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.     

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.     

Diagnostic criteria for irritable bowel syndrome: utility and applicability in clinical practice

BACKGROUND/AIMS: Symptom-based criteria have been introduced to aid the diagnosis of irritable bowel syndrome (IBS). Although they have been widely adopted and have proved useful for research purposes by ensuring homogeneity of study populations, there is little information about their utility in routine clinical practice. It was the aim of this study to assess the applicability of the Manning, Rome I and Rome II criteria in the clinical setting and to ascertain how often hospital specialists and general practitioners (GPs) use them. METHODS: Hundred secondary-care IBS patients were assessed for their conformity to these criteria. Forty-eight hospital specialists and 68 GPs were asked about their knowledge and utilization of these criteria. RESULTS: Seventy-three percent of IBS patients met Rome II diagnostic criteria with 82 and 94% meeting Rome I and Manning, respectively. Approximately 80% of GPs had no knowledge of any of the specific criteria, and only 4% had ever used them. The majority of specialists had knowledge of the criteria, with 70% having used them. CONCLUSION: The Rome II criteria are remarkably insensitive and if rigidly applied in the clinical situation would lead to much diagnostic uncertainty. The current lack of interest in them, especially amongst GPs, is unlikely to change unless they can be considerably improved.     

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.     

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。     

Irritable bowel syndrome in general practice: prevalence, characteristics, and referral

BACKGROUND AND AIMS: Little is known about the prevalence, symptoms, diagnosis, attitude, and referral to specialists of patients with irritable bowel syndrome (IBS) in general practice. This study aimed to determine these characteristics. METHODS: 3111 patients attending 36 general practitioners (GPs) at six varied locations in and near Bristol, UK, were screened to identify those with a gastrointestinal problem. These patients (n=255) and their doctors were given questionnaires. Six months later the case notes were examined to reach criteria based diagnoses of functional bowel disorders. RESULTS: Of 255 patients with a gastrointestinal complaint, 30% were judged to have IBS and 14% other functional disorders. Compared with 100 patients with an "organic" diagnoses, those with IBS were more often women and more often judged by their GP to be polysymptomatic and to have unexplained symptoms. The majority of patients with IBS (58%) were diagnosed as such by the GP; 22% had other functional diagnoses. Conversely, among 54 patients diagnosed as having IBS by the GPs, the criteria based diagnosis was indeed functional in 91%; only one patient had organic disease (proctitis). More patients with IBS than those with organic disease feared cancer. In most some fear remained after the visit to the doctor. On logistic regression analysis, predictors of referral to a specialist (29% referred) were denial of a role for stress, multiple tests, and frequent bowel movements. CONCLUSIONS: Half the patients with gut complaints seen by GPs have functional disorders. These are usually recognised, and few patients are referred. In IBS, cancer fears often remain, suggesting unconfident diagnosis or inadequate explanation.     

Irritable bowel syndrome in general practice: an overview

BACKGROUND: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is frequently seen in gastroenterological practice. Population-based studies have shown that at any point in time IBS symptoms are present in about 3%-22% of the general Western population. In general practice, half of all new patients have functional disorders and IBS is responsible for about five consultations per week. General practitioners (GPs) manage the majority of IBS patients, but most knowledge (and research) is based on the smaller percentage of patients managed in secondary care. There is a paucity of literature on differences or similarities between these two groups with regard to clinical characteristics or diagnostic approach. METHODS: The literature published in English about IBS in general practice was reviewed. CONCLUSIONS: Irritable bowel syndrome is frequently encountered in primary care. Primary care IBS patients, compared to secondary care patients, are likely to be young, female and to have less severe symptoms. But this is only true for some symptoms; for example, non-abdominal complaints are equally reported in both groups. The disorder can be diagnosed safely using internationally agreed symptom-based criteria, such as the Rome II criteria. Additional diagnostic measures will be necessary to support the diagnosis in only a minority of situations. Many primary care IBS patients can be managed given adequate reassurance and education, frequently without additional pharmacological treatment.     

Irritable bowel syndrome in primary care: the patients' and doctors' views on symptoms, etiology and management.

