Epidemiological, Clinical, and Psychological Characteristics of Individuals with Self-reported Irritable Bowel Syndrome Based on the Rome IV vs Rome III Criteria.

Published on Feb 1, 2020in Clinical Gastroenterology and Hepatology8.549
· DOI :10.1016/J.CGH.2019.05.037
Christopher J Black13
Estimated H-index: 13
(University of Leeds),
Yan Yiannakou13
Estimated H-index: 13
(County Durham and Darlington NHS Foundation Trust)
+ 1 AuthorsAlexander C. Ford86
Estimated H-index: 86
(University of Leeds)
Sources
Abstract
Objectives Few studies have examined the effects of applying the Rome IV criteria for irritable bowel syndrome (IBS) vs the previous standard, the Rome III criteria. We conducted a cross-sectional survey of individuals who self-identify as having IBS to examine this issue. Methods We collected complete demographic, symptom, mood, and psychological health data from 1375 adults who self-identified as having IBS, but were not recruited from a referral population. We applied the Rome III and the Rome IV criteria simultaneously to examine what proportion met each of these diagnostic criteria for IBS. We measured the level of agreement between the Rome III and Rome IV criteria, and assessed for presence of an alternative functional bowel disorder in individuals who no longer met diagnostic criteria for IBS with the more restrictive Rome IV criteria. Finally, we compared characteristics of individuals who met only Rome III criteria with those who met Rome IV criteria. Results In total, 1080 of 1368 individuals (78.9%) with IBS met the Rome III criteria. In contrast, 811 of 1373 individuals (59.1%) with IBS met the Rome IV criteria. Agreement between the criteria was only moderate (Kappa = 0.50). Among those who no longer had IBS according to the Rome IV criteria, 33 (11.5%) met Rome IV criteria for functional constipation, 118 (41.3%) for functional diarrhea, 68 (23.8%) for functional abdominal bloating or distension, and 67 (23.4%) for an unspecified functional bowel disorder. Individuals with Rome IV-defined IBS had more severe symptoms, and a higher proportion had a mood disorder and evidence of poor psychological health, compared with individuals who only met the Rome III criteria for IBS (P  Conclusions The characteristics of people who believe they have IBS differ between those who meet criteria as defined by Rome IV vs Rome III, including the spectrum of disease severity. Studies are needed to determine how these changes will affect outcomes of clinical trials.
📖 Papers frequently viewed together
35 Citations
7 Citations
51 Citations
References27
Newest
#1Christopher J Black (University of Leeds)H-Index: 13
#2Nicholas E Burr (University of Leeds)H-Index: 14
Last. Alexander C. Ford (University of Leeds)H-Index: 86
view all 6 authors...
Background & Aims Several secretagogues have been approved for the treatment of irritable bowel syndrome with constipation (IBS-C). However, their relative efficacy is unclear because there have been no head-to-head randomized controlled trials. We conducted a network meta-analysis to compare their efficacies in patients with IBS-C. Methods We searched MEDLINE, EMBASE, EMBASE Classic, and the Cochrane Central Register of Controlled Trials through June 2018 to identify randomized controlled trial...
68 CitationsSource
#1Imran Aziz (University of Gothenburg)H-Index: 21
#2Hans Törnblom (University of Gothenburg)H-Index: 33
Last. Magnus Simrén (UNC: University of North Carolina at Chapel Hill)H-Index: 21
view all 5 authors...
The diagnostic criteria for irritable bowel syndrome (IBS) have recently been updated from Rome III to Rome IV. Whereas in Rome III a diagnosis of IBS entailed chronic abdominal pain or discomfort at least 3 days per month, in Rome IV the term discomfort has been removed and the frequency of abdominal pain increased to at least 1 day per week. We examined how this change in IBS criteria impacts on clinical characteristics and pathophysiological factors. A total of 542 Swedish subjects with Rome ...
37 CitationsSource
#1Timothy R. Card (University of Nottingham)H-Index: 54
#2Paul EnckH-Index: 63
Last. Robin C. Spiller (NUH: Nottingham University Hospitals NHS Trust)H-Index: 90
view all 10 authors...
BackgroundGastrointestinal infection is an important risk factor for developing irritable bowel syndrome (IBS). Our aim was to characterise post-infectious IBS (PI-IBS) compared to other IBS patients.MethodsAn internet survey of IBS patients using Rome III diagnostic questionnaire, Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-12 Somatic Symptom (PHQ12-SS) scale score documenting the mode of onset was conducted.ResultsA total of 7811 participants (63.2% female), o...
14 CitationsSource
#1Darren M. Brenner (NU: Northwestern University)H-Index: 17
#2Ronald FogelH-Index: 14
Last. Patrick GriffinH-Index: 6
view all 10 authors...
Two identical, phase 3, randomized, double-blind, placebo-controlled trials evaluated the efficacy and safety of plecanatide in patients with irritable bowel syndrome with constipation (IBS-C). Adults meeting Rome III criteria for IBS-C were randomized (1:1:1) to placebo or plecanatide (3 or 6 mg) for 12 weeks. The primary efficacy end point was the percentage of overall responders (patients reporting ≥30% reduction from baseline in worst abdominal pain plus an increase of ≥1 complete spontaneou...
