeting the Rome criteria for IBS for at least 6 months before study entry. If prior evaluation had been > 2 yr previously, patients underwent colonic endoscopy/radiography at study entry. In addition, thyroid function tests, fecal ova and parasite determination, and a lactose hydrogen breath test were performed. RESULTS: Lactose malabsorption was diagnosed in 23% (256/1122) of patients. Colonic abnormalities were detected in 2% (7/306) of patients; in four patients, colonic inflammation (n = 3) or obstruction (n = 1) may have contributed to symptoms of abdominal pain or altered bowel habits. Abnormal thyroid-stimulating hormone levels were detected in 6% (67/1209) of patients, of whom half were hypothyroid and half were hyperthyroid. Positive fecal ova and parasite tests were noted in 2% (19/1154) of patients. CONCLUSIONS: Examination of screening tests in 1452 patients with an established history of IBS revealed an incidence of lactose malabsorption comparable to that in the general U.S. population and a low incidence of thyroid dysfunction, ova and parasite infestation, or colonic pathology. The limited detection rates, added costs, and inconvenience of these tests suggest that their routine use in the diagnostic evaluation of established IBS patients should be scrutinized.     

Subtypes of irritable bowel syndrome on Rome III criteria: a multicenter study

Background and Aim: The aim of this study was to explore the distribution and clinical characteristics of four subtypes of irritable bowel syndrome (IBS) based on Rome III criteria in Chinese. Methods: A total of 754 consecutive IBS outpatients from three tertiary hospitals in China were included. Diagnostic criteria were based on Rome II or Rome III. Results: Among 754 outpatients, 510 (67.6%) patients met the Rome II criteria, 735 (97.5%) patients met the Rome III criteria and 492 (65.3%) patients met both sets of criteria. Among 735 patients who met the Rome III criteria, 66.3% had IBS with diarrhea (IBS‐D), 14.7% had IBS with constipation (IBS‐C), 4.2% had mixed IBS (IBS‐M) and 14.8% had unsubtyped IBS (IBS‐U). Most of the IBS‐D, IBS‐C and IBS‐M patients based on the Rome III criteria matched the diarrhea‐predominant IBS, constipation‐predominant IBS and alternating IBS based on the Rome II criteria, respectively. Among IBS‐U patients, 57.0%, 33.3% and 9.7% had constipation‐predominant IBS, diarrhea‐predominant IBS and alternating IBS, respectively. For IBS‐M, the frequencies of bowel movements were stable in 48.4% patients and variable in 51.6% patients. Defecation urgency and straining were most frequent in IBS‐M and least frequent in IBS‐U patients than other subtypes. About 77.2% of IBS‐U patients had abnormal stool frequency (< 3 times/week or > 3 times/day). Conclusion: The Rome III criteria are more sensitive and practical in diagnosing IBS. IBS‐D is the most frequent subtype, which is followed by IBS‐U, IBS‐C and IBS‐M. IBS‐U is a new subtype, which warrants further studies.     

罗马Ⅲ标准研究肠易激综合征临床特点及亚型

目的:应用功能性胃肠病罗马Ⅲ诊断标准研究肠易激综合征(IBS)的临床特点及亚型分布.方法:应用罗马Ⅲ诊断标准,对消化科门诊IBS患者进行诊断和亚型分类,大便性状按照Brist01分级,统计学分析应用SPSS软件进行统计学处理.结果:罗马Ⅲ标准诊断IBs患者487例,年龄18.78岁.病程6.720 mo;病程达12 mo以上者420例,占86.2%,6.12 mo者67例,占13.8%.常见的消化道外的伴随症状依次为乏力、腰背痛、失眠、头晕、胸闷、体质量下降(≥5kg)、头痛、尿频、咽部异物感、肩痛、眼球痛、胸痛.诊断为腹泻型IBS(IBS.D)者316例(65%),便秘型IBSOBS.C)者59例(12%),混合型IBS(IBS-M)者24例(5%),未定型IBS(IBS.Ul者88例(18%).病程中发生亚型转化者16例,占3.29%.不同的IBS亚型性别分布不同(X2=30.86,P＜0.05),IBS-C和IBS-U中女性较多.IBS.D中男性较多(P＜0.05).不同的IBS亚型年龄分布无统计学差异(X2=16.67,P＞0.05).结论:罗马Ⅲ诊断标准可提高IBS的早期诊断率.按照IBs罗马Ⅲ诊断标准,IBS-D最多见,约占2/3;其次为IBS-U,IBS-C及IBS-M.IBS-U在临床上不少见,这一新的亚型值得进一步研究.     