BACKGROUND: To facilitate the development of clinical guidelines and to direct future irritable bowel syndrome (IBS) research, insight into the perceptions of patients and general practitioners (GPs) regarding IBS is required. OBJECTIVES: To compare patients' and GPs' views on the symptomatology, etiology and treatment of IBS. METHODS: One hundred forty-two IBS patients and 100 GPs were requested to complete a structured questionnaire. RESULTS: The response rates of the patients and GPs were 80% and 47%, respectively. Abdominal pain and bloating were considered to be the most bothersome symptoms in IBS, by both patients and GPs. Although all patients were diagnosed by their GP as having IBS, and 62% met the Manning criteria, only 18% fulfilled the Rome II criteria for IBS. Patients consider food intolerance and GPs regard lack of fibre as the main etiologic dietary factor. Many IBS patients expect a diagnostic work-up, but GPs generally restrict this to elderly patients. GPs start IBS management with dietary advice (94%), counselling (77%) and drug therapy (55%). Patients expect reassurance (47%) and drug treatment (37%), but dietary interventions are less appreciated (9%). CONCLUSIONS: Patients and GPs have different perceptions of the efficacy of diagnostic and dietary interventions in IBS. GPs should explore the patients expectations and incorporate these in their approach to IBS patients.     

Symptom patterns and relative distribution of functional bowel disorders in 1,023 gastroenterology patients in Iran

Background and aims There are scanty data on functional bowel disorder (FBD) patterns in Iran. This first-time study tried to provide preliminary data on relative distribution of different types of FBD and their symptom patterns in Iranian patients.Methods A consecutive sample of 1,023 patients in an outpatient gastroenterology clinic in central Tehran was interviewed using two questionnaires based on Rome II criteria from December 2004 to May 2005 to detect FBD patients.Results Of 1,023 gastroenterology patients, 410 met Rome II criteria for FBD; functional constipation, 115 (28%); irritable bowel syndrome (IBS), 110 (27%) [IBS-C, 29%; IBS-D, 11%; IBS-A, 60%]; functional bloating, 102 (25%); unspecified FBD, 76 (18%); and functional diarrhea, 7 (2%). FBD had no association with age or level of education, while it was more frequent in women (P=0.001). FBD was also more frequent among those with a history of abdominal/pelvic surgery (P=0.021). IBS patients had a lower mean of age compared with non-FBD group, while patients with constipation were older (Mann–Whitney U test, P=0.006). Constipation-related symptoms were the most frequent symptoms among IBS patients. Constipation (<3 defecations/week) was also the most frequent change in bowel habit in bloating and unspecified FBD patients. Fourteen percent of IBS consulters and 8.7% of functional constipation consulters met Rome II criteria for dyspepsia (disregarding the ruling out of upper gastrointestinal organic disease). Only 20% of patients with functional constipation were consulters.Conclusions Population-based studies at provincial levels are essential to clarify FBD patterns in each provincial district in the country.     

How useful are the Rome II criteria for identification of upper gastrointestinal disorders in general practice?

OBJECTIVE: The Rome II criteria are a classification of functional gastrointestinal disorders. It is not known whether they can be used as a diagnostic tool. This study evaluates the agreement between GPs and the Rome II criteria on the diagnosis of upper gastrointestinal disorders. MATERIAL AND METHODS: Consecutive patients with abdominal complaints were included in this pragmatic cross-sectional study. All patients answered a questionnaire based on the Rome II criteria. The diagnoses based on these criteria were compared with the GPs' diagnoses. RESULTS: A total of 549 consecutively selected patients were included in the study. The agreement between GPs and the Rome II criteria was 65%, kappa 0.34 (CI 0.27-0.41). The agreement was lower when dyspepsia and gastroesophageal reflux/functional heartburn were evaluated separately. The positive and negative predictive values of the Rome II criteria varied between 29-58% and 82-90%, respectively, in various groups of patients with confirmed diagnoses. CONCLUSIONS: The GPs' diagnoses differed from those based entirely on the Rome II criteria. Strict adherence to the criteria will result in other diseases being disregarded. The diagnoses of upper gastrointestinal disorders should be based on all available information and the Rome II criteria used only as an additional aid to improve the precise classification of functional disorders.     