54 CitationsSource
#1Lisa Vork (UM: Maastricht University)H-Index: 7
#2Zsa Zsa R. M. Weerts (UM: Maastricht University)H-Index: 5
Last. Ad A.M. Masclee (UM: Maastricht University)H-Index: 74
view all 9 authors...
Background The Rome criteria for irritable bowel syndrome (IBS) have been revised and are expected to apply only to the subset of Rome III IBS subjects with abdominal pain as predominant symptom, occurring at least once a week. The aim of this study was to determine the percentage of Rome III IBS subjects that fulfills Rome IV criteria and to evaluate differences between Rome IV-positive and Rome IV-negative subjects. Methods Four hundred and four Rome III IBS subjects completed a 14-day end-of-...
35 CitationsSource
#1Alfred D. Nelson (Mayo Clinic)H-Index: 10
#2Michael Camilleri (Mayo Clinic)H-Index: 146
Last. M. Hassan Murad (Mayo Clinic)H-Index: 88
view all 9 authors...
Objective To compare efficacy of pharmacotherapies for chronic idiopathic constipation (CIC) based on comparisons to placebo using Bayesian network meta-analysis. Data sources We conducted searches (inception to May 2015) of MEDLINE, EMBASE, Scopus and Cochrane Central, as well as original data from authors or drug companies for the medications used for CIC. Study selection Phase IIB and phase III randomised, placebo-controlled trials (RCT) of ≥4 weeks9 treatment for CIC in adults with Rome II o...
74 CitationsSource
#1William D. Chey (UM: University of Michigan)H-Index: 78
#2Anthony Lembo (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 71
Last. David P. RosenbaumH-Index: 6
view all 3 authors...
Tenapanor Treatment of Patients With Constipation-Predominant Irritable Bowel Syndrome: A Phase 2, Randomized, Placebo-Controlled Efficacy and Safety Trial
52 CitationsSource
#1Tao Bai (HUST: Huazhong University of Science and Technology)H-Index: 12
#2Jing Xia (HUST: Huazhong University of Science and Technology)H-Index: 3
Last. Xiaohua Hou (HUST: Huazhong University of Science and Technology)H-Index: 23
view all 9 authors...
Background and Aims The aims of this study were to investigate the proportion of clinical irritable bowel syndrome (IBS) at a tertiary hospital in China, to compare the Rome III and Rome IV criteria with regard to IBS diagnosis, to describe the agreement between the Rome III and Rome IV criteria, and to identify differences between Rome IV-positive and -negative IBS patients. Methods A cross-sectional survey was performed among outpatients in the gastrointestinal (GI) department of a tertiary ho...
42 CitationsSource
#1Anthony Lembo (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 71
#2Mark Pimentel (Cedars-Sinai Medical Center)H-Index: 61
Last. William P. ForbesH-Index: 28
view all 9 authors...
Background & Aims Few treatments have demonstrated efficacy and safety for diarrhea-predominant irritable bowel syndrome (IBS-D). A phase 3, randomized, double-blind, placebo-controlled trial was performed to evaluate the safety and efficacy of repeat treatment with the nonsystemic antibiotic rifaximin. Methods The trial included adults with IBS-D, mean abdominal pain and bloating scores of 3 or more, and loose stool, located at 270 centers in the United States and Europe from February 2012 thro...
128 CitationsSource
#1Olafur S. Palsson (UNC: University of North Carolina at Chapel Hill)H-Index: 50
#2William E. Whitehead (UNC: University of North Carolina at Chapel Hill)H-Index: 102
Last. Yunsheng Yang (Chinese PLA General Hospital)H-Index: 2
view all 17 authors...
The Rome IV Diagnostic Questionnaires were developed to screen for functional gastrointestinal disorders, serve as inclusion criteria in clinical trials, and support epidemiologic surveys. Separate questionnaires were developed for adults, children and adolescents, and infants and toddlers. For the adult questionnaire, we first surveyed 1162 adults without gastrointestinal disorders, and recommended the 90 th percentile symptom frequency as the threshold for defining what is abnormal. Diagnostic...
215 CitationsSource
Cited By29
Newest
#1Alfred D. Nelson (Mayo Clinic)H-Index: 10
#2Christopher J Black (St James's University Hospital)H-Index: 13
Last. Alexander C. Ford (University of Leeds)H-Index: 86
view all 6 authors...
BACKGROUND Although bloating is a highly prevalent and troublesome symptom in irritable bowel syndrome with constipation (IBS-C), treatment is empirical with no specific guidelines for its management. AIM To conduct a pairwise and network meta-analysis, using a frequentist approach, of Food and Drug Administration-licensed drugs for IBS-C comparing their efficacy for abdominal bloating as a specific endpoint. METHODS We searched the medical literature through December 2020 to identify randomised...