The prevalence of celiac disease in patients fulfilling Rome III criteria for irritable bowel syndrome

Background and aimsCeliac disease shares several symptoms which constitute some of the ROME criteria used for the diagnosis of irritable bowel syndrome (IBS), and as such many patients with underlying Celiac disease may be mistakenly diagnosed as having IBS. The aim of the present study was to determine the prevalence of Celiac disease in patients with IBS fulfilling ROME III criteria.Materials and methodsPatients who fulfilled ROME III criteria for irritable bowel syndrome were screened for Celiac disease using the Biocard^TM Celiac Disease Stick test, and patients who tested positive had their serum samples analyzed for antigliadin IgA and IgG, and anti-tissue transglutaminase IgA antibodies. Patients with detectable antibody levels underwent endoscopic duodenal biopsy to confirm a diagnosis of Celiac disease.ResultsTwo of 100 patients who were diagnosed as having irritable bowel syndrome as per the Roma III criteria were found to have elevated levels of serum antigliadin IgA and IgG, and anti-tissue transglutaminase IgA antibodies, with histological evidence of Celiac disease on examination of duodenal biopsy. Both patients were started on a gluten-free diet, showing significant improvement in their symptoms on follow-up.ConclusionsCeliac disease is a common finding among patients labeled as IBS. Celiac disease must be considered in differential diagnosis of IBS especially in the therapy refractory group.     

Diagnosing irritable bowel syndrome: poor agreement between general practitioners and the Rome II criteria

BACKGROUND: The new guidelines for diagnosing irritable bowel syndrome (IBS) in clinical practice recommend the use of the Rome II criteria. In this study the agreement between general practitioners (GPs) and the Rome II criteria for diagnosing of IBS and functional bowel disorders (FBD) is examined. METHODS: Consecutive patients in general practice were asked to report on abdominal complaints, for which they had consulted or wanted to consult a GP. Patients with such complaints completed a questionnaire based on the Rome II criteria for FBD. After consultations, the GPs reported their diagnoses on the abdominal complaints. RESULTS: Of 3097 screened patients, 553 patients were diagnosed by their GP and had complete data in the questionnaire. Of these patients, 107 had IBS according to the GPs and 209 had IBS according to the Rome II criteria (agreement 58%, kappa 0.01 (CI: -0.06; 0.09)). Agreement on IBS and FBD in patients without organic disease, without reflux or dyspepsia and in patients with a verified diagnosis was 45%-58%, with kappa values from -0.02 to 0.13. IBS and FBD cases were diagnosed by the Rome II criteria more often than by the GPs in all these groups of patients (P < 0.001). In patients with diagnostic discrepancies concerning IBS, 'stress-related symptoms' was predictive of a diagnosis of IBS made by the GPs only (OR 2.17 (CI: 1.1; 4.2)). CONCLUSIONS: This study shows poor agreement in the diagnosis of IBS between GPs and the Rome II criteria. Therefore, current knowledge about IBS based on strict criteria is not necessarily transferable to patients with IBS in general practice.     

Diagnosing irritable bowel syndrome: poor agreement between general practitioners and the Rome II criteria

Background: The new guidelines for diagnosing irritable bowel syndrome (IBS) in clinical practice recommend the use of the Rome II criteria. In this study the agreement between general practitioners (GPs) and the Rome II criteria for diagnosing of IBS and functional bowel disorders (FBD) is examined. Methods: Consecutive patients in general practice were asked to report on abdominal complaints, for which they had consulted or wanted to consult a GP. Patients with such complaints completed a questionnaire based on the Rome II criteria for FBD. After consultations, the GPs reported their diagnoses on the abdominal complaints. Results: Of 3097 screened patients, 553 patients were diagnosed by their GP and had complete data in the questionnaire. Of these patients, 107 had IBS according to the GPs and 209 had IBS according to the Rome II criteria (agreement 58%, kappa 0.01 (CI: ?0.06; 0.09)). Agreement on IBS and FBD in patients without organic disease, without reflux or dyspepsia and in patients with a verified diagnosis was 45%–58%, with kappa values from ?0.02 to 0.13. IBS and FBD cases were diagnosed by the Rome II criteria more often than by the GPs in all these groups of patients (P?Conclusions: This study shows poor agreement in the diagnosis of IBS between GPs and the Rome II criteria. Therefore, current knowledge about IBS based on strict criteria is not necessarily transferable to patients with IBS in general practice.     