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.     

Diagnosis of irritable bowel syndrome

Irritable bowel syndrome (IBS) is the most common disorder seen in gastroenterology practice. It is also a large component of primary care practices. Although the classic IBS symptoms of lower abdominal pain, bloating, and alteration of bowel habits is easily recognizable to most physicians, diagnosing IBS remains a challenge. This is in part caused by the absence of anatomic or physiologic markers. For this reason, the diagnosis of IBS currently needs to be made on clinical grounds. A number of symptom-based diagnostic criteria have been proposed over the last 15 years. The most recent of these, the Rome II criteria, seem to show reasonable sensitivity and specificity in diagnosing IBS. However, the role of the Rome II criteria in clinical practice remains ill defined. A review of the literature shows that, in patients with no alarm symptoms, the Rome criteria have a positive predictive value of approximately 98%, and that additional diagnostic tests have a yield of 2% or less. Diagnostic evaluation should also include a psychosocial assessment specifically addressing any history of sexual or physical abuse because these issues significantly influence management strategies and treatment success.     

How useful are the Rome II criteria for identification of upper gastrointestinal disorders in general practice?

Objective. The Rome II criteria are a classification of functional gastrointestinal disorders. It is not known whether they can be used as a diagnostic tool. This study evaluates the agreement between GPs and the Rome II criteria on the diagnosis of upper gastrointestinal disorders. Material and methods. Consecutive patients with abdominal complaints were included in this pragmatic cross-sectional study. All patients answered a questionnaire based on the Rome II criteria. The diagnoses based on these criteria were compared with the GPs’ diagnoses. Results. A total of 549 consecutively selected patients were included in the study. The agreement between GPs and the Rome II criteria was 65%, kappa 0.34 (CI 0.27–0.41). The agreement was lower when dyspepsia and gastroesophageal reflux/functional heartburn were evaluated separately. The positive and negative predictive values of the Rome II criteria varied between 29–58% and 82–90%, respectively, in various groups of patients with confirmed diagnoses. Conclusions. The GPs’ diagnoses differed from those based entirely on the Rome II criteria. Strict adherence to the criteria will result in other diseases being disregarded. The diagnoses of upper gastrointestinal disorders should be based on all available information and the Rome II criteria used only as an additional aid to improve the precise classification of functional disorders.     

Functional Bowel Disorders in Iranian Population using Rome III Criteria

Background/Aim:

To study the prevalence and risk factors of functional bowel disorders (FBD) in Iranian community using Rome III criteria.

Materials and Methods:

This study was a cross-sectional household survey conducted from May 2006 to December 2007 in Tehran province, Iran, including 18,180 participants who were selected randomly and interviewed face-to-face by a validated questionnaire based on Rome III criteria.

Results:

In all, 1.1% met the Rome III criteria for irritable bowel syndrome (IBS), 2.4% for functional constipation (FC), and 10.9% of the participants had any type of FBD. Among participants with functional dyspepsia, 83.8% had FBD; the majority cases were unspecified functional bowel disorder (U-FBD). Of the subjects fulfilling the IBS criteria, IBS with constipation (52%) was the most frequent subtype. In the multivariate analysis, women had a higher risk of any FBDs than men, except for functional diarrhea (FD). The prevalence of FBD, FC and FD increased and IBS decreased with increasing age. Marital status was only associated with a decrease in the risk of FBD and FD, respectively. IBS subtypes compared with FC and FD. There was no significant difference between FC and IBS with constipation (IBS-C), except for self-reported constipation; while, IBS with diarrhea (IBS-D) had more symptoms than FD.

Conclusion:

This study revealed a low rate of FBDs among the urban population of Tehran province. The ROME III criteria itself, and the problems with interpretation of the data collection tool may have contributed in underestimating the prevalence of FBD. In addition the reliability of recall over 6 months in Rome III criteria is questionable for our population.     

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.     