2 CitationsSource
#1Andrea Shin (IU: Indiana University)H-Index: 20
#2Lin Chang (UCLA: University of California, Los Angeles)H-Index: 73
Source
#1Christopher J BlackH-Index: 13
#2Orla Craig (Leeds Teaching Hospitals NHS Trust)H-Index: 1
Last. Alexander C. FordH-Index: 86
view all 4 authors...
Objectives Despite being proposed 4 years ago, there has been no independent validation study of the Rome IV criteria for IBS. We assessed their performance for the diagnosis of IBS in secondary care and compared them with the previous iteration, the Rome III criteria. Design We collected complete symptom data from consecutive adult patients with suspected IBS referred to a single UK clinic. All subjects underwent relatively standardised workup, with assessors blinded to symptom status. The refe...
6 CitationsSource
#1Melissa Hunt (UPenn: University of Pennsylvania)H-Index: 14
#2Sofia M. Miguez (UPenn: University of Pennsylvania)
Last. Sarah White (St George's, University of London)H-Index: 56
view all 5 authors...
BACKGROUND Patients with irritable bowel syndrome (IBS) experience abdominal pain, altered bowel habits, and defecation-related anxiety which can result in reduced productivity and impaired health related quality of life (HRQL). Cognitive-behavioral therapy (CBT) has been shown to reduce symptoms of IBS and to improve HRQL, but access to qualified therapists is limited. Smartphone-based digital therapeutic interventions have the potential to increase access to guided CBT at scale but require car...
Source
#1Vivek C. Goodoory (University of Leeds)
#2Lesley A. Houghton (University of Leeds)H-Index: 53
Last. Alexander C. Ford (University of Leeds)H-Index: 86
view all 5 authors...
ABSTRACT Objectives Irritable bowel syndrome (IBS) is a chronic functional bowel disorder diagnosed using the Rome criteria, which have evolved since their original description 30 years ago. Little is known about the effects on the natural history of IBS of moving to the latest iteration, Rome IV, from the previous Rome III criteria. We conducted a 12-month longitudinal follow-up study examining this. Methods We collected complete demographic, symptom, mood, and psychological health data at base...
1 CitationsSource
#1Christopher J Black (University of Leeds)H-Index: 13
#2Alexander C. Ford (University of Leeds)H-Index: 86
Source
#1Dipesh H. Vasant (University of Manchester)H-Index: 10
#2Peter Paine (University of Salford)H-Index: 15
Last. Alexander C. Ford (St James's University Hospital)H-Index: 86
view all 13 authors...
Irritable bowel syndrome (IBS) remains one of the most common gastrointestinal disorders seen by clinicians in both primary and secondary care. Since publication of the last British Society of Gastroenterology (BSG) guideline in 2007, substantial advances have been made in understanding its complex pathophysiology, resulting in its re-classification as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder. Moreover, there has been a considerable amount of new ev...
4 CitationsSource
#1Brigida Barberio (UNIPD: University of Padua)H-Index: 7
#2Yan Yiannakou (County Durham and Darlington NHS Foundation Trust)H-Index: 13
Last. Alexander C. Ford (University of Leeds)H-Index: 86
view all 6 authors...
ABSTRACT Objectives Disorders of gut-brain interaction, such as irritable bowel syndrome (IBS) and functional dyspepsia (FD) frequently overlap, but the impact of this on the natural history is unknown. We examined this issue in a longitudinal follow-up study conducted in a large cohort of individuals. Methods We collected complete demographic, symptom, mood, and psychological health data from 1374 adults who self-identified as having IBS. We applied the Rome IV criteria to examine what proporti...
Source
#1Vivek C. Goodoory (County Durham and Darlington NHS Foundation Trust)
#2Antonina Mikocka-Walus (University of Leeds)H-Index: 1
Last. Alexander C. FordH-Index: 86
view all 6 authors...
INTRODUCTION Psychological comorbidities are associated with irritable bowel syndrome (IBS), but little is known about their cumulative effect on its prognosis. We examined this issue in a longitudinal 12-month follow-up study. METHODS We collected complete demographic, symptom, and psychological comorbidity data (anxiety, depression, somatic symptom disorder, perceived stress, and gastrointestinal symptom-specific anxiety) at baseline from 807 adults who met Rome IV criteria for IBS. At 12 mont...
1 CitationsSource
#1Mohamed G. ShihaH-Index: 1
#2Zohaib Asghar (University of Sheffield)H-Index: 1
Last. Imran Aziz (University of Sheffield)H-Index: 21
view all 9 authors...
BACKGROUND The Rome IV criteria for disorders of gut-brain interaction define irritable bowel syndrome (IBS) as a functional bowel disorder associated with frequent abdominal pain of at least 1 day per week. In contrast, functional diarrhea (FD) and functional constipation (FC) are relatively painless. We compared differences in mood and somatization between Rome IV IBS and FC/FD. METHODS A total of 567 patients with Rome IV defined IBS or FD/FC completed a baseline questionnaire on demographics...
1 CitationsSource