A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome

OBJECTIVE: The aim of this study was to estimate the prevalence of irritable bowel syndrome using different standard definitions (Rome and Manning criteria) and to determine the degree of agreement between these definitions. METHODS: A population-based, cross-sectional survey study was conducted by mailing a valid, reliable questionnaire to an age- and gender-stratified random sample of residents of Olmsted County, MN, aged 30-69 yr. The threshold for a positive diagnosis of irritable bowel was varied from two to four of the six Manning criteria and from two to three of the five defecation disorders in the Rome criteria. Unadjusted as well as age- and gender-adjusted prevalence rates were calculated for each of the five definitions of IBS. Percent agreement and kappa statistics were calculated to assess agreement between the definitions. RESULTS: Questionnaires were returned by 643 of 892 eligible subjects (72% response rate). The age- and gender-adjusted prevalence of IBS varied from 20.4% using a threshold of two symptoms in the Manning criteria to 8.5% using a threshold of three defecation disorders in the Rome criteria. The percent agreement for each comparison of Manning and Rome definitions was always >90%. The kappa values ranged from 0.55 to 0.78, with the best agreement occurring between a threshold of three symptoms of Manning and two defecation disorders in Rome. CONCLUSIONS: The prevalence of IBS varied substantially depending on the specific definition of IBS used. The range of prevalence estimates in Olmsted County was similar to other published figures when IBS definition was accounted for. These findings are useful in interpreting epidemiological and clinical studies of IBS.     

Prevalence of irritable bowel syndrome in Hong Kong

BACKGROUND AND AIMS: As part of a public education program, the Hong Kong Society of Gastrointestinal Motility studied the prevalence of irritable bowel syndrome (IBS) in the community, which was based on the recently published Rome II criteria. The distribution of diarrhea or constipation-predominant IBS subtypes, the prevalence of bowel symptoms and the predictors of health-care seeking were also studied. METHODS: Among 1797 randomly selected respondents, 1000 successful telephone interviews (56%) were conducted from August 2000 to December 2000, using a validated questionnaire in Chinese that looked into demographic data and various bowel symptoms during the past year. RESULTS: The 12-month prevalence of IBS as defined by the Rome II criteria in Hong Kong was 6.6%. The female to male ratio was 1.3:1, but this ratio was the same in the control group. The distribution of IBS patients into diarrhea predominant, constipation predominant, and non-specific subtypes was 27, 17 and 56%, respectively. The predominant symptom in the IBS group was pain (54.5%), followed by urgency (15%), abdominal distension (15%) and diarrhea (11%). Forty-seven percent of IBS patients sought medical attention and only 21% of them knew that they had IBS. Moderate to severe pain severity (odds ratio 3.7, 95% CI 1.02-13) and mucus in stool (odds ratio 3.57, 95% CI 1.18-10.7) were associated with health-care seeking in univariate analysis. The prevalence of bowel symptoms such as urgency, straining, feeling of incomplete defecation, mucus in stool and abdominal distension ranged from 11 to 41%. CONCLUSION: The prevalence of IBS in Hong Kong was 6.6%, and the female to male ratio was similar to the control group. The majority was of non-specific IBS subtype. Gross underdiagnosis (21%) by Western practitioners was noted.     

A study of irritable bowel syndrome diagnosed by manning criteria in an African population

Symptoms of irritable bowel syndrome (IBS) using the Manning Criteria were sought by a questionnaire administered to 400 (male-female ratio 3:1) apparently healthy medical students. With a response rate of 84%, 230 (65.5%) reported more than six episodes of abdominal pain in the preceding year (1992–1993). Contrary to expectation, 100 (43.5%) reported symptoms consistent with the diagnosis of IBS. The one-year period prevalence of the syndrome was 30% overall, with prevalence figures of 24% for males and 48% for females (P<0.01). There was no difference in the type of diet (mainly high-fiber diets) consumed by subjects with and without IBS. About two thirds of the subjects with IBS had sought medical advice during the study period; the consultation behavior was influenced by factors such as the presence of other symptoms. This is the first detailed evidence in a random sample of an African population showing symptoms consistent with a diagnosis of IBS to be very common. It casts doubt on the assumption generated by other workers that IBS is rare among native Africans.