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.     

Value of different diagnostic criteria for the irritable bowel syndrome among men and women

INTRODUCTION: Whether the diagnostic value of various criteria used to diagnose irritable bowel syndrome (IBS) differ by sex is controversial. AIM: To evaluate the sex-specific value of varying IBS criteria and sex-specific symptoms in patients with IBS and organic disease. METHODS: Outpatients of a gastroenterology practice (64% female) completed a validated questionnaire and received a complete diagnostic work-up as required. Questionnaire data were collected prospectively and audited retrospectively. RESULTS: Overall 233 (male 21%) had a final diagnosis of IBS; 305 (male 47%) received a diagnosis of organic disease. Constipation and bloating were more frequent in females independent whether they had IBS or organic disease. The sensitivity of the diagnostic criteria in male patients was between 82% and 88%, when Manning (3 or more), Rome I or Rome II criteria were applied, whereas the specificity was 65% to 71%. In females, sensitivity was 62% to 64% and specificity was between 66% and 70%. Although all the diagnostic IBS criteria had higher positive predictive values in females versus males, the negative predictive values were lower in females. CONCLUSIONS: Current criteria for IBS differ modestly between sexes, probably reflecting variable prevalence of the disease rather than a sex-specific presentation of IBS.     

Epidemiology of irritable bowel syndrome in Chinese

Irritable bowel syndrome (IBS) is common in Caucasians and Japanese, but its epidemiology has not been studied in urbanized Chinese populations. Our aim was to compare diagnostic criteria and study the epidemiology of IBS in Hong Kong Chinese. In all, 964 subjects from public housing and 334 subjects from private housing were recruited for face-to-face interviews in Shatin, Hong Kong. A structured questionnaire was used to measure the prevalence of IBS according to the Manning, Rome I, and Rome II criteria. The SF-36 scale was used to measure quality of life (QOL) in subjects with IBS and in normal controls. The results were compared by the analysis of covariance (ANCOVA). Relevant medical consultations and absence from work were recorded. There was fair agreement between the Manning and Rome II criteria ( = 0.23; P < 0.001), but good agreement between the Rome I and Rome II criteria ( = 0.5; P < 0.001). The prevalence of IBS, based on the Rome II criteria, was 3.6% (95% CI = 2.0–5.2) in men and 3.8% (95% CI = 2.5–5.2) in women. Men with IBS had significantly lower vitality scores on the SF-36 scale than the controls (P < 0.05 by ANCOVA), and women with IBS had significantly lower mental health scores than controls (P < 0.05 by ANCOVA). In conclusion, IBS is quite prevalent in Hong Kong Chinese, and the QOL of subjects with IBS was significantly affected.     

Validation of the Japanese version of the Rome II modular questionnaire and irritable bowel syndrome severity index

Background Instruments for measuring the presence and severity of specific irritable bowel syndrome (IBS) symptoms, comparable to those used in Western countries, have been lacking in Japan. The aim of this study was to develop, validate, and confirm the reliability of the Japanese version of the Rome II modular questionnaire for IBS (RIIMQ-J) and the IBS severity index (IBSSI-J). Methods Forty-nine patients in the university hospital with chronic or recurrent abdominal pain and discomfort and/or altered bowel habits were enrolled. With Rome II criteria, 27 patients were diagnosed as having IBS, and the other 22 patients were evaluated as having other functional bowel disorders (FBDs). The English versions of RIIMQ and IBSSI were translated into Japanese. After back-translation and approval of the questionnaire, subjects completed both questionnaires twice within 14 days. Results Cronbach's alpha of the RIIMQ-J was high (0.72). The sensitivity of RIIMQ-J for the diagnosis of IBS was also high (89%). The specificity of RIIMQ-J for denial of IBS among patients with other FBD was satisfactory (73%). The IBSSI-J showed high internal consistency (0.69) and reproducibility (intraclass correlation coefficient, 0.86, P < 0.001). Conclusions The RIIMQ-J and IBSSI-J are valid, reliable, and appropriate instruments for detecting and assessing the severity of IBS status in Japanese patients.